Simulator Teaches Asthma Inhaler Use

Asthma patients can use simulator device to learn correct inhaler technique

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Proper use of inhalers can prevent asthma attacks. But often, patients with asthma do not learn how to correctly use their inhalers, leading to inconsistent dosing.

Traditionally, patients are taught to use their inhalers with standard teaching methods including demonstrators. But even with such training, some patients do not follow instructions completely.

Using an inhaler simulator device such as In-Check, which measures the air flow when the patient breathes and provides instant feedback, may help patients learn the right technique, according to a new study.

"Learn to use your inhaler correctly to control asthma."

This study was conducted by Catherine Vitari, BSN, RN, from the University of Pittsburgh Asthma Institute, and colleagues to determine if using a simulator device helps improve patient inhalation technique when compared to traditional teaching methods.

The researchers recruited 43 new patients for two visits, of which three patients did not show up for the second visit.

The control (comparison) group, consisting of 19 patients, was provided instruction using the standard teaching method using demonstrators.

The study group of 21 patients received the same instruction as the control group and also used the In-Check device that simulates resistance and measures inspiratory flow (the flow of air when the patient breathes in) and provides immediate feedback.  

The second visit was scheduled four weeks later and both groups were evaluated for inspiratory flow using the In-Check simulator.

The researchers found that 66.6 percent of the 21 patients who received instruction with the In-Check simulator demonstrated correct use of their inhaler as measured by inspiratory flow, whereas only 36.8 percent of the control group patients were able to use the inhaler correctly.

The subjects who used the simulator device were twice as likely as the subjects who did not to have acceptable inspiratory flow range, which means that they were able to take in the correct amount of the prescribed dose.

The improvement was greater for patients using a metered-dose inhaler closed mouth (a traditional inhaler in which the mouthpiece is directly applied to the mouth) than for those using a spacer, since spacers are usually easier to use and instruction may not be a major factor in correct use.

Catherine Vitari, the lead author is a certified asthma educator. “In my experience and in the literature, most patients are not taught how to use their inhalers correctly. I teach patients how to use their inhalers with demonstrator models. They can repeat the steps and use their inhaler but I cannot measure their inspiratory flows” she told dailyRx.

According to Vitari, each device has a specified range of inspiratory flow and a different resistance as determined by the manufacturer so that the patient gets the maximum effect of the medication. The In-Check device interested her because it simulates the different resistances of each inhaler as well as measures the inspiratory flow.

The authors also conducted a quality of life study using a questionnaire and will be publishing these results soon.

“I do plan to conduct larger studies in asthma patients and other pulmonary patients as well” said Vitari. “My premise is that patients' symptoms can be improved by using correct inhaler technique which should be evaluated before medications are increased.”

These findings come from a study abstract presented at a conference and should be considered preliminary until the entire study is published in a peer-reviewed journal. 

The study results were presented in May at the American Thoracic Society Conference in Philadelphia, Pennsylvania.

The research was funded by Healthy Lungs Pennsylvania, a non-profit organization focused on education, prevention and awareness about lung conditions. The authors did not disclose any potential financial affiliations or conflicts of interest.

Reviewed by: 
Review Date: 
May 20, 2013
Last Updated:
September 9, 2013