Development of a novel measure of inhaler technique: The Portsmouth Inhaler Technique (PIT) Score (ID 591)
Portsmouth Hospitals NHS Trust
Abstract
Background
Despite decades of inhaler use, poor technique remains a major barrier to effective respiratory disease management, leading to poor clinical outcomes and significant global economic burden. While scoring systems are commonly used in healthcare, no validated tool exists in the UK to assess and quantify inhaler technique across device types.
Aim
To develop and validate a novel scoring system to evaluate and measure inhaler technique across device types in adults and children.
Methods
A systematic review of literature identified 418 published inhaler technique checklists for adults and children across device types, from which 72 items (44 plus 28 terminology variants) were extracted to generate the item pool. Inhaler experts (n=18) participated in a 3-round Delphi study, and the Content Validity Ratio (CVR) was applied to assess item essentiality, reducing the pool to 23 items. A second panel of 34 inhaler experts then evaluated item relevance, and the Content Validity Index (CVI) calculated, which quantified rater agreement on the given construct of inhaler technique assessment. Items achieving an I-CVI (item level CVI) of ≥0.78 and modified kappa (k*) of >0.74 were retained. Lastly, 62 panellists which included inhaler users, assessed item clarity, resulting in an excellent scale-level average CVI (S-CVI-Ave) of 0.8, indicating high overall agreement.
Results
The final PIT Score consists of 10 items scored dichotomously and summatively across three dimensions of inhaler preparation, body and head positioning, and medication delivery. This structured approach provides a standardised and content-valid method to assess inhaler technique.
Conclusion
The PIT Score is the first validated tool in the UK to quantitatively measure inhaler technique across device types and age groups. Developed through a collaborative, iterative and expert-led process involving key respiratory stakeholders, core competencies and critical skills essential for effective inhaler use were established. The PIT Score enables healthcare professionals to identify errors and optimise inhaler use, addressing a critical gap in respiratory care.
Funding: A Health Professionals PhD Bursary was awarded from Asthma and Lung UK to support the final year of this project
Conflicts of interest: None
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