Highlights
- •Result of tools evaluation in the holding breath step of inhalers was consistent.
- •Poor agreement in actuation and inhalation time for MDI was found in both tools.
- •Fair agreement in inspiratory flow for DPI was observed between AIM and checklist.
- •Low specificity of the checklist overestimated the accuracy of critical techniques.
- •AIM can be used as an objective auxiliary tool to assess the inhalation technique.
Abstract
Background
Checklists are usually employed to assess the inhalation techniques in patients, but
partial techniques are difficult to evaluate visually. This study aimed to assess
the checklist validity and an agreement between checklists and an aerosol inhalation
monitor (AIM) assessments.
Methods
This study used a checklist and an AIM to evaluate the participants’ inhalation techniques
with a pressurized metered-dose inhaler (MDI) and two dry powder inhalers (DPIs).
The kappa (κ) coefficient, prevalence-adjusted and bias-adjusted κ (PABAK), sensitivity,
specificity, positive predictive value, and negative predictive value were all calculated
to determine the agreement between the checklist and AIM in an MDI and DPIs with different
inhalation technique steps.
Results
The checklist and AIM exhibited poor agreement in the MDI for actuation and inhalation
time, and a moderate agreement for inspiratory flow. The fair agreement was observed
in DPIs for inspiratory flow between the checklist and AIM. The steps of holding breath
in MDI and DPIs were highly correlated between both assessments. The lowest accuracy
evaluated with an AIM was found in the step of actuation and inhalation time in the
MDI and in the inspiratory flow step in DPIs.
Conclusion
The checklist tended to overestimate the accuracy of critical techniques including
the actuation and inhalation time in MDIs and the inspiratory flow in DPIs. Thus,
the AIM device can be used as an objective auxiliary tool to assess and quantify the
specific steps of inhalation technique for the users with MDI and DPIs.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: December 02, 2022
Accepted:
November 30,
2022
Received in revised form:
November 8,
2022
Received:
August 25,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
