Online inhaler technique resources often overlook critical steps
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Key takeaways:
- Online resources tended to feature more steps on inhalation technique rather than preparation/first use and post-usage/device care.
- Website quality was moderate based on two metrics and low based on one metric.
Websites focused on inhaler technique frequently overlook important preparation steps and device care/maintenance, according to results published in Respiratory Medicine.
These findings emphasize the importance of supplementing online resources with comprehensive education from health care professionals, according to researchers.
“Although online resources can be a helpful tool to supplement inhaler technique, these resources may miss important information,” Brandon Luu, MD, resident physician in internal medicine at the University of Toronto, told Healio. “Physicians and patients should be aware of this, as online resources should not replace in-person education.”
In this study, Luu, along with Dmitry Rozenberg, MD, PhD, FRCPC, respirologist at the University Health Network and assistant professor in the department of medicine at the University of Toronto, and colleagues evaluated the top five Google search results for 12 common inhaler devices in April 2023.
They analyzed website quality using several metrics such as the Global Quality Scale, DISCERN and JAMA Benchmark scores.
Additionally, they compared website content against product monographs for preparation to gauge the comprehensiveness of the information provided.
Most websites were from foundation/advocacy organizations (55%) or were classified as a scientific resource (38%) rather than an industry/for-profit resource (7%).
The geographic origins of the websites included North America (78%), Australia (15%) and Europe (7%).
Website content, quality
Using a predefined score from product monographs, in which a higher score signals more steps addressed, researchers observed a median content total score of 62%.
The 60 websites tended to feature more steps on inhalation technique (median score, 78%) rather than preparation/first use (median score, 58%) or post-usage/device care (median score, 50%).
According to Luu, there was less focus on how to prepare, maintain and store inhalers.
“We were surprised to find that information on many websites was not in line with many product monographs with several important instructions not discussed,” Luu told Healio. “This could have implications for respiratory disease control for people relying on this information.”
Based on website category type, industry resources had higher total content scores, inhalation technique scores and preparation/first use scores than foundation/advocacy organization websites and scientific resources (P < .05).
In terms of quality, researchers reported moderate website quality based on the Global Quality Scale and modified DISCERN scores (median score, 3) and low quality based on the JAMA Benchmark score (median score, 1).
Few websites had authorship (20%) or attribution (30%), which led to the low JAMA Benchmark score, the researchers wrote.
Inclusion of clinically relevant factors
In addition to content and quality, researchers looked for mentions of 10 clinically relevant factors on the 60 websites and found a median score of two factors per website.
Only 38% of websites directed patients on when they should go to their provider for urgent medical attention or highlighted frequent errors for a particular inhaler type.
Luu told Healio that a small percentage of websites featured information on side effects (25%), contraindications (10%) and the importance of inhaler technique supervision by a health care professional (28%).
Additionally, none of the included websites mentioned smoking cessation, environmental considerations or risk factors for poor technique, according to researchers.
Of the three website categories, the greatest median score for clinically relevant factors was found on industry resources (6.5), followed by scientific resources (2) and foundation/advocacy organization websites (1).
“We want to emphasize that the internet can be a helpful way to remind patients about inhaler technique, but if patients have any concerns/questions, they should connect with a health care professional and have their inhaler technique routinely supervised,” Luu said.
In terms of future research, the research team has plans to conduct a survey study to explore how patients and health care providers utilize and perceive online inhaler resources.
“We are excited to have characterized the current state of online inhaler resources; however, what remains unknown is how health care providers and patients currently use and perceive these online resources,” Luu said. “As such, we have received funding for a survey study from the Physicians' Services Incorporated Foundation to explore the use and perceptions of online inhaler resources by patients and health care providers.”
Perspective
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The findings from this study are significant and shed light on significant gaps and opportunities for improvement regarding online resources demonstrating proper inhaler technique. The study’s findings underscore a concerning trend: while the internet serves as a primary source of health information for many individuals, the quality and comprehensiveness of online resources regarding inhaler techniques are often inadequate. Notably, websites frequently omit critical steps crucial for proper inhaler use, particularly in preparation/first use and post-usage/device care. Ultimately, this knowledge gap could contribute to poor disease management and potentially exacerbate health outcomes for people with asthma and COPD.
I aided in creating a demo video of proper inhaler technique that was posted on the Allergy & Asthma Network TikTok account. It has earned over 33,000 views. We believe this is a strong effort to provide quality inhaler technique education. (We recognize the person exhales through the spacer, and this ideally should not occur.) It further demonstrates that there is a need for medically accurate inhaler technique education online and that people are searching for and watching these types of videos.
In my own experience of researching proper inhaler techniques for patients, I have noticed a scarcity of information addressing clinically relevant factors beyond basic inhaler technique, which is also found true in this study. Factors such as smoking cessation, environmental considerations and risk factors for poor technique are notably absent from most online resources. These factors have a significant impact on under-resourced groups of people and ongoing asthma and COPD disparities. They can lead to missed opportunities for comprehensive patient education. The study also points out the opportunity to develop patient education resources that are inclusive to all. For example, inhaler technique education should be made available in multiple languages.
Another noteworthy aspect of this study is that industry-based websites emerged as comparatively better performers of content and quality scores, suggesting potential areas of collaboration with nonprofit and patient advocacy organizations to expand reach and increase accurate content. Incorporating a combination of video and text-based materials, as observed in higher-performing websites, could enhance accessibility and comprehension, particularly for individuals with varying health literacy levels.
Researchers and organizations should take the next step and prioritize the development of high-quality, comprehensive online resources that address not only inhaler technique but also broader factors influencing disease management. Collaboration between patient organizations, health care professionals, industry stakeholders and health communication experts is essential to bridge existing gaps and ensure that individuals have access to accurate, reliable and actionable health information.
Allergy & Asthma Network has recognized that there is a gap in knowledge related to proper inhaler technique, particularly in inhaler demonstration videos found online. We are working with trusted messengers from various communities to create bilingual inhaler demonstration videos. We anticipate making those videos available online and across social media soon. By leveraging the insights provided by studies like this, we can expand the reach of medically accurate online health resources — and ultimately empower people to better manage their respiratory health and improve clinical outcomes.
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