Evaluation of the knowledge and correct use of metered-dose inhalers by healthcare professionals and medical students in Gauteng Province

BACKGROUND: The Global Initiative for Asthma (GINA) estimates that South Africa (SA) has over 3.9 million asthma sufferers, of whom 1.5% die of the condition annually. SA has the world’s fourth highest asthma death rate among 5 - 35-year-olds. Chronic obstructive pulmonary disease (COPD) will be the third leading cause of death globally by 2030, and will surpass HIV/AIDS in Africa. Uncontrolled asthma and COPD are frequent causes of emergency department visits and hospital admissions. Poor metered-dose inhaler (MDI) technique is probably a major contributory cause. It is the responsibility of all treating doctors and healthcare professionals to educate patients on inhaled therapy with the correct MDI technique, as well as to routinely check and repeatedly demonstrate the technique to them. OBJECTIVES: This study evaluated study participants’ knowledge of MDI technique, and their compliance in checking and demonstrating MDI use to patients prescribed inhaled therapy. The study participants included doctors, nurses and final-year medical students at Helen Joseph Hospital and Chris Hani Baragwanath Academic Hospital, in the Departments of Internal Medicine and Emergency Medicine, and the Division of Pulmonology. METHODS: A total of 195 study participants volunteered to take part in the study. A questionnaire was administered to participants to gauge their perceptions, level of knowledge and understanding of MDI technique. They were then requested to demonstrate correct inhaler technique via a placebo MDI. Participants’ use of a placebo MDI was evaluated by a scoring system. RESULTS: The total sample of 195 comprised 130 (67%) female and 65 (33%) male participants. Of these, 133 (68%) were qualified medical staff, and 62 were final-year medical students. Only 32 (16%) could demonstrate correct MDI technique. Over 50% of participants did not demonstrate MDI technique to patients, or check their patients’ technique at every hospital-related visit. CONCLUSION: Healthcare professionals and final-year medical students have poor knowledge of inhaler technique and are ill-prepared to teach patients. Also of concern is that the majority do not routinely demonstrate or observe patients’ inhaler technique.