Asthma is treated with inhaled medications through a metered dose inhaler. It is imperative for patients to know how to use an inhaler. The problem in this population is a lack of proper education and teaching of how to use an inhaler. A review of the evidence indicated that most patients do not correctly utilize an inhaler, leading to decreased medicine effectiveness and poor patient outcomes. At the author’s clinic, verbal inhaler technique education was provided but was not measured for effectiveness. Therefore, the question arises, in pediatric patients with asthma, how does the addition of hands-on inhaler education compared to only verbal inhaler education affect inhaler technique, appropriate utilization of medications, clinic exacerbation visits, ER utilization, school attendance, and parent work attendance over a 3-month period of time?
Based on the problem ineffective inhaler technique is due to lack of inhaler education. This scholarly project supported on EBP contained a fundamental component of nursing and provider education related to proper inhaler use and how to teach inhaler technique. Following education of nursing and provider staff, patients were instructed on correct inhaler technique. Expected outcomes measured in this project included improved inhaler technique, tightened asthma control, decreased asthma exacerbation visits to both clinic and emergency room and decreased missed school and parental work days.
The scholarly project started in July 2018 with data collection terminating October 19, 2018 but program continues to run in clinic. 312 asthmatic patients aged 5-21 prescribed an MDI were seen during this time; with 518 individual encounters. However, 63% of the patients did not receive the education either due to missed opportunities or provider declining to participate. 2 case studies will be reviewed to emphasize ownership of asthma care vs non-ownership of asthma care.
Inhaler technique. Prior to education, only 25 patients could correctly use an inhaler. After education, 116 patients could perform all 8 steps of inhaler technique correctly. 13 patients had a second educational encounter and 69% of the patients were not able to correctly utilize an inhaler again. These results correlate with the evidence that patients must have continued encounters to continue to learn proper inhaler technique. The patients also improved their inhaler technique by at least 1 step which was also noted in the literature.
Asthma Control: 120 patients participated in asthma control test (ACT) at visit one with 13 patients participating at visit 2. At both visits; 23% of the patients noted poor asthma control.
Decreased health care utilization and missed school days: The three months of implementation time did not allow for adequate assessment of these metrics. Further follow up and evaluation will be required.
Discussion: Patients were offered a new method of inhaler technique training that was based upon an evidence-based process project. The patients were able to improve inhaler technique by at least 1 step with the training, but as noted in the evidence, will need to have education at continued intervals to continue to improve technique. Sustainability of this project is indicated and is ongoing for continued improvement in asthma outcomes. With sustainability the author’s clinic will be able to measure the outcome metrics of asthma control, quality of life, health care utilization and missed school and work days. An Asthma Medical Home is now underway at this author’s clinic.