PHYSICIAN-TARGETED PROGRAM ON INHALED THERAPY FOR CHILDHOOD ASTHMA

Background: Inhaled medications are the mainstay of asthma therapy but significant deficiencies exist in the knowledge and skills of physicians regarding use of metered-dose inhalers (MDI) and spacer devices. Objective: We developed, implemented and evaluated the effects of a physician-targeted educational program on inhaled therapy in a group of pediatric residents in our institution. Methods: Patient-directed instruction sheets on aerosol therapy were developed on the basis of literature review and expert guidelines. These sewed to establish a consistent foundation for the educational curriculum. The program was delivered through one-on-two teaching sessions (45 minutes). Residents were provided with a summary of theoretical and practical information and with devices for practice (a placebo MDI, InspirEase and AeroChamber holding chambers, and the AeroChamber device with mask). Each session included review of an educational monograph, demonstration of proper technique, and practice with the different devices. The program was evaluated by a randomized-control design. Assessment of practical skills included number of correct steps for the use of MDI (maximum score, 7), InspirEase (maximum, 7) and AeroChamber (maximum, 6). Theoretical knowledge was assessed with 25 multiple-choice questions. Results: Pretest scores in the experimental group (n = 24) were 3.7 of 7, 1.9 of 7, and 0.3 of 6 steps correct for MDI, InspirEase, and AeroChamber devices, respectively): and 13 of 25 for the theoretical knowledge assessment. The control group (n = 26) had similar pretest scores. After the program the experimental group significantly improved in all parameters: 6.3 of 7, 5.9 of 7, and 4.5 of 6 steps correct for MDI, InspirEase, and AeroChamber devices, respectively, and 18 of 25 questions correct (p < 0.01 for all parameters). Conclusions: Implementation of a simple educational program among pediatric residents can significantly increase their skills in the use of inhalational therapy.