Investigating the maintenance of inhaler device mastery of healthcare professionals

Background: Healthcare professionals(HCPs) play a key role in patients’ ability to use inhaler devices but a high proportion of HCPs are unable to demonstrate inhaler device mastery. Availability of a more intuitive inhaler device may facilitate HCPs,who are required to continually train patients, that both their device master and maintenance of device mastery are achieved. Aim: To examine the extent of inhaler device mastery maintenance by HCP trainees with respect to correct use of Turbohaler® (TH) vs Spiromax® (SM). Method: Randomised, cross-over, 8-week study comprising 3 visits (only Visit 2 results reported). Participants were students enrolled in Medical, Pharmacy and Nursing degrees who did not have asthma and had no previous use or training on TH or SM within 6 months of Visit 1. At Visit 1, participants were trained in a 6-level training process (level 1 - intuitive use; 2 - patient information leaflet; 3 -instructional video; 4 - expert tuition; 5 and 6 - repeats expert tuition), until device mastery (no observed errors) was achieved with TH and SM placebo inhalers. Visits 2 and 3 took place 4- and 8-weeks after Visit 1, respectively, to assess maintenance of device mastery. If participants failed to maintain device mastery, additional training was given. Device errors (impairing drug delivery) were assessed by inhaler device experts. Level of training needed tore-establish device mastery, proportion of participants maintaining correct technique and impact of device order at Visit 2 were examined. McNemar’s or v2-tests were used as appropriate (P < 0.05).Results: Of the 427 participants, 62%maintained device mastery on SM at Visit 2 vs 40% on TH (P < 0.001). When randomised as first device, 60% of participants maintained device mastery with SM vs 31% on TH (P < 0.001). When used as second device, 64% maintained mastery with SM vs 49% on TH (P = 0.004). After patient information leaflet training (Level 2), 86% achieved mastery on SM vs 77% on TH (P = 0.001). When randomised as first device at Level 2, 84% achieved mastery with SM vs 70% on TH (P < 0.001).As the second device at Level 2, 87% achieved mastery on SM vs 84% on TH(P = 0.441). The median number of training levels to achieve device mastery was 1 for SM and 2 for TH (P < 0.001).Conclusion: More participants maintained device mastery with SM than TH at Visit 2. Significantly fewer training levels were needed to re-establish device mastery with SM than with TH.