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.