Impact of a Structured Workshop on the Inhaler Technique Knowledge and Skills of Healthcare Workers in a Tertiary Government Hospital

Authors

  • Ma. Cecilia C. Lozada, MD Philippine General Hospital, Manila
  • Henry Y. Medina, Jr., MD Philippine General Hospital, Manila
  • Cary Amiel G. Villanueva, MD Philippine General Hospital, Manila
  • Ma. Sergia Fatima P. Sucaldito, MD Philippine General Hospital, Manila
  • Carla Emille D. Barbon, RN, MD-MBA Philippine General Hospital, Manila
  • Ma. Kriselda Karlene G. Tan, MD Philippine General Hospital, Manila

DOI:

https://doi.org/10.70172/pjcd.v23i2.11137

Keywords:

inhaler technique, structured workshop, bronchial asthma, chronic obstructive pulmonary disease, healthcare workers

Abstract

Background: Poor inhaler technique is associated with poor disease control. With the advent of newer inhaler devices, this study aimed to evaluate the effectiveness of a structured workshop on the knowledge and skills in inhaler technique of healthcare workers in the Department of Medicine of the Philippine General Hospital. 

Methodology: This was a quasi-experimental study which compared the knowledge and skills of HCWs on inhaler technique before and immediately after a structured inhaler workshop. A follow-up evaluation was conducted to measure the effect after a one-month period.

Results: A total of 101 participants comprised of interns, nurses, and residents were included in the final analysis. Participants had low baseline knowledge scores; only 41 participants passed the pre-workshop knowledge assessment. The knowledge scores significantly increased immediately post-workshop which persisted until one month after for the residents but not for the nurses and interns. For all groups, the skill scores in using dry powder inhaler significantly improved immediately after the workshop. After one month, there was a decline in skill scores for all, but scores remained significantly higher than pre-workshop values. The metered-dose inhaler skill scores of participants immediately post-workshop showed an improvement from baseline that was sustained on follow-up. For all HCW groups, the single-dose DPI skill scores also improved immediately after the workshop and persisted after one month. At baseline, none of the interns possessed any skill in using soft mist inhaler while both nurses and residents had low skill scores. Immediately post-workshop and on one-month follow-up, SMI skill scores improved across all HCW groups.

Conclusion: A structured inhaler workshop improves the knowledge and skills of HCWs on inhaler technique on a short-term basis and at one-month follow-up. Further studies are needed to determine the longevity of the effect.

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This article has supplementary materials which can be accessed here.

Author Biographies

Ma. Cecilia C. Lozada, MD, Philippine General Hospital, Manila

Division of Pulmonary Medicine, Department of Medicine

Henry Y. Medina, Jr., MD, Philippine General Hospital, Manila

Division of Pulmonary Medicine, Department of Medicine

Cary Amiel G. Villanueva, MD, Philippine General Hospital, Manila

Division of Pulmonary Medicine, Department of Medicine

Ma. Sergia Fatima P. Sucaldito, MD, Philippine General Hospital, Manila

Division of Adult Medicine, Department of Medicine

Carla Emille D. Barbon, RN, MD-MBA, Philippine General Hospital, Manila

Division of Pulmonary Medicine, Department of Medicine

Ma. Kriselda Karlene G. Tan, MD, Philippine General Hospital, Manila

Division of Pulmonary Medicine, Department of Medicine

References

Adeloye D, Song P, Zhu Y, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022;10(5):447-458. Accessed July 31, 2025. https://doi.org/10.1016/j.rmed.2011.01.005 DOI: https://doi.org/10.1016/S2213-2600(21)00511-7

World Health Organization. Chronic obstructive pulmonary disease (COPD). Published 2023. Accessed July 31, 2025. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

World Health Organization. Asthma. Published 2023. Accessed July 31, 2025. https://www.who.int/news-room/fact-sheets/detail/asthma

Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930-938. Accessed July 31, 2025. https://doi.org/10.1016/j.rmed.2011.01.005 DOI: https://doi.org/10.1016/j.rmed.2011.01.005

Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest. 2005;127(1):335-371. Accessed July 31, 2025. https://doi.org/10.1378/chest.127.1.335 DOI: https://doi.org/10.1378/chest.127.1.335

Haughney J, Price D, Barnes N, Virchow J, Roche N, Chrystyn H. Choosing inhaler devices for people with asthma: current knowledge and outstanding research needs. Respir Med. 2010;104(9):1237-1245. Accessed July 31, 2025. https://www.resmedjournal.com/article/S0954-6111(10)00191-5/fulltext DOI: https://doi.org/10.1016/j.rmed.2010.04.012

Sestini P, Cappiello V, Aliani M, et al. Prescription bias and factors associated with improper use of inhalers. J Aerosol Med. 2006;19(2):127-136. Accessed July 31, 2025. https://doi.org/10.1089/jam.2006.19.127. DOI: https://doi.org/10.1089/jam.2006.19.127

Vitacca M, Paneroni M, Fracassi M, et al. Inhaler technique knowledge and skills before and after an educational program in obstructive respiratory disease patients: a real-life pilot study. Pulmonology. 2023;29(2):130-137. https://doi.org/10.1016/j.pulmoe.2020.04.010 DOI: https://doi.org/10.1016/j.pulmoe.2020.04.010

Kelling JS, Strohl KP, Smith RL, Altose MD. Physician knowledge in the use of canister nebulizers. Chest. 1983;83(4):612-614. Accessed July 31, 2025. https://doi.org/10.1378/chest.83.4.612 DOI: https://doi.org/10.1378/chest.83.4.612

Hanania NA, Wittman R, Kesten S, Chapman KR. 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. Accessed July 31, 2025. https://doi.org/10.1378/chest.105.1.111 DOI: https://doi.org/10.1378/chest.105.1.111

Plaza V, Sanchis J. Medical personnel and patient skill in the use of metered dose inhalers: a multicentric study. CESEA Group. Respiration. 1998;65(3):195-198. Accessed July 31, 2025. https://doi.org/10.1159/000029259 DOI: https://doi.org/10.1159/000029259

Barbon C, Anuran G, Angeles R, Tan M, Santiaguel J. Knowledge and skills of resident physicians in the Department of Internal Medicine and Department of Family and Community Medicine on inhaler technique patient education: a pre- and post-intervention study. [Unpublished manuscript]. Division of Pulmonary Medicine, Department of Medicine, Philippine General Hospital

Klijn SL, Hiligsmann M, Evers SMAA, Román-Rodríguez M, van der Molen T, van Boven JFM. Effectiveness and success factors of educational inhaler technique interventions in asthma and COPD patients: a systematic review. NPJ Prim Care Respir Med. 2017;27(1):24. Accessed July 31, 2025. https://doi.org/10.1038/s41533-017-0022-1 DOI: https://doi.org/10.1038/s41533-017-0022-1

Usmani OS, Lavorini F, Marshall J, et al. Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes. Respir Res. 2018;19(1):10. Accessed July 31, 2025. https://doi.org/10.1186/s12931-017-0710-y DOI: https://doi.org/10.1186/s12931-017-0710-y

Gregory KL, Elliott D, Dunne P. Guide to Aerosol Delivery Devices for Physicians, Nurses, Pharmacists and Other Health Care Professionals. 2nd ed. Irving, TX: American Association for Respiratory Care; 2013. Accessed July 31, 2025. https://www.aarc.org/wp-content/uploads/2014/08/aerosol_guide_pro.pdf

Iwanaga T, Tohda Y, Nakamura S, Suga Y. The Respimat® Soft Mist Inhaler: Implications of Drug Delivery Characteristics for Patients. Clin Drug Investig. 2019;39(11):1021-1030. Accessed July 31, 2025. https://doi.org/10.1007/s40261-019-00835-z DOI: https://doi.org/10.1007/s40261-019-00835-z

Inhaler Error Steering Committee, Price D, Bosnic-Anticevich S, et al. Inhaler competence in asthma: common errors, barriers to use and recommended solutions. Respir Med. 2013;107(1):37-46. Accessed July 31, 2025. https://doi.org/10.1016/j.rmed.2012.09.017 DOI: https://doi.org/10.1016/j.rmed.2012.09.017

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2023. Accessed July 31, 2025. https://goldcopd.org/2023-gold-report-2/

Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2023. Accessed July 31, 2025. https://ginasthma.org/2023-gina-main-report/

Williamson PA, McKinlay L, Ho B, Mohammed AY, Lipworth BJ. A cross-sectional survey of inhaler technique and training among Dundee medical students. J Allergy Clin Immunol. 2011;127(2):527-528.e1. Accessed July 31, 2025. https://www.jacionline.org/article/S0091-6749(10)02412-7/fulltext

Vesbianu C, Quaye E, Rodriguez K. Improving knowledge of inhaler technique among internal medicine residents. Chest. 2019;156(4)(Suppl):A849. Accessed July 31, 2025. https://journal.chestnet.org/article/S0012-3692(19)32306-2/fulltext DOI: https://doi.org/10.1016/j.chest.2019.08.808

Kellman DA, Iserson KV, Levy RD, McIntosh B, Maxwell Y. Brief education improves proper metered-dose inhaler use. Chest. 1990;97(3):583-586. Accessed Aeptember 1, 2025. https://doi.org/10.1016/j.jemermed.2020.02.011 DOI: https://doi.org/10.1016/j.jemermed.2020.02.011

Basheti IA, Qunaibi EA, Hamadi SA, Reddel HK. Inhaler technique training and health-care professionals: effective long-term solution for a current problem. Respir Care. 2014;59(11):1716-1725. Accessed July 31, 2025. https://doi.org/10.4187/respcare.02671 DOI: https://doi.org/10.4187/respcare.02671

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Published

04.01.2026

How to Cite

Lozada, M. C., Medina Jr, H., Villanueva, C. A., Sucaldito, M. S. F., Barbon, C. E., & Tan, M. K. K. (2026). Impact of a Structured Workshop on the Inhaler Technique Knowledge and Skills of Healthcare Workers in a Tertiary Government Hospital. Philippine Journal of Chest Diseases. https://doi.org/10.70172/pjcd.v23i2.11137

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