INTRODUCTION
Asthma exacerbations are one of the main reasons for presentation to the
Pediatric Emergency Department (PED), representing 5% of all
consultations1. Performing inhaler technique (IT)
correctly is a simple but effective method to improve asthma control in
children2-4. However, many reports have shown that the
majority of the healthcare providers involved in caring for patients
with respiratory diseases, including doctors and nurses, have poor
knowledge of IT5-7.
It is known that inadequate IT is related to poorer asthma control,
which can cause an increase in the number of Emergency Department
visits, hospital admissions and school absenteeism8.
The optimal way of using inhaled medication with metered-dose inhaler
(MDI) depends on the age and ability of the patient2.
However, it is common to find discrepancies regarding the information
given to the patients and their families due to a lack of knowledge of
healthcare providers on this matter. This problem has been recently
addressed in the adult population. Morton et al pointed out that many
asthmatic patients are managed by non-asthma specialists who,
themselves, may not know how to use an inhaler device and consequently,
do not know how to teach IT correctly9. Additionally,
Plaza et al performed a systematic review in which they analyzed
healthcare professionals’ IT knowledge: only 15,5% performed IT
correctly, with a downward trend over time during the study
period10.
Unfortunately, few studies have been conducted with healthcare
professionals in pediatric settings, and even fewer in emergency units.
Among the studies performed in PED, Spaggiari et al. assessed IT in
nurses and pediatricians, observing that IT was perfectly mastered by
49% of the participants and almost perfectly mastered by another 34%,
highlighting that nurses obtained better results than
doctors11. These results underline the need of
“training trainers”, hence, the importance of conveying training
programs addressed to healthcare providers. The analysis of the impact
of education interventions in healthcare providers have been
predominantly performed with medical intern residents (MIR). Single or
repeated instruction sessions, which include a theoretical lecture and
practical demonstration of IT, have demonstrated to improve IT
performance among MIR, however, no studies have been performed analyzing
the impact of training programs with other professional categories nor
in the PED13,14.
Therefore, this study was designed to evaluate if an education
intervention was an effective strategy to provide information about IT
for healthcare professionals in a PED. The main aim of this study was to
improve PED healthcare providers’ IT technique by carrying out an
education intervention and sustain it for 6 months. We evaluated IT
among different healthcare categories (doctors, nurses and nursing
assistants) and evaluated which factors influenced baseline results.