Internal Medicine Residents' Knowledge of Asthma Management, Respiratory Inhaler Technique, and Inhaler Policy Change

Background:

Hospitalization rates in Chicago are double the national average for asthma and triple that among African Americans compared with whites in Chicago. In 2009, to protect the ozone layer, the familiar easy‐to‐use metered dose inhalers (MDIs) that contain chlorofluorocarbons (CFCs) will be replaced by environmentally friendlier hydroflouroalkane (HFA) inhalers. This change may be particularly difficult for underserved minority patients with low health literacy because HFA inhalers are costlier and more difficult to use. As resident physicians care for a disproportionate share of minority asthma patients, it is imperative that they are able to help patients through this transition. The aim of this study was to assess internal medicine (IM) resident knowledge regarding inhaler technique, asthma self‐management, and the inhaler policy change.

Methods:

An anonymous 22‐item survey to assess resident knowledge and familiarity with asthma management, inhaler technique, and HFA policy changes was administered to a convenience sample of resident physicians attending the 2008 Illinois American College of Physicians meeting in October 2008. Those participating were entered into a raffle for an Apple iTouch. Participants were asked if they had ever prescribed an HFA or MDI‐CFC inhaler. Confidence with teaching inhaler technique and knowledge regarding the correct steps for inhaler use was also ascertained. Residents were asked if they were aware of differences between HFA and CFC inhalers and policy changes regarding inhalers.

Results:

Of the surveys distributed, 94% (134 of 143) were returned. Surveys from nonresidents (faculty and students) were excluded. Residents (n = 119) represented 15 Illinois internal medicine residency programs. Half (50%) were international medical graduates, 63% were male, and 61% intended to pursue a subspecialty fellowship. Roughly one third were interns, one third were PGY2s, and one third were PGY3s. Although 59% of residents felt confident in their ability to teach inhaler technique, only 49% could correctly identify the steps in using an inhaler. Correctly identifying the steps for inhaler use was not associated with confidence in (he ability to teach inhaler technique (49% confident vs. 49% not confident, P = 0.97). Residents were more likely to have ever prescribed an MDI‐CFC than an HFA inhaler (81% MDI‐CFC vs. 52% HFA, P < 0.001). Although 26% of residents stated they knew the difference between an HFA and an MDI‐CFC inhaler, only 5% were able to correctly describe the difference. Only 3% of residents were aware of the upcoming policy change to HFA inhalers.

Conclusions:

A significant fraction of internal medicine residents are not familiar with correct inhaler technique, and the overwhelming majority are not aware of the differences between MDI‐CFC and HFA inhalers or of the pending policy change. An educational intervention to improve resident ability to care for minority asthma patients in Chicago is currently underway.

Author Disclosure:

D. Baker, none; A. Pincavage, none; A. Pappalardo, none; F. Hoyte, none; W. Conwell, none; O. Estrada, none; V. Press, ACP foundation, research funding; V. Arora, ACP foundation, research funding; AHRQ, NIA, NIGMS, Hartford Foundation, research funding; J. Kleckzek, none.