Effect of reinforcement by pictograph versus audiovisual training on proper inhaler usage skills in asthma patients

Objectives: Asthma is a disease in which the mainstay of therapy is aerosol therapy, which requires certain steps to be followed according to the device used. Training and reinforcing the inhalational skills are of paramount importance for good disease control. Materials and Methods: The study was a prospective observational study conducted at the respiratory medicine department of a tertiary care centre, with inclusion criteria: recently diagnosed cases of asthma prescribed metered dose inhalers with valved spacer; ≥12 years and exclusion criteria: patients scoring full marks on National Institutes of Health (NIH) Expert panel 3 score after demonstration; already using inhaler; not using valved spacer. 100 patients were recruited and randomly divided into two groups with different reinforcement in the form of either a written leaflet or a video. Results: The mean age was 39.83 years, with no significant difference in baseline demographic characteristics. This study found that both methods were able to show significant score improvement on baseline score, evidenced by the pre- and post-intervention scores in both groups. The video group (NIH expert panel 3 score, pre: 3.88, post: 6.14) was superior in comparison to the written group (NIH expert panel 3 score, pre: 4.28, post: 5.26). Peak expiratory flow rate (PEFR) measurements of the two groups showed improvement between pre- and post-intervention values. PEFR, as well as the asthma control test score, was suggestive of better asthma control in the video group. Conclusion: Reinforcement is essential for better results of inhaler technique usage. Audiovisual is better than Pictograph as a tool for reinforcement. With the increasing affordability of smartphones in India and the world, the relevance of the study is increasing day by day. Also, playing videos in the outpatient department waiting hall could be a useful way for better inhaler compliance and asthma control.