A one-year prospective audit of an asthma education programme in an out-patient setting. Counseling about turbuhaler technique: needs assessment and effective strategies for community pharmacists. Effects of instruction by practice assistants on inhaler technique and respiratory symptoms of patients. A controlled randomized videotaped intervention study. Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines. Effectiveness of pharmacist intervention for asthma control improvement The Effect of Training Inhalation Technique with or without Spacer on Maximum Expiratory Flow Rate and Inhaler Usage Skills in Asthmatic Patients: A Randomized Controlled Trial Efficacy of two educational interventions about inhalation techniques in patients with chronic obstructive pulmonary disease (COPD). TECEPOC: study protocol for a partially randomized controlled trial (preference trial) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Inhaler technique in Turkish people with poor English: a case of information discrimination? Inhaler device technique can be improved in older adults through tailored education: findings from a randomised controlled trial Evaluation of an educational programme for socially deprived asthma patients. Handling of inhaler devices in actual pulmonary practice: metered-dose inhaler versus dry powder inhalers. Exploring the role of quantitative feedback in inhaler technique education: a cluster-randomised, two-arm, parallel-group, repeated-measures study Effectiveness of pharmaceutical care for patients with chronic obstructive pulmonary disease (PHARMACOP): a randomized controlled trial. Pharmaceutical care for asthma patients: a community pharmacy-based pilot project. A cluster randomised intervention trial of asthma clubs to improve quality of life in primary school children: the School Care and Asthma Management Project (SCAMP) Assessment of a community pharmacy-based program for patients with asthma. Assessment of Patient Acceptance and Inhalation Technique of a Pressurized Aerosol Inhaler and Two Breath-Actuated Devices Pharmaceutical care for patients with persistent asthma: assessment of treatment compliance and use of inhaled medications. Improvement of rural children's asthma self-management by lay health educators. Comparison of elderly people's technique in using two dry powder inhalers to deliver zanamivir: randomised controlled trial Evaluating the Outcome of Two Teaching Methods of Breath Actuated Inhaler in an Inner City Asthma Clinic The effects of additional care by a pulmonary nurse for asthma and COPD patients at a respiratory outpatient clinic: results from a double blind, randomized clinical trial. Effect of patient education on self-management skills and health status in patients with asthma: a randomized trial. Using videos to teach children inhaler technique: a pilot randomized controlled trial Effect of a pharmacist intervention on asthma control. A cluster randomised trial. Metered-Dose Inhaler Technique: The Effect of Two Educational Interventions Delivered in Community Pharmacy Over Time The potential of a 2Tone Trainer to help patients use their metered-dose inhalers. Effectiveness of an education programme by a general practice assistant for asthma and COPD patients: results from a randomised controlled trial. Feasibility and Effectiveness of an Evidence-Based Asthma Service in Australian Community Pharmacies: A Pragmatic Cluster Randomized Trial Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial A controlled trial of two forms of self-management education for adults with asthma. The effect of telepharmacy counseling on metered-dose inhaler technique among adolescents with asthma in rural Arkansas. Internet-Based Home Monitoring and Education of Children With Asthma Is Comparable to Ideal Office-Based Care: Results of a 1-Year Asthma In-Home Monitoring Trial Results from a community-based trial testing a community health worker asthma intervention in Puerto Rican youth in Chicago Short and long-term evaluation of two structured self management programmes on asthma. A randomized controlled trial of a public health nurse-delivered asthma program to elementary schools. An Internet-based store-and-forward video home telehealth system for improving asthma outcomes in children. Use and misuse of metered-dose inhalers by patients with chronic lung disease. A controlled, randomized trial of two instruction methods. Pictures and text in instructions for medical devices: effects on recall and actual performance. Evaluation of the efficacy and cost effectiveness of health education methods to increase medication adherence among adults with asthma. Interactive Small-Group Asthma Education in the Community Pharmacy Setting: A Pilot Study
A prospect i ve r and omised trial was performed to evaluate the effectiveness of an asthma education programme administered by an asthma nurse specialist in an out-patient setting . Sixty asthmatic patients ( mean age 28.5 years ) were enrolled , 30 to a  usual care control group and 30 to an  education group . The education group underwent an individual education programme lasting at least one hour . The following variables were measured at baseline , one month after the education programme and at one year follow-up : asthma knowledge by MCQ ( 36 point question naire ) , inhaler technique ( 7 point scale ) , peak expiratory flow rate ( PEFR ) and symptomatology by visual analogue score ( 0 to 10 score ) . The education group 's inhaler technique and MCQ score both improved significantly at one month , from 5.4 ( 0.3 ) ( mean [ SEM ] ) to 6.5 ( 0.3 ) , p < 0.001 , and from 7.5 ( 2.4 ) to 22 ( 1.8 ) , p < 0.0001 respectively . Both of these improvements were significantly greater than in the control group , and both were maintained at one year follow-up . The symptom score improved over one year in the education group , from 5.4 ( 0.6 ) to 7.6 ( 0.5 ) , p < 0.05 , and was unchanged in the control group . There was no change in the PEFR in either group . This study shows clear objective benefits to an out-patient asthma education programme conducted by an asthma nurse specialist Optimal effects of asthma medications are dependent on correct inhaler technique . In a telephone survey , 77/87 patients reported that their Turbuhaler technique had not been checked by a health care professional . In a subsequent pilot study , 26 patients were r and omized to receive one of 3 Turbuhaler counseling techniques , administered in the community pharmacy .  Turbuhaler technique was scored before and 2 weeks after counseling ( optimal technique = score 9/9 ) . At baseline , 0/26 patients had optimal technique . After 2 weeks , optimal technique was achieved by 0/7 patients receiving st and ard verbal counseling ( A ) , 2/8 receiving verbal counseling augmented with emphasis on Turbuhaler position during priming ( B ) , and 7/9 receiving augmented verbal counseling plus physical demonstration ( C ) ( Fisher 's exact test for A vs C , p = 0.006 ) . Satisfactory technique ( 4 essential steps correct ) also improved ( A : 3/8 to 4/7 ; B : 2/9 to 5/8 ; and C : 1/9 to 9/9 patients ) ( A vs C , p = 0.1 ) . Counseling in Turbuhaler use represents an important opportunity for community pharmacists to improve asthma management , but physical demonstration appears to be an important component to effective Turbuhaler training for educating patients toward optimal Turbuhaler technique BACKGROUND Many patients with asthma or chronic obstructive pulmonary disease use their medication inhalers incorrectly . General practitioners , pharmacists and other health care providers do not always have the opportunity to instruct patients in correct inhaler technique . OBJECTIVE To find out whether the inhaler technique and respiratory symptoms of patients can be improved after instruction by practice assistants . METHODS Single blind , r and omized intervention study in which 48 patients who had been using a dry powder inhaler for at least one month took part . Their inhaler technique was videotaped on two visits with a two-week interval between visits . The inhaler technique on the videos was subsequently scored by two experts on nine criteria . At both visits the patients completed a question naire about their respiratory symptoms . After the first video , 25 patients were r and omly chosen to receive instruction from one of six practice assistants who had followed a one evening course about inhaler instruction , and who had been issued an instruction-set . RESULTS The patients who received instruction had a significantly greater reduction in number of mistakes at the second visit than the patients who did not ( P = 0.01 ) . The instructed patients also reported less dyspnoea at the second visit ( P = 0.03 ) . No effect of instruction was found on wheezing , cough and sputum production . CONCLUSION The inhaler technique of patients can be improved significantly by the instruction of patients by trained practice assistants , possibly result ing in less dyspnoea Inhaled medication is important in the treatment of chronic obstructive pulmonary disease ( COPD ) . In this paper a comparison of the long-term efficacy of three instruction-models is presented . A total of 152 COPD - patients were r and omized into one of four groups : Personal- , video- , group-instruction and a control group . Inhalation technique was assessed by means of checklists , on which essential inhalation manoeuvres were identified . Up to 9 months later , 148 patients returned for follow-up assessment . Prior to instruction 61 % of patients in the control group had a perfect score on essential actions , compared to 62 , 65 and 53 % for those receiving group- , personal- and video-instruction respectively . At follow-up these percentages were 49 , 97 , 75 and 76 % . For group-(35 % ) and video-instruction ( 24 % ) the increase from baseline was significant . Examining the different inhalers under investigation , it is striking , that only 24 % of all patients with a Metered Dose Inhaler ( MDI ) performed all essential checklist items correctly , versus 96 % for those using a Diskhaler . The fact that for the MDI this percentage improved to 90 % post-instruction , shows that time spent on instruction , is time well spent . We conclude that group instruction seems superior to personal counselling , and equally effective or even better than video instruction . Personal instruction should not be dismissed and a combination with video instruction might prove to be effective as well Education on optimal medication use is an essential strategy to improve asthma control . The current authors investigated whether pharmacist interventions , focused on appropriate use of asthma medication and tailor-made to the patient 's current asthma control , would improve asthma control in adult patients . A 6-month r and omised , controlled , parallel-group trial was conducted in 66 community pharmacies in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 94 ) or a pre-defined pharmacist intervention ( n = 107 ) . This intervention mainly focused on improving inhalation technique and medication adherence . Primary outcome was the level of asthma control , as assessed by the Asthma Control Test ® ( ACT ) . Mean ACT scores did not change from baseline for both study groups . However , a pre-defined subgroup analysis of patients having insufficiently controlled asthma at baseline showed that the intervention had significantly increased the ACT score after 6 months compared with usual care . The intervention also reduced , for the complete study group , reliever medication use and the frequency of night-time awakenings due to asthma . Inhalation technique and adherence to controller medication were significantly better in the intervention group . In conclusion , pragmatic community pharmacy-based programmes can significantly improve therapeutic outcomes in adult asthma patients Background : The most common treatment for asthma is transferring the drug into the lungs by inhaler devices . Besides , correct use of inhaled medication is required for effectiveness of pharmacotherapy . Thus , it is necessary to train the patients how to use Metered Dose Inhaler ( MDI ) . This study aim ed to determine the effect of training about MDI usage with or without spacer on maximum expiratory flow rate and inhaler usage skills in asthmatic patients . Methods : This r and omized clinical trial was conducted on 90 asthmatic patients who were r and omly divided into inhalation technique group with spacer , inhalation technique group without spacer , and a control group . Then , the Peak Expiratory Flow Rate ( PEFR ) was measured using a peak flow meter , as a basic test . In addition , the patients ’ functional skills of inhalation technique were assessed using two checklists . Afterwards , 3 sessions of training were arranged for both groups . PEFR and the ability to use the MDI were evaluated immediately and 1 month after the intervention . Finally , the data were entered into the SPSS statistical software ( v. 18 ) and analyzed using independent t-test and repeated measures ANOVA . Results : After the intervention , MDI usage skills improved in the two intervention groups compared to the control group ( P<0.001 ) . In addition , a significant difference was found between the intervention groups and the control group regarding the mean of PEFR after the intervention ( P<0.001 ) . However , no significant difference was observed between the two intervention groups ( P=0.556 ) . Conclusion : According to the results , providing appropriate training for asthmatic patients increased MDI usage skills , and both methods of inhalation ( with or without spacer ) could improve the PEFR among the patients . Trial Registration Number : I RCT Background Drugs for inhalation are the cornerstone of therapy in obstructive lung disease . We have observed that up to 75 % of patients do not perform a correct inhalation technique . The inability of patients to correctly use their inhaler device may be a direct consequence of insufficient or poor inhaler technique instruction . The objective of this study is to test the efficacy of two educational interventions to improve the inhalation techniques in patients with Chronic Obstructive Pulmonary Disease ( COPD ) . Methods This study uses both a multicenter patients ´ preference trial and a comprehensive cohort design with 495 COPD -diagnosed patients selected by a non-probabilistic method of sampling from seven Primary Care Centers . The participants will be divided into two groups and five arms . The two groups are : 1 ) the patients ´ preference group with two arms and 2 ) the r and omized group with three arms . In the preference group , the two arms correspond to the two educational interventions ( Intervention A and Intervention B ) design ed for this study . In the r and omized group the three arms comprise : intervention A , intervention B and a control arm . Intervention A is written information ( a leaflet describing the correct inhalation techniques ) . Intervention B is written information about inhalation techniques plus training by an instructor . Every patient in each group will be visited six times during the year of the study at health care center . Discussion Our hypothesis is that the application of two educational interventions in patients with COPD who are treated with inhaled therapy will increase the number of patients who perform a correct inhalation technique by at least 25 % . We will evaluate the effectiveness of these interventions on patient inhalation technique improvement , considering that it will be adequate and feasible within the context of clinical practice .Trial registration Current Controlled Trials Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objectives ( a ) To compare metered dose inhaler ( MDI ) technique in users with poor English and fluent English , ( b ) to evaluate two interventions : a translated patient information leaflet ( PIL ) plus support from an translator ( PIL + verbal ) and a multimedia touch screen system ( MTS ) using video clips and own- language instruction . Methods ( a ) Inhaler technique was videotaped and key steps rated blind for 105 fluent English-speakers ( FE ) and 69 Turkish-speakers with poor English ( EP ) . ( b ) The EP group was r and omised to receive information by MTS ( n = 34 ) or PIL + verbal ( n = 35 ) . Inhaler technique was videotaped before and after information . Main outcome measures ( a ) Global inhaler technique ; ( b ) breathing-in time ; ( c ) co-ordination of inspiration and inhaler actuation . Results Global technique , co-ordination and breath-holding were all significantly worse in MDI users with poor English . Only 17 % of that group had adequate technique compared to over half ( 62 % ) of FE . The EP group were significantly less likely than the FE group to report ever seeing the practice nurse about their asthma . After information , global technique was rated as improved in 50 % of the MTS group compared to 28 % of those given a translated PIL . A further six people ( 17 % ) in the PIL group improved after subsequent verbal advice in their own language . Both information methods significantly increased inhaler shaking and mouthpiece checking , but co-ordination only improved in a small number of people . Conclusions : The study suggests that Turkish-speaking MDI users with poor English may be disadvantaged in terms of access to medicines information in the UK . The acceptability of pharmacy-based support services for this , and other specific language groups should be explored . Multimedia offers an alternative to a translator for brief explanations , particularly for first-time users , but improving poor co-ordination requires individualised “ h and s on ” teaching from health professionals Aim : To investigate the effects of inhaler device technique education on improving inhaler technique in older people with asthma . Methods : In a r and omised controlled trial , device technique education was provided to a sample of 123 adults aged > 55 years who had a doctor diagnosis of asthma . The active education group received one-on-one technique coaching , including observation , verbal instruction and physical demonstration at baseline . The passive group received a device-specific instruction pamphlet only . Inhaler technique , including the critical steps for each device type , was assessed and scored according to Australian National Asthma Council ( NAC ) guidelines . Device technique was scored objective ly at baseline and again at 3 and 12 months post education . Results : The majority of participants demonstrated poor technique at baseline . Only 11 ( 21 % ) of the active intervention group and 7 ( 16 % ) of the passive group demonstrated 100 % correct technique . By 3 months 26 ( 48 % ) of the active group achieved adequate technique . Improvement in technique was observed in the active group at 3 months ( P<0.001 ) and remained significant at 12 months ( P<0.001 ) . No statistically significant improvement was observed in the passive group . Conclusion : The provision of active device technique education improves device technique in older adults . Passive education alone fails to achieve any improvement in device technique The aim of this study was to evaluate the effectiveness of an asthma education programme in moderate and severe asthma patients in a longitudinal , prospect i ve and r and omized study with a control group . Fifty-three asthmatic patients were studied , 26 of whom were assigned to the  educational group and 27 to the  control group . The educational group attended the programme regularly for a period of 6 months . The programme included information about asthma , instruction on the appropriate use of medication and training in the metered dose inhaler ( MDI ) technique , and information about the identification and control of asthma attacks and the recognition of early signs of exacerbation . The control group was su bmi tted to the routine care provided at the Asthma Clinic , with no formal instruction regarding asthma control . The groups were identical with regard to severity parameters , skills , lung function and quality of life at the beginning of the trial . At the end of the study , the education group showed significant differences when compared with the control group ( education/control ( mean values ) ) with respect to : visits to the asthma emergency room over the previous 6 months , 0.7/2 ( p=0.03 ) ; nocturnal symptoms , 0.3/0.7 ( p=0.04 ) ; score of symptoms , 1.3/2 ( p=0.04 ) . Improvements were also observed in skills and quality of life , knowledge of how to deal with attacks and how to control the environmental triggering factors , 73/35 ( < 0.05 ) ; correct use of the MDI , 8/4 ( 0.001 ) ; underst and ing of the difference between relief and anti-inflammatory medication , 86/20 ( < 0.05 ) ; and in the global limitation quality of life score , 28/50 ( 0.02 ) . It is concluded that the educational programme led to a significant improvement in asthma morbidity and that the implantation of educational programmes is possible for special population s when these programmes are adapted to the socioeconomic profile of the patients , with a significant gain in terms of the reduction of symptoms and improved pulmonary function and quality of life of asthmatics BACKGROUND H and ling of inhaler devices such as pressurized metered-dose inhalers ( MDIs ) and dry-powder inhalers ( DPIs ) in actual pulmonary practice is not well studied . OBJECTIVE The aim of this study was to evaluate patients ' proper h and ling of inhaler devices during actual pulmonary practice . METHODS Prospect i ve observational evaluations were conducted at 3 pulmonary clinics in Jordan , from February 2006 until August 2006 .  MDI ( without spacer ) , Turbuhaler , Diskus , and Aerolizer devices were studied . Incorrect h and ling was defined as improper technique in any of the predefined essential steps . RESULTS Patients ( n = 300 ) were recruited and 525 inhaler-device h and ling technique evaluations were completed . Diskus inhaler had the lowest rate of incorrect h and ling ( 7/103 , 6.8 % ) and MDI had the highest rate of incorrect h and ling ( 144/193 , 74.6 % ) . Turbuhaler and Aerolizer were h and led incorrectly by 63/146 ( 43.2 % ) and 14/83 ( 16.9 % ) patients , respectively . DPI had a lower rate of incorrect h and ling , when compared with the MDI ( p < 0.001 ) . Among the DPI devices , the Diskus had the lowest rate of incorrect h and ling ( p < 0.031 ) . CONCLUSIONS In actual pulmonary clinical practice the majority of patients were unable to use MDI correctly , whereas correct h and ling of DPI devices was variable . Regular checking of inhalation technique and proper teaching by health care providers is crucial for optimum use of most inhaler devices Background : Feedback is a critical component of any educational intervention . When it comes to feedback associated with inhaler technique education , there is a lack of knowledge on its role or its potential to solve the major issue of poor inhaler technique . Aims : This study aims to explore the role of feedback in inhaler technique education and its impact on the inhaler technique of patients over time . Methods : A parallel-group , repeated- measures study was conducted in the community pharmacy in which the effectiveness of current best practice inhaler technique education utilising qualitative visual feedback ( Group 1 ) was compared with a combination of qualitative and quantitative visual feedback ( Group 2 ) . The impact of these two interventions on inhaler technique maintenance was evaluated . Community pharmacists were r and omly allocated to recruit people with asthma who were using a dry powder inhaler . At Visit 1 their inhaler technique was evaluated and education delivered and they were followed up at Visit 2 ( 1 month later ) . Results : Both educational interventions result ed in an increase in the proportion of patients with correct inhaler technique : from 4 % to 51 % in Group 1 and from 6 % to 83 % in Group 2 ( Pearson ’s Chi-Squared , P=0.03 , n=49 , and Pearson ’s Chi-Squared , P=0.01 , n=48 , respectively ) . The magnitude of improvement was statistically significantly higher for Group 2 compared with Group 1 ( n=97 , P=0.02 , Pearson ’s Chi-Square test ) . Conclusions : The nature of feedback has an impact on the effectiveness of inhaler technique education with regard to correct inhaler technique maintenance over time AIMS Few well- design ed r and omized controlled trials have been conducted regarding the impact of community pharmacist interventions on pharmacotherapeutic monitoring of patients with chronic obstructive pulmonary disease ( COPD ) . We assessed the effectiveness of a pharmaceutical care programme for patients with COPD . METHODS The pharmaceutical care for patients with COPD ( PHARMACOP ) trial is a single-blind 3 month r and omized controlled trial , conducted in 170 community pharmacies in Belgium , enrolling patients prescribed daily COPD medication , aged ≥ 50 years and with a smoking history of ≥ 10 pack-years . A computer-generated r and omization sequence allocated patients to an intervention group ( n = 371 ) , receiving protocol -defined pharmacist care , or a control group ( n = 363 ) , receiving usual pharmacist care ( 1:1 ratio , stratified by centre ) . Interventions focusing on inhalation technique and adherence to maintenance therapy were carried out at start of the trial and at 1 month follow-up . Primary outcomes were inhalation technique and medication adherence . Secondary outcomes were exacerbation rate , dyspnoea , COPD -specific and generic health status and smoking behaviour . RESULTS From December 2010 to April 2011 , 734 patients were enrolled . Forty-two patients ( 5.7 % ) were lost to follow-up . At the end of the trial , inhalation score [ mean estimated difference (Δ),13.5 % ; 95 % confidence interval ( CI ) , 10.8 - 16.1 ; P < 0.0001 ] and medication adherence ( Δ , 8.51 % ; 95 % CI , 4.63 - 12.4 ; P < 0.0001 ) were significantly higher in the intervention group compared with the control group . In the intervention group , a significantly lower hospitalization rate was observed ( 9 vs. 35 ; rate ratio , 0.28 ; 95 % CI , 0.12 - 0.64 ; P = 0.003 ) . No other significant between-group differences were observed . CONCLUSIONS Pragmatic pharmacist care programmes improve the pharmacotherapeutic regimen in patients with COPD and could reduce hospitalization rates Asthma is a clinical problem with social , psychological , and economic burdens . To improve patient disease management and quality of life ( QOL ) , different education programs have been developed . The purpose of this study is to adapt and implement a community-based educational program for patients with asthma . A prospect i ve , r and omized , controlled trial was performed . Fifty individuals with mild asthma ( aged 18 - 40 years ) that have been attending pharmacies were included in the sample . The duration of the disease was 9 + /- 4.21 years . A 4-month study was conducted on essence of asthma and factors that can intensify it ; nourishing facts , allergens , and physical activities ; self-management and use of tobacco ; and pharmacotherapy , inhalation technique , and possible adverse drug reactions . Patient 's health-related QOL was assessed in the beginning and at the end of the survey . Parameters assessed during the four stages of the program were patients ' peak expiratory flow ( PEF ) ; inhaler technique ; severe asthma symptoms , including breathlessness , hospitalization rates , frequency of urgent medical aid calls , and frequency of general practitioner visits ; compliance with therapy ; and satisfaction with pharmacy services . Health-related QOL of the intervention patients was improved at 4 months and there was improvement in the PEF rate , decrease in patients ' breathlessness and wheezing rate , decrease in the reported hospitalizations rate because of the disease , decrease in the physician 's visits , and increase in satisfaction with pharmacist-provided information . The positive results from the educational approach show a potential to decrease asthma disease complications and show a positive impact on patients ' inhaler technique , patients ' opinions about the pharmacy services , and information obtained Aim : To evaluate the effectiveness of a programme of asthma clubs in improving quality of life in primary school children with asthma . Methods : A cluster r and omised intervention trial was undertaken in 22 primary schools within the urban area of south and east Belfast , Northern Irel and . Schools were r and omised in pairs to immediate or delayed groups . The study subjects comprised 173 children aged 7–11 years whose parents had notified the school of their asthma diagnosis . Children attended school based weekly clubs over an 8 week period . The main outcome measures were the interview administered Paediatric Quality of Life Question naire scores , ranging from 1 ( worst ) to 7 ( best ) , spirometry , and inhaler technique . Results : Over 15 weeks , small but non-significant improvements in the overall quality of life score ( mean 0.20 ; 95 % confidence interval ( CI ) −0.20 to 0.61 ) and in each of its three components , activity limitation ( 0.20 ; −0.43 to 0.84 ) , symptoms ( 0.23 ; −0.23 to 0.70 ) , and emotional function ( 0.17 ; −0.18 to 0.52 ) , were observed in the immediate compared with the delayed group . Inhaler technique at week 16 was markedly better in the immediate group , with 56 % having correct technique compared with 15 % in the delayed group . No significant effect of the intervention on spirometry results could be demonstrated . Conclusion : This primary school based asthma education programme result ed in sustained improvements in inhaler technique , but changes in quality of life scores were not significant STUDY OBJECTIVE To implement and assess a community-based pharmaceutical care program for patients with asthma . DESIGN Prospect i ve , r and omized , controlled trial . SETTING Community pharmacies ( 11 control , 11 intervention ) in Malta . PATIENTS Community-dwelling patients with asthma . INTERVENTIONS A comprehensive asthma education and monitoring program was implemented . Intervention patients received verbal counseling , an educational video , an information leaflet , and subsequent monitoring with reinforcement ;  control patients received routine dispensing services . MEASUREMENTS AND MAIN RESULTS Parameters assessed at baseline and at 4 , 8 , and 12 months were health-related quality of life , peak expiratory flow ( PEF ) , inhaler technique , compliance with therapy , hospitalization rates , days lost from work , asthma symptoms , and patient satisfaction . Health-related quality of life of the intervention patients improved at 12 months ( p=0.044 ) . In the same time period , PEF significantly decreased in control patients compared with intervention patients ( p=0.009 ) whereas inhaler technique improved in the intervention group ( p=0.021 ) . There were significantly fewer self-reported hospitalizations in intervention patients . CONCLUSIONS A community-based pharmaceutical care program was appreciated by the participants and had a positive impact on the vitality of patients with asthma , inhaler technique , and PEE OBJECTIVE : To assess inhalation technique in patients after written instruction alone , written and verbal instruction , and clinical use of two new inhalation devices . DESIGN : R and omized , crossover evaluation of the albuterol Diskhaler and the terbutaline Turbuhaler . SETTING : Canadian tertiary-care hospital . PATIENTS : Twenty hospitalized adults with asthma or chronic obstructive pulmonary disease currently using an albuterol metered-dose inhaler ( MDI ) . Nineteen patients received  Diskhaler , 16 received Turbuhaler , 15 received both inhalers , and 10 patients used both inhalers for three days each . INTERVENTIONS : Patients were r and omized to receive either Diskhaler or Turbuhaler for three days . Inhaler technique was assessed after written instruction , written plus verbal instruction , at the first scheduled dose after instruction , and after three days of clinical use . Patients remaining in the hospital after three days crossed over to the other study inhaler and the same protocol was followed . MAIN OUTCOME MEASURES : Patient inhalation technique was assessed and compared for the MDI , Diskhaler , and Turbuhaler . RESULTS : Assessment of MDI technique revealed that 35 percent of patients used their MDI correctly on the first puff , and 42 percent used it correctly on the second puff . Following written instruction alone , correct technique was demonstrated by 32 percent of patients with Diskhaler and 6 percent with Turbuhaler . Technique significantly improved following verbal instruction , although 40 percent of the patients required up to three attempts to demonstrate correct technique on at least one of the study inhalers . After three days of clinical use , correct technique was demonstrated in only 54 percent of the Diskhaler and 64 percent of the Turbuhaler assessment s. Performance at this assessment was , however , significantly better on the Turbuhaler than on the MDI ( p=0.01 ) . Performance on the Diskhaler was not significantly different from the performance on the other inhalers . CONCLUSIONS : Written instruction alone is inadequate in teaching correct inhalation technique . Verbal instruction and technique assessment are essential for patients to achieve proper technique . Patients may perform better on the Turbuhaler than on other inhalation devices OBJECTIVE To evaluate treatment compliance and use of inhaled medications of patients with asthma receiving complementary pharmaceutical care . METHODS A controlled prospect i ve parallel study involving a study group and a control group . We selected 60 patients with persistent asthma and using metered-dose inhalers ( MDIs ) , dry powder inhalers ( DPIs ) or both .  The patients were evaluated three times over 60 days . Instructions were provided to the patients in the study group at all visits but only at the first visit to those in the control group . The patients using < 80 % or > 120 % of the total number of prescribed doses were classified as noncompliant . The inhalation technique was quantified by a scoring system . A satisfactory technique was defined as a score higher than 7 ( maximum , 9 ) for MDIs and higher than 4 ( maximum , 5 ) for DPIs . RESULTS The final study sample comprised 28 study group patients and 27 control group patients , of whom 18 ( 64.3 % ) and 20 ( 74.7 % ) , respectively , were considered treatment compliant . From the first to the third visits , there were increases , in the study and control groups , in the median MDI-use score ( from 3 [ range , 0 - 5 ] to 8 [ range , 8 - 9 ] ; p < 0.001 ; and from 5 [ range , 2 - 6 ] to 7 [ range , 6 - 8 ] ) , as well as in the median DPI-use score ( from 3 [ range , 2 - 4 ] to 5 [ range , 4 - 5 ] and from 3 [ range , 2 - 4 ] to 4 [ range , 3 - 5 ] ) . CONCLUSIONS The counseling provided by the pharmacist to the patient was important to assist in the implementation of the appropriate inhalation technique , especially for MDI use BACKGROUND The purpose of the present analysis is to examine changes in rural children 's  asthma self-management after they received lay health educator (LHE)-delivered classes . METHODS Elementary schools were r and omly assigned to the treatment or attention-control condition and their participating students received either asthma education or general health promotion education , respectively . The triethnic sample was composed of 183 children ( 46 % Hispanic , 29.5 % non-Hispanic white , 22 % African American , and 2.6 % other categories ) who had a mean age of 8.78 years ( SD = 1.24 ) . The time frame from baseline to postintervention was 12 weeks . RESULTS Repeated measures analysis of variance found main effects in changes in scores for children 's asthma knowledge , asthma self-management , self-efficacy for managing asthma symptoms , and metered dose inhaler ( MDI ) technique and significant group interaction effects for the treatment intervention on the measures of children 's asthma knowledge , asthma self-management , and MDI technique . CONCLUSIONS The delivery of an asthma health education intervention by trained LHEs to school-aged children was an effective means for improving children 's  knowledge and skills in asthma self-management Abstract Objective : To determine whether elderly people can learn to use the inhaler used to deliver zanamivir ( Relenza Diskhaler ) as effectively as the Turbohaler and to identify which aspects of inhaler technique are most problematic . Design : R and omised , controlled , intervention study . Setting : Wards for acute elderly care in a large district general hospital . Participants : 73 patients who were unfamiliar with the use of an inhaler , aged 71 to 99 ( mean 83 ) years . Main outcome measures : Initial scores and changes in scores 24 hours later using a 10 point scoring system of five aspects of inhaler technique . Results : 38 patients were allocated the Relenza Diskhaler and 35 the Turbohaler . The mean total score was significantly greater in the Turbohaler than Diskhaler groups both initially ( 8.74 v 7.05 ) and after 24 hours ( 8.28 v 5.43 ) . The major difference between inhalers was in loading and priming . After tuition 50 % ( 19 of 38 ) of patients allocated the Diskhaler were unable to load and prime the device and 65 % ( 24 of 37 ) were unable to do so 24 hours later . Of those allocated the Turbohaler , two patients were unable to load and prime the device after initial review and one after 24 hours . Conclusion : Most elderly people can not use the inhaler device used to deliver the anti-influenza drug zanamivir . Treatment with this drug is unlikely to be effective in elderly people unless the delivery system is Objectives : Our objective was to compare two different teaching methods used to educate patients in the use of a breath actuated inhaler ( BAI ) and to assess the impact of its continued use on their metered-dose inhaler ( MDI ) technique . Design : Prospect i ve , r and omized , controlled trial . Setting : Adult Pulmonary/Asthma clinic of Cook County Hospital , Chicago , IL . Patients : Diagnosed , stable asthmatics . Intervention : The patients were r and omized into two groups . The experimental group received verbal instructions and demonstration on breath actuated inhaler technique while the control group received written instructions only on BAI use . The metered dose inhaler technique of both groups of patients was also evaluated . Measures : A checklist evaluating the key aspects of proper BAI and MDI inhalation techniques was used to assess the use of both types of inhalers at entry into the study and upon postintervention follow-up at 8 to 20 weeks . Results : At baseline , 97 % of patients in the experimental group and 83 % of patients in the control group were initially able to demonstrate BAI inhalation technique correctly . Upon follow-up , 82 % of the control group and 68 % of the experimental group were able to use the BAI correctly , which was a statistically significant deterioration in the experimental group . In both of these groups , there was a statistically significant improvement in MDI technique . Conclusions : Written instructions alone may be an adequate teaching tool for proper inhalation technique of BAI . Continued BAI use appears not to impact adversely on proper MDI technique OBJECTIVE To assess the effects of additional information based nursing care program in the treatment of asthma and COPD patients at a pulmonary outpatient clinic . METHODS In a double blind , r and omized clinical trial , 191 patients were allocated to an  additional care group or control group . Patients in the intervention group received a protocol -based education program on individual basis by a pulmonary nurse on individual basis ( average duration 60 min per patient ) . All patients were masked for the trial objectives . Effectiveness was expressed in terms of knowledge , inhalation technique , self-management , exacerbation rate ( primary outcomes ) , and health-related quality of life and satisfaction with care received ( secondary outcomes ) . The time interval between the initial and final assessment s was 6 months . RESULTS Ninety-seven patients were r and omized into the additional care group and 94 into the control group , of which 157 had a complete data set . (Un)adjusted analyses did not show differences between treatment groups in terms of knowledge , inhalation technique , self-management , health-related quality of life , and satisfaction with care . Multivariate logistic regression adjusting for baseline covariates showed a significant treatment effect with regard to exacerbation rate ( odds ratio=0.35 ; 95 % confidence limits : 0.13/0.94 , p=0.04 ) . CONCLUSION With the exception of exacerbation rate , we could not demonstrate efficacy of additional nursing care in a broad range of outcome parameters . PRACTICE IMPLICATION S At present we do not recommend to implement our patient-tailored education program in daily practice We conducted a r and omized clinical trial to assess the effectiveness of a newly established education program for adults with asthma . The program was design ed to improve patients ' health and functional status . Hospitalized patients with asthma were r and omly assigned to immediate education or a 6-month waiting list . The education program consisted of three group sessions , delivered by trained educators , and focused on improving patients ' self-management skills . Of 253 eligible patients , 131 agreed to participate ( 66 assigned to immediate education , 65 controls ) and 115 ( 88 % ) completed the follow-up assessment at 6 months . At follow-up , most indicators of self-management skills and health and functional status had improved significantly among educated patients , but similar improvements were also seen among controls . The trial arms differed significantly on only four variables : patients in the immediate-education group were more likely to develop confidence in their asthma treatment ( odds ratio adjusted for baseline [ OR ] = 2.9 ; 95 % confidence interval [ CI ] : 1.0 to 8.1 ) , to improve their knowledge of correct inhalation technique ( OR = 2.4 ; 95 % CI : 1.0 to 5.7 ) , and to improve knowledge of the peak flow reading that warrants calling a physician ( OR = 3.1 ; 95 % CI : 1.4 to 6.7 ) , but they improved less on the Asthma Quality of Life Question naire " activity " score ( difference : -0.4 on a 1 to 7 scale ; 95 % CI : -0.8 to 0.0 ) . Use of health services during follow-up was similar in the two groups . The education program did not enhance patients ' health and functional status , despite improving a few self-management skills . These results underscore the need for controlled evaluations of education programs Abstract Objective : This primary objective of this pilot r and omized , controlled trial was to determine whether a brief video intervention delivered after a pediatric office visit could improve inhaler technique in children with asthma immediately and one month later . The intervention ’s effect on children ’s inhaler self-efficacy and asthma control was also evaluated . Methods : Children ( n = 91 ) ages 7–17 years with persistent asthma were recruited at two pediatric practice s in North Carolina . Eligible children demonstrated their inhaler technique for metered dose inhalers ( MDIs ) either with or without a spacer . A trained research assistant used a vali date d inhaler technique checklist to record which steps children performed correctly . After a regularly scheduled office visit , children were r and omized to watch either a 3-min MDI video ( intervention group ) or a nutrition video ( control group ) in English or Spanish . Children ’s technique was assessed again after watching the video and one month later . Results : Children were primarily male ( 56 % ) and non-White ( 60 % ) . When compared with the control group , children in the intervention group demonstrated a significant improvement in MDI technique post-intervention [ mean = 1.12 steps , 95 % CI ( 0.73 , 1.50 ) ] but the improvement was not sustained at 1-month follow-up . The intervention did not lead to significant improvements in inhaler self-efficacy or asthma control . Conclusions : A brief video intervention offered during pediatric clinic visits can lead to immediate improvements in children ’s inhaler technique . Future studies should evaluate whether booster training videos can help maintain improvements in children ’s inhaler technique over time INTRODUCTION Achievement and maintenance of good asthma control is a major objective in asthma management . However , asthma control in many patients is suboptimal , due to improper use of asthma medications and non-adherence . The aim of this study was to evaluate the effect of a pharmacist intervention on asthma control in adult patients . METHODS A 6-month cluster r and omized controlled trial was undertaken with allocation of community pharmacies to intervention or control group . Adult asthma patients in the intervention group received a protocol -based intervention addressing individual needs related to asthma control , inhaler technique and medication adherence . Patients in the control group received usual care . Main variables were measured at baseline , 3 and 6 months . RESULTS 336 patients completed the study , 150 in the control group and 186 in the intervention group . The intervention result ed in enhanced asthma control : Patients receiving the intervention had an Odds ratio of 3.06 ( 95 % CI:1.63 - 5.73 ; p < 0.001 ) of having controlled asthma six months later . In the intervention group mean ACQ scores significantly improved [ 0.66 points ( SD : 0.78 ) ; p < 0.001 ] and the number of controlled asthma patients increased by 30.1 % ( p < 0.001 ) after 6 months . The intervention also result ed in improved medication adherence ( by 40.3 % , p < 0.001 ) and inhaler technique ( by 56.2 % , p < 0.001 ) . No significant changes for any of these variables were observed in the control group . CONCLUSION The AFasma study focused on the important outcomes of asthma management , and showed that through the design ed intervention , community pharmacists can increase controlled asthma patients compared to usual care . Trial registration NCT01085474 Instruction is critical in order to ensure correct technique with pressurized metered-dose inhalers ( pMDIs ) by patients . The aim of this study was to compare the effects over time of two educational interventions delivered in community pharmacy to pMDI users . In this r and omized controlled parallel-group study , pMDI technique was assessed before and after written and verbal instruction , alone or with physical demonstration , at baseline and 4 , 8 , and 16 weeks . The study recruited 52 subjects with asthma or chronic obstructive pulmonary disease ( COPD ) . Initially only 1/52 ( 6 % ) subject had correct pMDI technique (= checklist score 8/8 ) , with mean baseline score 5 ( SD 1 ) for both groups . Written and verbal information improved pMDI technique at 16 weeks ( 7 ± 1 , p < .05 ) . Addition of physical demonstration result ed in significant improvement at weeks 4 , 8 , and 16 ( 7 ± 1 , 7 ± 1 , 7 ± 1 respectively ; p < .05 for each ) . Subjects receiving written and verbal information alone were less likely to return for follow-up than those receiving physical demonstration ( 8 weeks : 6/25 versus 19/27 ; p < .001 ) . By the 8-week visit , 80 % subjects in the physical demonstration group had correct technique prior to education , compared with 10 % of subjects receiving written and verbal information alone ( p < .05 ) . There was some decline in inhaler technique by 16 weeks . The results demonstrate that adding a physical demonstration is more effective in improving pMDI technique than written and verbal instructions alone BACKGROUND Many patients have problems using the correct inhalation technique when they use their metered-dose inhalers ( MDIs ) . We have investigated whether a training aid ( 2Tone Trainer [ 2 T ] ; C and ay Medical Ltd ; Newmarket , UK ) helps to maintain the correct inhaler technique after patients leave the clinic METHODS Ethics committee approval was obtained , and patients gave consent . Asthmatic patients who had been prescribed an MDI had their inhalation technique assessed . Their peak inhalation flow ( PIF ) when using their MDI , FEV(1 ) , and the Juniper asthma quality of life question naire ( AQLQ ) score were measured . Those patients using the recommended MDI technique were the good-technique ( GT ) group . The remainder were r and omized to receive verbal training ( VT ) or VT plus the 2 T to improve their MDI technique . All patients returned 6 weeks later . RESULTS There were 36 , 35 , and 36 asthmatic patients , respectively , who completed the GT , VT , and 2 T procedures . FEV1 did not change within all groups between visit 1 and 2 . PIF and AQLQ score did not change in the GT group . In the VT and 2 T groups , the AQLQ score increased by mean differences of 0.33 ( 95 % confidence interval [ CI ] , 0.14 to 0.53 ; p < 0.001 ) and 0.74 ( 95 % CI , 0.62 to 0.86 ; p < 0.001 ) . At visit 1 , all patients in the VT and 2 T groups inhaled > 90 L/min decreasing to 12 patients and 1 patient , respectively , at visit 2 ( p < 0.001 both groups ) . The overall changes in the 2 T group for PIF and AQLQ score , between visits 1 and 2 , were significantly ( p < 0.001 ) greater than the corresponding changes in the VT group . CONCLUSION The 2 T helps patients to maintain the recommended MDI technique posttraining with improvements in AQLQ score In this study a r and omised controlled trial was carried out to investigate the effectiveness of an education programme for patients with asthma or chronic obstructive pulmonary disease ( COPD ) . All asthma and COPD patients using medication and experiencing pulmonary symptoms were r and omly assigned to the intervention ( n=139 ) or usual-care group ( n=137 ) . The intervention consisted of taylor-made education conducted by a general practice assistant and focussing on a patients ' technical skills and coping with the disease . Measurements took place at baseline , and after 1 and 2 years of follow-up . After 1 and 2 years the inhalation technique was significantly better in the intervention group compared to the usual-care group . No significant differences were observed regarding disease symptoms , health related quality of life , compliance , smoking cessation , self-efficacy , and coping . The results only support the implementation of the intervention regarding the technical skills ( inhalation technique ) . However , given the importance of improvement of patients ' coping and the need for more efficient care , we recommend further exploration of the possibilities of a more structured and intensive education programme Objective . To test the feasibility , effectiveness , and sustainability of a  pharmacy asthma service  in primary care . Methods . A pragmatic cluster r and omized trial in community pharmacies in four Australian states/territories in 2009 .  Specially trained pharmacists were r and omized to deliver an asthma service in two groups , providing three versus four consultations over 6 months . People with poorly controlled asthma or no recent asthma review were included . Follow-up for 12 months after service completion occurred in 30 % of r and omly selected completing patients . Outcomes included change in asthma control ( poor and fair/good ) and Asthma Control Question naire ( ACQ ) score , inhaler technique , quality of life , perceived control , adherence , asthma knowledge , and asthma action plan ownership . Results . Ninety-six pharmacists enrolled 570 patients , with 398 ( 70 % ) completing .  Asthma control significantly improved with both the three- and four-visit service , with no significant difference between groups ( good/fair control 29 % and 21 % at baseline , 61 % and 59 % at end , p = .791 ) . Significant improvements were also evident in the ACQ ( mean change 0.56 ) , inhaler technique ( 17–33 % correct baseline , 57–72 % end ) , asthma action plan ownership ( 19 % baseline , 56 % end ) , quality of life , adherence , perceived control , and asthma knowledge , with no significant difference between groups for any variable . Outcomes were sustained at 12 months post-service . Conclusions . The pharmacy asthma service delivered clinical ly important improvements in both a three-visit and four-visit service . Pharmacists were able to recruit and deliver the service with minimal intervention , suggesting it is practical to implement in practice . The three-visit service would be feasible and effective to implement , with a review at 12 months ABSTRACT BACKGROUND Hospitalized patients frequently misuse their respiratory inhalers , yet it is unclear what the most effective hospital-based educational intervention is for this population . OBJECTIVE To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease ( COPD ) . DESIGN A Phase-II r and omized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD . PARTICIPANTS Hospitalized adults ( age 18 years or older ) with asthma or COPD . INTERVENTIONS Participants were r and omized to brief intervention [ BI ] : single-set of verbal and written step-by-step instructions , or , teach-to- goal [ TTG ] : BI plus repeated demonstrations of inhaler use and participant comprehension assessment s (teach-back).MAIN MEASURES The primary outcome was metered-dose inhaler ( MDI ) misuse post-intervention ( < 75 % steps correct ) . Secondary outcomes included Diskus ® misuse , self-reported inhaler technique confidence and prevalence of 30-day health-related events . KEY RESULTS Of 80 eligible participants , fifty ( 63 % ) were enrolled ( BI n = 26 , TTG n = 24 ) . While the majority of participants reported being confident with their inhaler technique ( MDI 70 % , Diskus ® 94 % ) , most misused their inhalers pre-intervention ( MDI 62 % , Diskus ® 78 % ) . Post-intervention MDI misuse was significantly lower after TTG vs. BI ( 12.5 vs. 46 % , p = 0.01 ) . The results for Diskus ® were similar and approached significance ( 25 vs. 80 % , p = 0.05 ) . Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI ( 1 vs. 8 , p = 0.02 ) . CONCLUSIONS TTG appears to be more effective compared with BI . Patients over-estimate their inhaler technique , emphasizing the need for hospital-based interventions to correct inhaler misuse . Although TTG was associated with fewer post-hospitalization health-related events , larger , multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education PURPOSE Excess morbidity and mortality due to asthma , aggravated by demonstrably poor patient self-management practice s , suggest the need for formal patient education programs . Individual and group asthma education programs were developed and evaluated to determine their cognitive , behavioral , and clinical effects . PATIENTS AND METHODS We compared changes in asthma symptoms , utilization of medical services , knowledge about asthma , metered-dose inhaler ( MDI ) technique , and self-management behaviors for 323 adult Kaiser Permanente patients with moderate to severe asthma who were r and omly assigned to  small-group education , individual teaching , or 1 of 2 control conditions -- an information ( workbook ) control or usual control ( no formal asthma education ) . Data were collected from patients by question naire , diary , and physical examination at enrollment and at 5 months and 1 year after intervention . Medical record data on these patients were abstract ed for a total 3-year period , from 1 year before to 2 years after enrollment . RESULTS Compared with the usual control , the self-management education programs were associated with significant improvements in control of asthma symptoms ( reduced " bother " due to asthma and increased symptom-free days ) , MDI technique , and environmental control practice s. Small-group education also was associated with significant improvements in physician evaluation of the patients ' asthma status and in patients ' level of physical activity . For both group and individual education recipients , improvement in MDI technique was positively correlated with improved control of symptoms ; however , the degree of improvement in symptoms was greater than that which could be accounted for on the basis of improvement in MDI technique alone . The time course over which changes occurred in the various outcome measures suggests the mechanism by which education result ed in improvement in the patient 's status . Significant improvements in MDI technique and environmental control practice s were manifest immediately following education ( 5-month follow-up ) and at the 1-year follow-up . Significant improvements in symptom measures were not apparent until the 1-year follow-up . The rate of utilization of medical care for acute exacerbations decreased between baseline and the 2-year follow-up period , but this decrease did not differ significantly among treatment conditions . However , there was a trend toward greater reduction in patients receiving small-group education . An ad hoc finding of a significant difference favoring small-group education between the baseline and the second follow-up year acute visit rates was observed . This result must be regarded as tentative , since it is not clear that unambiguous statistical significance is attained in the light of multiplicity issues . However , this trend is consistent with the antecedent benefits of the small-group education , and appears to warrant further investigation . CONCLUSIONS Carefully design ed asthma education programs for adults can improve patients ' underst and ing of their condition and its treatment and increase their motivation and confidence that the condition can be controlled , thereby increasing their adherence to the treatment regimen and management of symptoms , and , in turn , improving control of symptoms . Both small-group education and individual education were associated with significant benefits , but the group program was simpler to administer , better received by patients and educators , and more cost-effective . The results show promise for improving clinical outcomes , through well- design ed educational programs , for patients with asthma and other chronic health problems The increased prevalence , morbidity , mortality , and health costs associated with asthma among children suggest the need for accessible asthma education . This study examined the effect of telepharmacy counseling , using interactive compressed video , on metered-dose inhaler ( MDI ) technique and patient satisfaction among adolescents with asthma in rural Arkansas . The telepharmacy counseling provided accessible education regarding MDI technique for adolescents in this study . Twenty percent of the adolescents who participated had never been shown the appropriate use of an MDI . The study used an experimental design with r and om assignment of participants to a  telepharmacy counseling group ( n = 15 ) or a control group ( n = 21 ) . Both groups participated in pre-test , post-test , and 2- to 4-week follow-up assessment s for MDI technique and patients satisfaction ( follow-up assessment only ) via interactive compressed video . Results indicated that from pre-test to follow-up the telepharmacy counseling group showed more improvement in MDI technique than participants in the control group ( p < 0.001 ) . There was no significant difference between the telepharmacy counseling group and control group in satisfaction with the instructional sessions ( p = 0.132 ) . Both groups had high levels of satisfaction with the telepharmacy sessions . The study findings demonstrated that patient education provided by pharmacists via interactive compressed video was superior to education provided via written instructions on an inhaler package insert . Interactive compressed video is an effective medium for teaching and improving MDI technique in this rural , adolescent , predominantly African-American population OBJECTIVE . The goal was to determine whether home asthma telemonitoring with store- and -forward technology improved outcomes , compared with in-person , office-based visits . METHODS . A total of 120 patients , 6 to 17 years of age , with persistent asthma were assigned r and omly to the office-based or virtual group . The 2 groups followed the same ambulatory clinical pathway for 12 months . Office-based group patients received traditional in-person education and case management . Virtual group patients received computers , Internet connections , and in-home , Internet-based case management and received education through the study Web site . Disease control outcome measures included quality of life , utilization of services , and symptom control . RESULTS . A total of 120 volunteers ( 45 female ) were enrolled . The groups were clinical ly comparable ( office-based : 22 female/38 male ; mean age : 9.0 ± 3.0 years ; virtual : 23 female/37 male ; mean age : 10.2 ± 3.1 years ) . Virtual patients had higher metered-dose inhaler with valved holding chamber technique scores than did the office-based group at 52 weeks ( 94 % vs 89 % ) , had greater adherence to daily asthma symptom diary su bmi ssion ( 35.4 % vs 20.8 % ) , had less participant time ( 636 vs 713 patient-months ) , and were older . Caregivers in both groups perceived an increase in quality of life and an increase in asthma knowledge scores from baseline . There were no other differences in therapeutic or disease control outcome measures . CONCLUSIONS . Virtual group patients achieved excellent asthma therapeutic and disease control outcomes . Compared with those who received st and ardized office-based care , they were more adherent to diary su bmi ssion and had better inhaler scores at 52 weeks . Store- and -forward telemedicine technology and case management provide additional tools to assist in the management of children with persistent asthma Abstract Objective : Puerto Rican children suffer disproportionately from asthma . Project CURA tested the efficacy of a community health worker ( CHW ) intervention to improve use of inhaled corticosteroids ( ICS ) and reduce home asthma triggers in Puerto Rican youth in Chicago . Methods : This study employed a behavioral r and omized controlled trial design with a community-based participatory research approach . Medications and technique were visually assessed ; adherence was determined using dose counters . Home triggers were assessed via self-report , visual inspection and salivary cotinine . All participants received education on core asthma topics and self-management skills . Participants in the CHW arm were offered home education by the CHW in four visits over four months . The attention control arm received four newsletters covering the same topics . Results : While most of the participants had uncontrolled persistent asthma , < 50 % had ICS at baseline . In the CHW arms , 67 % of participants received the full four-visit intervention . In the Elementary school cohort ( n = 51 ) , the CHW arm had lower odds of having an ICS ( OR = 0.2 ; p = 0.02 ) at 12-months ; no differences were seen in other outcomes between arms at any time point . The only significant treatment arm difference in the high school cohort ( n = 50 ) was in inhaler technique where the CHW arm performed 18.0 % more steps correct at five months ( p < 0.01 ) and 14.2 % more steps correct at 12 months ( p < 0.01 ) . Conclusions : While this CHW intervention did not increase the number of participants with ICS or reduce home asthma triggers , important lessons were learned including challenges to CHW intervention fidelity and the need for CHWs to partner with clinical providers In recent years education programmes for adults have been developed focusing on improving patient self-management . The aim of this study was to evaluate the efficacy of two different educational programmes on asthma at one year ( short-term efficacy ) and three years ( long-term efficacy ) . Changes in pulmonary function ( FEV1 ) , knowledge of disease and skill concerning inhalation technique were evaluated to determine the efficacy of the educational programme . Forty patients were r and omly assigned to the two different educational programmes . Twenty subjects ( mean age 49 + /- 11 yrs ; FEV1 79 % + /- 15 of predicted ) were assigned , to a basic educational programme , while the others ( mean age 44 + /- 11 yrs ; FEV1 79 % + /- 14 of predicted ) were assigned to an " asthma school " programme . In both " basic " and " asthma school " groups there was a significant increase from baseline to one year ( p < 0.05 ) and three years ( p < 0.05 ) in FEV1 , number of correct answers to the knowledge question naire , and number of correct steps during the inhalation procedure . No significant differences were found between the two groups at baseline , one year and three years for all three variables studied . This study confirms that both educational programmes determine in asthmatics an improvement in lung function , knowledge of disease and skill for inhalation technique at one year and three years following commencement of the programme . A " basic " educational programme is as effective as an " asthma school " one BACKGROUND Childhood asthma is a serious and common chronic disease that requires the attention of nurses and other school personnel . Schools are often the first setting that children take the lead in managing their asthma . Often , children are ill prepared for this role . Our study evaluated a school-based , multifaceted asthma program that targeted students with asthma and the broader school community . METHODS A r and omized trial involving 130 schools with grade s 1 - 5 and 1316 children with asthma and their families was conducted . Outcomes of interest for the child , at 1 year , were urgent care use and school absenteeism for asthma , inhaler technique , and quality of life , and for the school , at 14 months , were indicators of a supportive school environment . RESULTS Improvements were observed at the child and school level for the intervention group . Fewer children in the intervention group had a school absence ( 50 % vs 60 % ; p < .01 ) , required urgent care for asthma ( 41 % vs 51 % ; p < .0001 ) , or reported a day of interrupted activity ( 51 % vs 63 % ; p < .01 ) , and had improved quality of life ( 5.8 ± 1.2 vs 5.4 ± 1.4 ; p < .0001 ) . Schools in the intervention group were more likely to have practice s supporting an asthma-friendly environment . CONCLUSIONS Implementation of a multifaceted school-based asthma program can lead to asthma-friendly schools that support children with asthma to be successful managers of their asthma and experience improved quality of life and decreased disease associated burden The adherence and disease-control outcomes associated with the use of an Internet-based store- and -forward video home telehealth system to manage asthma in children were studied . Pediatric patients with persistent asthma were provided with home computers and Internet access and monitored biweekly over the Internet .  All patients were seen in the pediatric clinic at 0 , 2 , 6 , 12 , and 24 weeks . Half of the patients received  asthma education in person and half via an interactive Web site .  Adherence measures were assessed by therapeutic and diagnostic monitoring . Therapeutic monitoring included digital videos of patients using their controller medication inhaler . Diagnostic monitoring included an asthma symptom diary and a video of peak flow meter use . Videos were su bmi tted electronically twice a week by using in-home telemonitoring with store- and -forward technology . Feedback was provided electronically to each patient . Disease control was assessed by examining quality of life , utilization of services , rescue-therapy use , symptom control , satisfaction with home telemonitoring , and retention of asthma knowledge . Patients were r and omly assigned to an asthma education group ( Internet versus office ) , and the data were analyzed by comparing results for study days 0 - 90 and 91 - 180 . Ten children participated . A total of 321 videos of inhaler use and 309 videos of peak flow meter use were su bmi tted . Inhaler technique scores improved significantly in the second study period . Su bmi ssion of diagnostic monitoring videos and asthma diary entries decreased significantly . Peak flow values as a percentage of personal best values increased significantly . Overall , there was no change in quality of life reported by patients . However , the caregivers in the virtual-education group reported an increase in the patients ' quality -of-life survey scores . Emergency department visits and hospital admissions for asthma were avoided . Rescue therapy was infrequent . A high rate of satisfaction with home telemonitoring was reported . Internet-based , store- and -forward video assessment of children 's use of asthma medications and monitoring tools in their homes appeared effective and well accepted Metered-dose inhalers are often used incorrectly by patients with chronic airflow obstruction , and there is a lack of controlled studies design ed to evaluate methods to teach the correct use of these devices . Therefore , we screened 100 consecutive stable out patients for correct or incorrect inhaler use and then conducted a r and omized trial of two methods to teach correct use . Patients were classified as correct or incorrect users with a modified metered-dose inhaler containing a thermistor that detected inspiration , inhaler activation , and the duration of breath-holding . Patients were classified as incorrect users if they failed to : ( 1 ) activate the inhaler once during inspiration , and /or ( 2 ) hold their breath at the end of inspiration . There were 38 correct users and 62 incorrect users . Incorrect users were r and omized to one of two teaching protocol s : ( 1 ) st and ardized verbal instruction alone , or ( 2 ) st and ardized verbal instruction plus an automatic visual signal during inspiration . Incorrect users were restudied 6 to 10 wk later to reassess technique . Both treatment protocol s were equally effective in converting incorrect user . However , the verbal instruction alone required significantly less time than the instruction with the mechanical aid . For all subjects , the proportion using correct technique declined over time , particularly for incorrect users . We also examined a series of patient characteristics , obtained by question naire and spirometry , to determine whether they could be used in the clinical setting to identify incorrect users . By discriminant analysis , a group of four variables predicted correct metered-dose inhaler use : bronchodilator responsiveness , a history of additional about proper technique , verbal knowledge of the correct inhaler maneuvers , and the patient 's perception of whether it is important to use an inhaler . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE The present study aim ed to contribute to the design of effective health education information . Based on cognitive-psychological theory , pictures were expected to improve underst and ing of two existing textual instructions for using asthma devices ( inhaler chamber and peak flow meter ) . From an analysis of the affordances and constraints of both devices this effect was expected to be stronger with the inhaler chamber than with the peak flow meter . METHODS To test this , both instructions were systematic ally illustrated with seven line-drawings visualizing the actions . In two separate r and omized controlled trials with in total 99 participants from the general public , the original text-only versions were compared to the text-picture versions of the same instruction . Dependent variables were participants ' recall of the instructions and the quality of their performance with the instruction observed from video-recordings . RESULTS Conform expectations , the results showed significant positive effects of pictures on recall and performance in both instructions , especially with the inhaler chamber . CONCLUSION Thus , pictures may contribute to a better comprehension and use of medical devices that are inherently less clear . PRACTICE IMPLICATION S Health educators may optimize instruction design by careful analysis of the device with instruction and observational testing with potential users We r and omized 135 adult asthma patients to a control group , and 132 patients to an experimental group which received a special health education intervention . Four adherence measures were documented at baseline and 12-month follow-up : correct inhaler use , inhaler adherence , medication adherence , and total adherence rating . Costs to routinely deliver the intervention were $ 32.03/patient . Experimental group patients exhibited a significantly higher level of improvement in adherence ( 44 percent ) than control group patients ( 2 percent ) Background . This study aim ed to compare the effects of two small-group asthma education interventions ( one delivered by specially trained pharmacists ( group A ) and one delivered by a pharmacist research er trained as an asthma educator ( group B ) ) with usual care provided by community pharmacists ( group C ) on clinical and humanistic outcomes for people with asthma . Methods . Pharmacies were r and omly selected to provide either group A , B , or C interventions . Data were collected at baseline , post intervention ( groups A and B ) and at 6 and 12 weeks ( final visit ) . Results . Forty-eight people with asthma were recruited into groups A ( n = 16 ) , B ( n = 16 ) , and C ( n = 16 ) and there were no significant differences between the groups at baseline . At 12 weeks there was a significant decrease in the proportion of patients with severe asthma/poor control in groups A and B compared with group C ( 56 % , 44 % and 50 % to 25 % , 13 % and 50 % [ n = 48 , p < 0.05 ] , respectively ) . In Groups A and B , the proportion of patients with optimal metered dose inhaler ( MDI ) technique improved from 9 % and 14 % , respectively , at baseline to 82 % and 93 % ( n = 11 , p = 0.02 , n = 14 , p < 0.001 ) , respectively , at 12 weeks . The proportion of patients with optimal dry powder inhaler ( DPI ) technique improved in Groups A and B from 0 % and 8 % , respectively , at baseline to 86 % and 92 % ( n = 7 , p < 0.001 ; n = 13 , p = 0.002 ) , respectively , at 12 weeks . No change in inhaler technique was observed for Group C. There were significant improvements in asthma knowledge scores in Groups A and B compared to Group C over time . Conclusions . Small-group asthma education delivered by pharmacists appears to be more effective than usual care in improving clinical and humanistic asthma outcomes
With the current wealth of new inhalers available and insurance policy driven inhaler switching , the need for insights in optimal education on inhaler use is more evident than ever .
We aim ed to systematic ally review educational inhalation technique interventions , to assess their overall effectiveness , and identify main drivers of success .