An aerosol inhalation monitor would improve the accuracy of checklist assessment in drug inhalation techniques

Tzu Yu Lin, Dah Chin Yan, Yi Jung Wang, Yu Ting Liang, Tun Liang Chen*, Gwo Hwa Wan*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review


Background: Checklists are usually employed to assess the inhalation techniques in patients, but partial techniques are difficult to evaluate visually. This study aimed to assess the checklist validity and an agreement between checklists and an aerosol inhalation monitor (AIM) assessments. Methods: This study used a checklist and an AIM to evaluate the participants’ inhalation techniques with a pressurized metered-dose inhaler (MDI) and two dry powder inhalers (DPIs). The kappa (κ) coefficient, prevalence-adjusted and bias-adjusted κ (PABAK), sensitivity, specificity, positive predictive value, and negative predictive value were all calculated to determine the agreement between the checklist and AIM in an MDI and DPIs with different inhalation technique steps. Results: The checklist and AIM exhibited poor agreement in the MDI for actuation and inhalation time, and a moderate agreement for inspiratory flow. The fair agreement was observed in DPIs for inspiratory flow between the checklist and AIM. The steps of holding breath in MDI and DPIs were highly correlated between both assessments. The lowest accuracy evaluated with an AIM was found in the step of actuation and inhalation time in the MDI and in the inspiratory flow step in DPIs. Conclusion: The checklist tended to overestimate the accuracy of critical techniques including the actuation and inhalation time in MDIs and the inspiratory flow in DPIs. Thus, the AIM device can be used as an objective auxiliary tool to assess and quantify the specific steps of inhalation technique for the users with MDI and DPIs.

Original languageEnglish
Article number107068
Pages (from-to)107068
JournalRespiratory Medicine
StatePublished - 01 2023

Bibliographical note

Copyright © 2022 Elsevier Ltd. All rights reserved.


  • Aerosol inhalation monitor
  • Agreement
  • Checklist
  • Dry powder inhaler
  • Inhalation
  • Metered-dose inhaler
  • Dry Powder Inhalers
  • Humans
  • Metered Dose Inhalers
  • Administration, Inhalation
  • Aerosols
  • Nebulizers and Vaporizers


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