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An aerosol inhalation monitor would improve the accuracy of checklist assessment in drug inhalation techniques

  • Tzu-Yu Lin
    Affiliations
    Department of Pharmacy, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
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  • Author Footnotes
    1 Dah-Chin Yan had equal contributions to the first author.
    Dah-Chin Yan
    Footnotes
    1 Dah-Chin Yan had equal contributions to the first author.
    Affiliations
    Department of Pediatrics, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan

    Department of Respiratory Therapy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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  • Yi-Jung Wang
    Affiliations
    Department of Pharmacy, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
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  • Yu-Ting Liang
    Affiliations
    Department of Pharmacy, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
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  • Tun-Liang Chen
    Correspondence
    Corresponding author. Department of Pharmacy, Taipei Chang Gung Memorial Hospital., No.199, Dunhua N. Rd., Songshan Dist., Taipei, 105, Taiwan.
    Affiliations
    Department of Pharmacy, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
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  • Gwo-Hwa Wan
    Correspondence
    Corresponding author. Department of Respiratory Therapy, College of Medicine, Chang Gung University., No. 259, Wen-Hua 1st Rd, Guishan Dist., Taoyuan, 333, Taiwan.
    Affiliations
    Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Department of Obstetrics and Gynaecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan

    Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan

    Center for Environmental Sustainability and Human Health, Ming Chi University of Technology, Taishan, New Taipei, Taiwan
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  • Author Footnotes
    1 Dah-Chin Yan had equal contributions to the first author.
Published:December 02, 2022DOI:https://doi.org/10.1016/j.rmed.2022.107068

      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

      Keywords

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