Easy Low Instruction Over Time (ELIOT): inhaler technique mastery and maintenance in healthcare professionals trained on different devices

Insufficient inhaler technique remains one of the most common causes of failure in achieving symptoms control in patients with asthma. Healthcare professionals (HCPs) are required to assess and train patients in the correct use of inhaler devices, yet it has been previously shown that many HCPs themselves lack the knowledge and skill on inhaler techniques to educate patients. As such, it is pertinent to correct this issue either through training of HCPs or by the introduction of newer, easier-to-use inhaler device models.

Bringing together our internal expertise in real-life respiratory research and experts from different branches of specialities, this systematic, investigative and experimental project represents the world’s first attempt to assess the extent of training required for HCPs to master inhaler techniques. This project also aimed to assess the benefits of using a newer, more intuitive, inhaler device model (Spiromax®) compared to an established model used in Singapore (Turbuhaler®).

The initial stages of this project focused on designing a study capable of generating clinically meaningful research data.  This includes outlining steps of training for participants and measures to assess each participants’ device mastery. A 6-steps device training was formulated by the panel of experts, beginning from intuitive use, proceeding to the use of instructional materials and expert tuition.

A randomized, unblinded, crossover study was conducted involving 516 undergraduate HCPs from universities in Australia. Participants underwent training in both inhaler devices, with each participants’ inhaler technique assessed after each training step by the clinical experts. Inhaler technique mastery was reassessed at 4 and 8 weeks since the initial training.

We observed a significantly higher proportion of participants maintaining mastery for Spiromax compared to Turbuhaler at 4 and 8 weeks after initial training (64% vs 41% and 79% vs 65%, respectively). More participants demonstrated Spiromax mastery prior to initial training (22% vs 4%) and also required less training steps to achieve mastery (median 2 steps vs 3 steps). This result was published in the Journal of Asthma (Impact Factor: 1.8).

Our results demonstrated that significant differences in the nature and extent of training required for HCPs to achieve and maintain mastery with different DPI devices. However, we believe that more insight is required on the impact of HCP training and further device innovation on clinical outcomes in patients.


Sinthia Bosnic-Anticevich, Christina Callan, Henry Chrystyn, Federico Lavorini, Vasilis Nikolaou, Vicky Kritikos, PN Richard Dekhuijzen, Nicolas Roche, Leif Bjermer, Cynthia Rand, Nicholas Zwar, David B Price. Inhaler technique mastery and maintenance in healthcare professionals trained on different devices. J Asthma 2018: 55(1): 79-88.
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