Inhaler technique in Turkish people with poor English: a case of ...

Pharm World Sci (2006) 28:107–114 111
Approximately, a quarter of both language
groups said they had not received initial instruction
from a health professional on how to use
their inhalers. There was no difference in use of
spacing devices: approximately a third of both
groups used these for at least some of their doses.
The EP group were significantly less likely to report
seeing the practice nurse about their asthma
than the FE group. Nearly half (45%) the EP
group said they never saw the nurse, compared
with 25% of the English-speaking group. (Chi
square = 6.8, df 1, P < 0.01).
Tables 4 and 5 compare inhaler technique.
Turkish-speakers performed better than Englishspeakers
in terms of shaking the inhaler and were
more likely to check the mouthpiece. However,
there was a marked difference in global scores for
inhaler technique, in co-ordination, and in breathholding,
all of which were significantly worse in
the group with poor English.
Impact of interventions in group with poor
English
Thirty-four Turkish patients with EP were
randomised to the MTS group and thirty-five to
the PIL/verbal group. Groups were well matched
for age, gender and baseline (before information)
inhaler technique ratings. Only 4 of the 35 people
in the MTS group had used a computer. Despite
this, they needed little instruction on use of the
system.
Changes in inhaler technique after information
are presented in Tables 6–8. Half the MTS group
were rated as improved compared to 28% of
those given a translated leaflet. A further six
people (17%) improved after subsequent verbal
advice in their own language.
Table 4 Global technique assessments in fluent Englishspeakers
and Turkish-speakers with poor English
Global technique rating
Poor Adequate Good Total
Fluent English 36 48 11 95
(37.9%) (50.5%) (11.6%)
Poor English 57 12 0 69
(83%) (17%) –
Chi-square = 30.36 df 2 P < 0.0001
Many subjects had shallow breathing which
made accurate assessment difficult. In some cases,
they failed to take any perceptible inhalation and
five failed to release a dose. Own-language verbal
instruction after reading the PIL produced small
but statistically significant improvement in
breath-holding.
Inhaler-shaking and mouthpiece-checking
improved significantly in both groups after information.
The proportion of patients with correct
co-ordination also increased in both groups but
numbers were small and changes did not reach
statistical significance.
Multiple quick actuation of the inhaler was
observed in 21% MTS and 20% PIL/verbal
before instruction. This problem was resolved in
most subjects by all modes of instruction.
Discussion
The inhaler users with FE and EP in this study
came from three London boroughs with diverse
mix of ethnic backgrounds and languages.
Approximately, a third of the local population in
each borough had been born outside the UK. All
participants were volunteers who were interested
in having an ‘‘inhaler technique check’’. The FE
group could all read English; most of the EP
group could not.
The FE and EP groups were recruited by different
methods, and assessed in different settings.
We did not take an education history, but the
broad occupational profile of the two groups was
clearly different, with more retired people in the
English group and more women looking after the
home in the Turkish group.
Inhaler technique in the FE group was in line
with previous reports, [5–9] with around a third
graded as poor and two-thirds having some
co-ordination deficiencies. Global technique in
the EP group was almost universally rated as
poor, with some extreme co-ordination problems
observed. It was not possible to compare asthma
severity in the two groups, as the researchers only
had access to GP records for patients recruited
through surgeries. However, the reported prescribing
of large volume spacer devices (roughly a
third of both groups said they used a spacer)
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