Running head: RECOMMENDATIONS FOR PRACTICE IN ASTHMA PATIENTS 1

Recommendations for Practice in Asthma Patients

Jency N. Godoy

Florida Atlantic University

RECOMMENDATIONS FOR PRACTICE IN ASTHMA PATIENTS 2

Recommendations for Practice in Asthma Patients

Introduction

The purpose of this paper is to make evidenced-based recommendations for changes in

practice in regards to asthma patients that use inhalers. The suggestions are based on the

following PICOT question: In asthma patients, how does repetitive review of inhaler technique

compare to those without, affect correct use and asthma management within a month? The intent

of the research articles reviewed was to observe if inhaler use improved and to determine if

patients experienced better control of asthma symptoms following repetitive education. This is

of particular importance because asthma has statistically shown to be poorly managed in many

countries and healthcare providers underestimate or fail to monitor patients technique among the

variety of inhalers (Yildiz, 2014). Although there is no cure for asthma, it can be managed with

proper treatment (Asthma and Allergy Foundation of America [AAFA], 2015).

Summary of Evidence

The systematic review conducted by (Gillette, Rockich-Winston, Kuhn, Flesher, &

Shepherd, 2016), assessed the technique of inhaler use among children, the effects of educational

interventions on improvement of technique, and how that related to improvement of asthma

symptoms. The experimental versus observational design included twenty-eight studies. There

were no statistical data provided, however, recommendations were established based on

descriptive evaluations (Melnyk & Fineout-Overholt, 2015, pg.128). The Downs and Black

checklist is a type of data analysis tool designed to determine the quality of randomized and

non-randomized studies of health care interventions (National Collaborating Centre for

Methods and Tools [NCCMT], 2016). The Downs and Black checklist was utilized two

independent investigators to assess the quality of the data (Gillette et al., 2016, p. 606). This tool
RECOMMENDATIONS FOR PRACTICE IN ASTHMA PATIENTS 3

assesses for study quality, external validity, study biases, confounding and selection bias, and

power of the study (NCCMT, 2016). Based on the objectives of this article and the data analysis

tool applied, the results provided clinically significant evidence. In addition, systematic reviews

combine the results of several studies, produce larger sample sizes and thus greater power to

accurately determine the magnitude of the effects, making this type of evidence a hallmark of

EBP (Melnyk & Fineout-Overholt, 2015, p. 129). It highlighted a clear correlation between

providing inhaler education with the improvement of inhaler technique and improved asthma

outcomes (Gillette et al., 2016).

In a randomized control trial (RCT) conducted by Rhamati et al., used a block

randomization, grouping the 90 into two intervention groups and a control group (Rahmati,

Ansarfard, Ghodsbin, Ghayumi, & Sayadi, 2014, p. 213). The objectives were to determine the

effects of training about meter dose inhaler (MDI) usage with and without spacer on Peak Flow

Expiratory Rate (PFER) and inhaler usage skills (Rahmati et al., 2014, p. 212). It was not a

blind study, which can increase the risk of biased results (Melnyk & Fineout-Overholt, 2015, p.

120). The validity of the MDI checklist was backed by literature, references, reviewed and

corrected by 4 professors, and checked by two researchers and yielded a correlation of P=0.63.

The reliability and variability of the collected data was interpreted utilizing SPSS statistical

software and analyzed using independent T-test, chi-square, Fischer exact test, and ANOVA

and showed no significant differences among the study participants (Rahmati, 2014). These

research instruments and data analysis tools decrease the likelihood of confounding or

extraneous variables (Melnyk & Fineout-Overholt, 2015). The study revealed a significant

difference and improvement (P=0.000) in both intervention groups compared to the control

group (Rahmati et al., 2014, p. 215). The trial noted improved MDI usage skills directly related
RECOMMENDATIONS FOR PRACTICE IN ASTHMA PATIENTS 4

to education interventions, as well as improved PEFR (p.217). According to this study, patients

benefitted from an assessment of their Peak Flow levels and their MDI use techniques to provide

remediation as needed (217-218). RCTs are ideal for emphasizing intervention causality and

increased confidence in the outcomes measured (Melnyk & Fineout-Overholt, 2015).

Recommendations for Practice

Based on the evidence reviewed, a recommendation for practice would be to assess and

provided on-going reassessment and remediation to patients that are taking medications

delivered by inhalers. Patients should be reminded to take their inhaler medications to follow up

appointments for ongoing education. Evidence has proven that asthma patients, adult and

children alike, have improved asthma outcomes from their inhaler medications when performing

proper technique.

Conclusion

In order for asthma patients to reap the benefits of their inhaler medications, it is

imperative to determine a patients ability to use the inhaler correctly. Baseline, on-going

reassessment, and continued educational interventions are proven to enhance the patients inhaler

technique. Ultimately, patients benefit from correctly administering their inhaler medications by

obtaining their optimal effects and achieving better control of their asthma symptoms.
RECOMMENDATIONS FOR PRACTICE IN ASTHMA PATIENTS 5

References

Asthma and Allergy Foundation of America. (2015). Asthma Facts and Figures. Retrieved June

10th, 2017, from http://www.aafa.org/page/asthma-facts.aspx

Gillette, C., Rockich-Winston, N., Kuhn, J. A., Flesher, S., & Shepherd, M. (2016). Inhaler

technique in children with asthma: A systemic review. Academic of Pediatrics, 16(7),

605-615. http://dx.doi.org/10.1016/j.acap.2016.04.006

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & heathcare:

A guide to best practice (3 ed.). Philadelphia: Wolters Kluwer Health.

National Collaborating Centre for Methods and Tools. (2016). Quality checklist for health care

intervention studies: A summary of. Retrieved from

http://www.nccmt.ca/resources/search/9

Rahmati, H., Ansarfard, F., Ghodsbin, F., Ghayumi, M. A., & Sayadi, M. (2014, August 10th).

The effect of training Inhalation Technique with or without spacer on maximum

expiratory flow rate and inhaller usage skills in asthmatic patients: Arandomized

controlled trial. International Journal of Community Based Nursing & Midwifery, 2(4),

211-219. Retrieved from

http://web.a.ebscohost.com.ezproxy.fau.edu/ehost/pdfviewer/pdfviewer?sid=208a3826-

50af-4759-8c31-8aee9c6eba38%40sessionmgr4007&vid=4&hid=4114