This preprint is under consideration at BMC Pulmonary Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Investigating the validity and reliability of the traditional checklist for assessment of specific inhalation techniques with pressurized metered-dose inhalers using the Aerosol Inhalation Monitor
Tun-Liang Chen
Department of Pharmacy, Linko Chang Chung Memorial Hospital, Taiwan
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Correct inhalation techniques are essential for optimum delivery of drugs to the airways for patients with asthma and chronic obstructive pulmonary disorder. Checklists often are used to assess the techniques, but the validity of checklists is unknown and few studies have been conducted to date. We investigated the validity and reliability of checklists.
Methods: A prospective, observational study was conducted at a tertiary care teaching hospital in Taiwan using an objective tool, the aerosol inhalation monitor (AIM). Inhalation techniques using pressurized metered-dose inhalers (pMDIs) were assessed by checklist and AIM. The κ coefficient and prevalence and bias-adjusted κ (PABAK) were calculated to determine the consistency between the checklist and AIM in four specific techniques, including actuation, inspiratory flow, inhalation time, and breath hold time. Sensitivity and specificity were used to evaluate the validity of the checklist using these techniques.
Results: The κ and PABAK values were −0.023 and −0.176 for actuation, 0.43 and 0.529 for inspiratory flow, −0.046 and −0.412 for inhalation time, and 0.12 and 0.686 for breath hold time, respectively. Sensitivity and specificity for the four individual steps were 0.706 versus 0.265, 0.833 versus 0.600, 1 versus 0.1, and 0.955 versus 0.143, respectively.
Conclusion: Our results invalidate use of the checklist alone as a reliable tool to assess inhalation techniques. The low specificity indicates that the checklist tends to overestimate the accuracy of inhalation techniques. AIM can be added as an objective tool to assess and quantify specific steps for MDIs.
Keywords
metered-dose inhaler (MDI), inhalation technique, Vitalograph AIM, checklist, Agreement, accurate assessment
Figure 1
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 21 Dec, 2020
No community comments so far
Review #6 received
Received 19 Jan, 2021
Review #9 received
Received 19 Jan, 2021
Review #8 received
Received 19 Jan, 2021
Review #1 received
Received 19 Jan, 2021
Reviewer #8 agreed
On 04 Jan, 2021
Reviewer #11 agreed
On 04 Jan, 2021
Reviewer #10 agreed
On 04 Jan, 2021
Reviewer #2 agreed
On 04 Jan, 2021
Reviewer #1 agreed
On 04 Jan, 2021
Reviewer #3 agreed
On 04 Jan, 2021
Reviewers invited
Invitations sent on 24 Dec, 2020
Editor assigned
On 24 Dec, 2020
Editor invited
On 20 Dec, 2020
Submission checks complete
On 19 Dec, 2020
First submitted
On 25 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pulmonology
Learn more about our company.
This preprint is under consideration at BMC Pulmonary Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Investigating the validity and reliability of the traditional checklist for assessment of specific inhalation techniques with pressurized metered-dose inhalers using the Aerosol Inhalation Monitor
Tun-Liang Chen
Department of Pharmacy, Linko Chang Chung Memorial Hospital, Taiwan
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 21 Dec, 2020
No community comments so far
Review #6 received
Received 19 Jan, 2021
Review #9 received
Received 19 Jan, 2021
Review #8 received
Received 19 Jan, 2021
Review #1 received
Received 19 Jan, 2021
Reviewer #8 agreed
On 04 Jan, 2021
Reviewer #11 agreed
On 04 Jan, 2021
Reviewer #10 agreed
On 04 Jan, 2021
Reviewer #2 agreed
On 04 Jan, 2021
Reviewer #1 agreed
On 04 Jan, 2021
Reviewer #3 agreed
On 04 Jan, 2021
Reviewers invited
Invitations sent on 24 Dec, 2020
Editor assigned
On 24 Dec, 2020
Editor invited
On 20 Dec, 2020
Submission checks complete
On 19 Dec, 2020
First submitted
On 25 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pulmonology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Correct inhalation techniques are essential for optimum delivery of drugs to the airways for patients with asthma and chronic obstructive pulmonary disorder. Checklists often are used to assess the techniques, but the validity of checklists is unknown and few studies have been conducted to date. We investigated the validity and reliability of checklists.
Methods: A prospective, observational study was conducted at a tertiary care teaching hospital in Taiwan using an objective tool, the aerosol inhalation monitor (AIM). Inhalation techniques using pressurized metered-dose inhalers (pMDIs) were assessed by checklist and AIM. The κ coefficient and prevalence and bias-adjusted κ (PABAK) were calculated to determine the consistency between the checklist and AIM in four specific techniques, including actuation, inspiratory flow, inhalation time, and breath hold time. Sensitivity and specificity were used to evaluate the validity of the checklist using these techniques.
Results: The κ and PABAK values were −0.023 and −0.176 for actuation, 0.43 and 0.529 for inspiratory flow, −0.046 and −0.412 for inhalation time, and 0.12 and 0.686 for breath hold time, respectively. Sensitivity and specificity for the four individual steps were 0.706 versus 0.265, 0.833 versus 0.600, 1 versus 0.1, and 0.955 versus 0.143, respectively.
Conclusion: Our results invalidate use of the checklist alone as a reliable tool to assess inhalation techniques. The low specificity indicates that the checklist tends to overestimate the accuracy of inhalation techniques. AIM can be added as an objective tool to assess and quantify specific steps for MDIs.
Figure 1