A specialized training program on inhaler technique delivered by pharmacists to nurses: a study from the United Arab Emirates
Main Article Content
Keywords
Asthma , Inhaler technique, Training, United Arab Emirates, Nursing
Abstract
Background: Inhaled drug delivery has been hailed as a major advancement in respiratory therapeutics. However, a major limitation to use the inhaled medications effectively is the inability of patients and nurses to use and demonstrate the proper use of these devices correctly. Being the drug experts, pharmacists are in a pivotal position to delivered tailored education to their peers, the nurses. Aim: This study aims to examine nurses’ knowledge of asthma management, their ability to demonstrate proper inhaler technique, and the impact of a specialized workshop training program delivered by skilled pharmacists on improving their performance. Methods: This is a pre- and post-cross-sectional study design in hospital setting where nurses were recruited from the respiratory and emergency departments within a healthcare facility in the United Arab Emirates (UAE). The nurses attended a training workshop prepared and delivered by skilled pharmacists on inhaler technique demonstration skills. Nurses’ inhaler technique demonstration skills for Diskus, Turbuhaler, and pMDI were assessed at baseline, immediately after the workshop, and after four weeks. The nurses completed the demographic and Asthma Knowledge Questionnaire (AKQ). Results: A random convenience sample of registered nurses (n=20) from the respiratory and emergency departments was recruited from a tertiary hospital in Sharjah, UAE, with a mean age of 35.25 (SD=6.96) years, of whom 90% were females. The mean number of years of experience was 12.00 years (SD=5.81). Inhaler technique assessment revealed low inhaler technique scores for all the three study inhalers at baseline (mean score for Diskus=3.85 (SD=2.87); Turbuhaler=3.70 (SD=3.20); pMDI=4.50 (SD=2.65)) Significant improvements in inhaler technique scores were noted after the workshop (Diskus=8.9 (SD=0.31); Turbuhaler=8.9 (SD=0.31); pMDI=8.0 (SD=0.00), P<0.001). A significant difference in AKQ scores was found before (mean=4.85 (SD=1.27)) and after (mean=7.50 (SD=0.95)) the workshop training session (P<0.001), and four weeks after the workshop training session (mean=7.55 (SD=0.76), P<0.001). Conclusion: The UAE nurses’ inhaler technique and AKQ scores were suboptimal at baseline. The specialized training program prepared and delivered by the skilled pharmacists improved nurses’ inhaler technique demonstration skills and AKQ scores. Such improvements would reflect positively on patients’ asthma management outcomes as nurses are the health care professionals who interact the most with the patients during hospitalization.
References
1. Mahboub BHSH, Santhakumar S, Soriano JB, et al. Asthma insights and reality in the United Arab Emirates. Ann Thorac Med. 2010;5(4):217-221. https://doi.org/10.4103/1817-1737.69109
2. Mahboub BH, Al-Hammadi S, Rafique M, et al. Population prevalence of asthma and its determinants based on European
Community Respiratory Health Survey in the United Arab Emirates. BMC Pulm Med. 2012;12(1). https://doi.org/10.1186/1471-2466-12-4
3. Basheti IA, Qunaibi E, Bosnic-Anticevich SZ, et al. User error with diskus and turbuhaler by asthma patients and pharmacists in Jordan and Australia. Respir Care. 2011;56(12):1916-1923. https://doi.org/10.4187/respcare.01205
4. De Oliveira MA, Bruno VF, Ballini LS, et al. Evaluation of an educational program for asthma control in adults. J Asthma. 1997;34(5):395-403. https://doi.org/10.3109/02770909709055381
5. Van Der Palen J, Klein JJ, Kerkhoff AHM, et al. Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines. Patient Educ Couns. 1997;32:87-95. https://doi.org/10.1016/s0738-3991(97)00100-6
6. Hanania NA, Wittman R, Kesten S, et al. Medical personnel’s knowledge of and ability to use inhaling devices: Metered-dose inhalers, spacing chambers, and breath-actuated dry powder inhalers. Chest. 1994;105(1):111-116. https://doi.org/10.1378/
chest.105.1.111
7. Interiano B, Guntupalli KK. Metered-dose inhalers: do health care providers know what to teach? Arch Intern Med.1993;153(1):81-85. https://doi.org/10.1001/archinte.153.1.81
8. Jones JS, Holstege CP, Riekse R, et al. Metered-Dose Inhalers: Do Emergency Health Care Providers Know What to Teach? Ann Emerg Med. 1995;26(3):308-311. https://doi.org/10.1016/s0196-0644(95)70078-1
9. Plaza V, Sanchis J, Antepara I, et al. Medical personnel and patient skill in the use of metered dose inhalers: A multicentric study. Respiration. 1998;65(3):195-198. https://doi.org/10.1159/000029259
10. Tsang KWT, Lam WK, Ip M, et al. Inability of physicians to use metered-dose inhalers. J Asthma. 1997;34(6):493-498. https://doi.org/10.3109/02770909709055393
11. Newman SP, Weisz AWB, Talaee N, et al. Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. Thorax. 1991;46(10):712-716. https://doi.org/10.1136/thx.46.10.712
12. Lahdensuo A, Muittari A. Bronchodilator effects of a fenoterol metered dose inhaler and fenoterol powder in asthmatics withpoor inhaler technique. Eur J Respir Dis. 1986;68(5):332-335.
13. Lindgren S, Bake B, Larsson S. Clinical consequences of inadequate inhalation technique in asthma therapy. Eur J Respir Dis. 1987;70(2):93-98.
14. Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur Respir J.2002;19(2):246-251. https://doi.org/10.1183/09031936.02.00218402
15. Fink JB, Rubin BK. Problems with inhaler use: A call for improved clinician and patient education. Respir Care. 2005;50(10):1360-1374.
16. King D, Earnshaw S, Delaney J. Pressurised aerosol inhalers: the cost of misuse. Br J Clin Pract. 1991;45(1):48-49.
17. Basheti IA, Reddel HK, Armour CL, et al. Counseling about turbuhaler technique: Needs assessment and effective strategies for community pharmacists. Respir Care. 2005;50(5):617-623.
18. Basheti IA, Armour CL, Bosnic-Anticevich SZ, et al. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Educ Couns. 2008;72(1):26-33. https://doi.org/10.1016/j.pec.2008.01.014
19. Basheti IA, Reddel HK, Armour CL, et al. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007;119(6):1537-1538. https://doi.org/10.1016/j.jaci.2007.02.037
20. Basheti IA, Armour CL, Reddel HK, et al. Long-term maintenance of pharmacists’ inhaler technique demonstration skills. Am J Pharm Educ. 2009;73(2):1-8. https://doi.org/10.5688/aj730232
21. Ilic AD, Zugic V, Zvezdin B, et al. Influence of inhaler technique on asthma and COPD control: A multicenter experience. Int J COPD. 2016;11(1):2509-2517. https://doi.org/10.2147/copd.s114576
22. Wang W, Xu T, Qin Q, et al. Effect of a Multidimensional Pharmaceutical Care Intervention on Inhalation Technique in Patients with Asthma and COPD. Can Respir J. 2020;2020:1-10. https://doi.org/10.1155/2020/8572636 .
23. Perumal R, Leite M, van Zyl-Smit RN. The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients. Int J COPD. 2020;15:1217-1224. https://doi.org/10.2147/copd.s249620
24. O’Donnell J, Birkinshaw R, Burke V, et al. The ability of A&E personnel to demonstrate inhaler technique. Emerg Med J. 1997;14(3):163-164. https://doi.org/10.1136/emj.14.3.163
25. Bodenheimer T, MacGregor K, Stothart N. Nurses as leaders in chronic care. Br Med J. 2005;330(7492):612-613. https://doi.org/10.1136/bmj.330.7492.612
26. Rance KS. Helping patients attain and maintain asthma control: Reviewing the role of the nurse practitioner. J Multidiscip Healthc. 2011;4:299-309. https://doi.org/10.2147/jmdh.s22966
27. Alasad J, Tabar NA, Aburuz ME. Patient satisfaction with nursing care: Measuring outcomes in an international setting. J Nurs Adm. 2015;45(11):563-568. https://doi.org/10.1097/nna.0000000000000264
28. Basheti IA, Qunaibi EA, Hamadi SA, et al. Inhaler technique training and health-care professionals: effective long-term solution for a current problem. Respir Care. 2014;59(11):1716-1725. https://doi.org/10.4187/respcare.02671
29. Kritikos V, Krass I, Hui SC, et al. The validity and reliability of two asthma knowledge questionnaires. J Asthma. 2005;42(9):795-801. https://doi.org/10.1080/02770900500308627
30. Basheti IA, Bosnic-Anticevich SZ, Armour CL, et al. Checklists for powder inhaler technique: A review and recommendations.Respir Care. 2014;59(7):1140-1154. https://doi.org/10.4187/respcare.02342
31. Bosnic-Anticevich SZ, Sinha H, So S, et al. Metered-dose inhaler technique: The effect of two educational interventionsdelivered in community pharmacy over time. J Asthma. 2010;47(3):251-256. https://doi.org/10.3109/02770900903580843
32. Milavetz G, Kelly HW, Whelan AM, et al. Optimizing drug delivery from metered-dose inhalers. Dicp. 1991;24(4):409. https://doi.org/10.1177/106002809102500614
33. Plaza V, Giner J, Rodrigo GJ, et al. Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. J Allergy Clin Immunol Pract. 2018;6(3):987-995. https://doi.org/10.1016/j.jaip.2017.12.032
34. Plaza V, Sanchis J, Roura P, et al. Physicians’ knowledge of inhaler devices and inhalation techniques remains poor in Spain. J Aerosol Med Pulm Drug Deliv. 2012;25(1):16-22. https://doi.org/10.1089/jamp.2011.0895
35. Self TH, Arnold LB, Czosnowski LM, et al. Inadequate skill of healthcare professionals in using asthma inhalation devices. J Asthma. 2007;44(8):593-598. https://doi.org/10.1080/02770900701554334
36. Lareau SC, Hodder R. Teaching inhaler use in chronic obstructive pulmonary disease patients. J Am Acad Nurse Pract. 2012;24(2):113-120. https://doi.org/10.1111/j.1745-7599.2011.00681.x
37. De Tratto K, Gomez C, Ryan CJ, et al. Nurses’ knowledge of inhaler technique in the inpatient hospital setting. Clin Nurse Spec.2014;28(3):156-160. https://doi.org/10.1097/nur.0000000000000047
38. Giner J, Roura P, Hernández C, et al. Knowledge and Attitudes of Nurses in Spain about Inhaled Therapy: Results of a National Survey. J Aerosol Med Pulm Drug Deliv. 2016;29(1):86-93. https://doi.org/10.1089/jamp.2014.1198
39. Kellman DA, Iserson KV, Levy RD, et al. Brief Education Improves Proper Metered-Dose Inhaler Use. J Emerg Med. 2020;58(4):667-672. https://doi.org/10.1016/j.jemermed.2020.02.011
40. Basheti IA, Hamadi SA, Reddel HK. Inter-professional education unveiling significant association between asthma knowledge and inhaler technique. Pharm Pract (Granada). 2016;14(1):713. https://doi.org/10.1089/jamp.2014.1198
41. Adeyeye OO, Kuyinu YA, Bamisile TR, et al. A preliminary assessment of nurses’ asthma education needs and the effect of a training programme in an urban tertiary healthcare facility. African J Respir Med. 2015;10(2):13-17.
42. Beerendonk I van, Mesters I, Mudde AN, et al. Assessment of the Inhalation Technique in Outpatients with Asthma or Chronic Obstructive Pulmonary Disease Using a Metered-Dose Inhaler or Dry Powder Device. J Asthma. 1998;35(3):273-279. https://
doi.org/10.3109/02770909809068218
43. Duerden M, Price D. Training issues in the use of inhalers. Dis Manag Heal Outcomes. 2001;9(2):75-87. https://doi.org/10.2165/00115677-200109020-00002
44. Molimard M, Raherison C, Lignot S, et al. Assessment of handling of inhaler devices in real life- an observational study in 3811 patients in primary care. J aerosol Med. 2003;16(3):249-254. https://doi.org/10.1089/089426803769017613
45. Molimard M, Gros V Le. Impact of patient-related factors on asthma control. J Asthma. 2008;45(2):109-113. https://doi.org/10.1080/02770900701815727
46. Price DB, Román-Rodríguez M, McQueen RB, et al. Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes. J Allergy Clin Immunol Pract. 2017;5(4):1071-1081.e9. https://doi.org/10.1211/pj.2017.20202501
47. Basheti IA, Obeidat NM, Ammari WG, et al. Associations between inhaler technique and asthma control among asthma patients using pressurised MDIs and DPIs. Int J Tuberc Lung Dis. 2016;20(5):689-695. https://doi.org/10.5588/ijtld.15.0557
48. Chorão P, Pereira AM, Fonseca JA. Inhaler devices in asthma and COPD - An assessment of inhaler technique and patient preferences. Respir Med. 2014;108(7):968-975. https://doi.org/10.1016/j.rmed.2014.04.019
49. AL-Jahdali H, Ahmed A, AL-Harbi A, et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Allergy, Asthma Clin Immunol. 2013;9(1):1-7. https://doi.org/10.1186/1710-1492-9-8
50. Sawalha AF, Sweileh WM, Zyoud SH, et al. Comparative Analysis of Patient Package Inserts of Local and Imported Anti-Infective Agents in Palestine. Libyan J Med. 2008;3(4):181-185. https://doi.org/10.3402/ljm.v3i4.4790
51. Chew SY, Leow JYL, Chan AKW, et al. Improving asthma care with Asthma-COPD Afterhours Respiratory Nurse at Emergency (A-CARE). BMJ open Qual. 2020;9(2):e000895. https://doi.org/10.1136/bmjoq-2019-000894
2. Mahboub BH, Al-Hammadi S, Rafique M, et al. Population prevalence of asthma and its determinants based on European
Community Respiratory Health Survey in the United Arab Emirates. BMC Pulm Med. 2012;12(1). https://doi.org/10.1186/1471-2466-12-4
3. Basheti IA, Qunaibi E, Bosnic-Anticevich SZ, et al. User error with diskus and turbuhaler by asthma patients and pharmacists in Jordan and Australia. Respir Care. 2011;56(12):1916-1923. https://doi.org/10.4187/respcare.01205
4. De Oliveira MA, Bruno VF, Ballini LS, et al. Evaluation of an educational program for asthma control in adults. J Asthma. 1997;34(5):395-403. https://doi.org/10.3109/02770909709055381
5. Van Der Palen J, Klein JJ, Kerkhoff AHM, et al. Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines. Patient Educ Couns. 1997;32:87-95. https://doi.org/10.1016/s0738-3991(97)00100-6
6. Hanania NA, Wittman R, Kesten S, et al. Medical personnel’s knowledge of and ability to use inhaling devices: Metered-dose inhalers, spacing chambers, and breath-actuated dry powder inhalers. Chest. 1994;105(1):111-116. https://doi.org/10.1378/
chest.105.1.111
7. Interiano B, Guntupalli KK. Metered-dose inhalers: do health care providers know what to teach? Arch Intern Med.1993;153(1):81-85. https://doi.org/10.1001/archinte.153.1.81
8. Jones JS, Holstege CP, Riekse R, et al. Metered-Dose Inhalers: Do Emergency Health Care Providers Know What to Teach? Ann Emerg Med. 1995;26(3):308-311. https://doi.org/10.1016/s0196-0644(95)70078-1
9. Plaza V, Sanchis J, Antepara I, et al. Medical personnel and patient skill in the use of metered dose inhalers: A multicentric study. Respiration. 1998;65(3):195-198. https://doi.org/10.1159/000029259
10. Tsang KWT, Lam WK, Ip M, et al. Inability of physicians to use metered-dose inhalers. J Asthma. 1997;34(6):493-498. https://doi.org/10.3109/02770909709055393
11. Newman SP, Weisz AWB, Talaee N, et al. Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. Thorax. 1991;46(10):712-716. https://doi.org/10.1136/thx.46.10.712
12. Lahdensuo A, Muittari A. Bronchodilator effects of a fenoterol metered dose inhaler and fenoterol powder in asthmatics withpoor inhaler technique. Eur J Respir Dis. 1986;68(5):332-335.
13. Lindgren S, Bake B, Larsson S. Clinical consequences of inadequate inhalation technique in asthma therapy. Eur J Respir Dis. 1987;70(2):93-98.
14. Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur Respir J.2002;19(2):246-251. https://doi.org/10.1183/09031936.02.00218402
15. Fink JB, Rubin BK. Problems with inhaler use: A call for improved clinician and patient education. Respir Care. 2005;50(10):1360-1374.
16. King D, Earnshaw S, Delaney J. Pressurised aerosol inhalers: the cost of misuse. Br J Clin Pract. 1991;45(1):48-49.
17. Basheti IA, Reddel HK, Armour CL, et al. Counseling about turbuhaler technique: Needs assessment and effective strategies for community pharmacists. Respir Care. 2005;50(5):617-623.
18. Basheti IA, Armour CL, Bosnic-Anticevich SZ, et al. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Educ Couns. 2008;72(1):26-33. https://doi.org/10.1016/j.pec.2008.01.014
19. Basheti IA, Reddel HK, Armour CL, et al. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007;119(6):1537-1538. https://doi.org/10.1016/j.jaci.2007.02.037
20. Basheti IA, Armour CL, Reddel HK, et al. Long-term maintenance of pharmacists’ inhaler technique demonstration skills. Am J Pharm Educ. 2009;73(2):1-8. https://doi.org/10.5688/aj730232
21. Ilic AD, Zugic V, Zvezdin B, et al. Influence of inhaler technique on asthma and COPD control: A multicenter experience. Int J COPD. 2016;11(1):2509-2517. https://doi.org/10.2147/copd.s114576
22. Wang W, Xu T, Qin Q, et al. Effect of a Multidimensional Pharmaceutical Care Intervention on Inhalation Technique in Patients with Asthma and COPD. Can Respir J. 2020;2020:1-10. https://doi.org/10.1155/2020/8572636 .
23. Perumal R, Leite M, van Zyl-Smit RN. The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients. Int J COPD. 2020;15:1217-1224. https://doi.org/10.2147/copd.s249620
24. O’Donnell J, Birkinshaw R, Burke V, et al. The ability of A&E personnel to demonstrate inhaler technique. Emerg Med J. 1997;14(3):163-164. https://doi.org/10.1136/emj.14.3.163
25. Bodenheimer T, MacGregor K, Stothart N. Nurses as leaders in chronic care. Br Med J. 2005;330(7492):612-613. https://doi.org/10.1136/bmj.330.7492.612
26. Rance KS. Helping patients attain and maintain asthma control: Reviewing the role of the nurse practitioner. J Multidiscip Healthc. 2011;4:299-309. https://doi.org/10.2147/jmdh.s22966
27. Alasad J, Tabar NA, Aburuz ME. Patient satisfaction with nursing care: Measuring outcomes in an international setting. J Nurs Adm. 2015;45(11):563-568. https://doi.org/10.1097/nna.0000000000000264
28. Basheti IA, Qunaibi EA, Hamadi SA, et al. Inhaler technique training and health-care professionals: effective long-term solution for a current problem. Respir Care. 2014;59(11):1716-1725. https://doi.org/10.4187/respcare.02671
29. Kritikos V, Krass I, Hui SC, et al. The validity and reliability of two asthma knowledge questionnaires. J Asthma. 2005;42(9):795-801. https://doi.org/10.1080/02770900500308627
30. Basheti IA, Bosnic-Anticevich SZ, Armour CL, et al. Checklists for powder inhaler technique: A review and recommendations.Respir Care. 2014;59(7):1140-1154. https://doi.org/10.4187/respcare.02342
31. Bosnic-Anticevich SZ, Sinha H, So S, et al. Metered-dose inhaler technique: The effect of two educational interventionsdelivered in community pharmacy over time. J Asthma. 2010;47(3):251-256. https://doi.org/10.3109/02770900903580843
32. Milavetz G, Kelly HW, Whelan AM, et al. Optimizing drug delivery from metered-dose inhalers. Dicp. 1991;24(4):409. https://doi.org/10.1177/106002809102500614
33. Plaza V, Giner J, Rodrigo GJ, et al. Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. J Allergy Clin Immunol Pract. 2018;6(3):987-995. https://doi.org/10.1016/j.jaip.2017.12.032
34. Plaza V, Sanchis J, Roura P, et al. Physicians’ knowledge of inhaler devices and inhalation techniques remains poor in Spain. J Aerosol Med Pulm Drug Deliv. 2012;25(1):16-22. https://doi.org/10.1089/jamp.2011.0895
35. Self TH, Arnold LB, Czosnowski LM, et al. Inadequate skill of healthcare professionals in using asthma inhalation devices. J Asthma. 2007;44(8):593-598. https://doi.org/10.1080/02770900701554334
36. Lareau SC, Hodder R. Teaching inhaler use in chronic obstructive pulmonary disease patients. J Am Acad Nurse Pract. 2012;24(2):113-120. https://doi.org/10.1111/j.1745-7599.2011.00681.x
37. De Tratto K, Gomez C, Ryan CJ, et al. Nurses’ knowledge of inhaler technique in the inpatient hospital setting. Clin Nurse Spec.2014;28(3):156-160. https://doi.org/10.1097/nur.0000000000000047
38. Giner J, Roura P, Hernández C, et al. Knowledge and Attitudes of Nurses in Spain about Inhaled Therapy: Results of a National Survey. J Aerosol Med Pulm Drug Deliv. 2016;29(1):86-93. https://doi.org/10.1089/jamp.2014.1198
39. Kellman DA, Iserson KV, Levy RD, et al. Brief Education Improves Proper Metered-Dose Inhaler Use. J Emerg Med. 2020;58(4):667-672. https://doi.org/10.1016/j.jemermed.2020.02.011
40. Basheti IA, Hamadi SA, Reddel HK. Inter-professional education unveiling significant association between asthma knowledge and inhaler technique. Pharm Pract (Granada). 2016;14(1):713. https://doi.org/10.1089/jamp.2014.1198
41. Adeyeye OO, Kuyinu YA, Bamisile TR, et al. A preliminary assessment of nurses’ asthma education needs and the effect of a training programme in an urban tertiary healthcare facility. African J Respir Med. 2015;10(2):13-17.
42. Beerendonk I van, Mesters I, Mudde AN, et al. Assessment of the Inhalation Technique in Outpatients with Asthma or Chronic Obstructive Pulmonary Disease Using a Metered-Dose Inhaler or Dry Powder Device. J Asthma. 1998;35(3):273-279. https://
doi.org/10.3109/02770909809068218
43. Duerden M, Price D. Training issues in the use of inhalers. Dis Manag Heal Outcomes. 2001;9(2):75-87. https://doi.org/10.2165/00115677-200109020-00002
44. Molimard M, Raherison C, Lignot S, et al. Assessment of handling of inhaler devices in real life- an observational study in 3811 patients in primary care. J aerosol Med. 2003;16(3):249-254. https://doi.org/10.1089/089426803769017613
45. Molimard M, Gros V Le. Impact of patient-related factors on asthma control. J Asthma. 2008;45(2):109-113. https://doi.org/10.1080/02770900701815727
46. Price DB, Román-Rodríguez M, McQueen RB, et al. Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes. J Allergy Clin Immunol Pract. 2017;5(4):1071-1081.e9. https://doi.org/10.1211/pj.2017.20202501
47. Basheti IA, Obeidat NM, Ammari WG, et al. Associations between inhaler technique and asthma control among asthma patients using pressurised MDIs and DPIs. Int J Tuberc Lung Dis. 2016;20(5):689-695. https://doi.org/10.5588/ijtld.15.0557
48. Chorão P, Pereira AM, Fonseca JA. Inhaler devices in asthma and COPD - An assessment of inhaler technique and patient preferences. Respir Med. 2014;108(7):968-975. https://doi.org/10.1016/j.rmed.2014.04.019
49. AL-Jahdali H, Ahmed A, AL-Harbi A, et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Allergy, Asthma Clin Immunol. 2013;9(1):1-7. https://doi.org/10.1186/1710-1492-9-8
50. Sawalha AF, Sweileh WM, Zyoud SH, et al. Comparative Analysis of Patient Package Inserts of Local and Imported Anti-Infective Agents in Palestine. Libyan J Med. 2008;3(4):181-185. https://doi.org/10.3402/ljm.v3i4.4790
51. Chew SY, Leow JYL, Chan AKW, et al. Improving asthma care with Asthma-COPD Afterhours Respiratory Nurse at Emergency (A-CARE). BMJ open Qual. 2020;9(2):e000895. https://doi.org/10.1136/bmjoq-2019-000894
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A specialized training program on inhaler technique delivered by pharmacists to nurses: a study from the United Arab Emirates. Pharm Pract (Granada) [Internet]. 2022 Sep. 23 [cited 2024 Oct. 8];20(3):01-9. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/2726
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A specialized training program on inhaler technique delivered by pharmacists to nurses: a study from the United Arab Emirates. Pharm Pract (Granada) [Internet]. 2022 Sep. 23 [cited 2024 Oct. 8];20(3):01-9. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/2726