Abstract
[Author declined to make full text available]Background
Despite decades of inhaler use in respiratory disease management, poor technique remains prevalent, leading to poor clinical outcomes and a significant global economic burden. Whilst scoring systems are commonly used in healthcare to evaluate outcomes and inform clinical decisions, the UK lacks a validated score to measure inhaler technique.
Aim
To develop a novel scoring system to evaluate and measure inhaler technique across device types in adults and children.
Methods
Published inhaler technique checklists for adults and children were systematically reviewed and mutual steps across device types extracted, forming an item pool. Key respiratory stakeholders participated in a Delphi study to evaluate item essentiality using the content validity ratio (CVR), with sub-threshold items eliminated or refined. The remaining items underwent further evaluation through surveys assessing relevance and clarity, quantified with the content validity index (CVI) to determine rater agreement.
Results
From 418 published inhaler technique checklists, a pool of 72 items (44 plus 28 terminology variants) were extracted. With a CVR threshold set at ≥0.444, a three-round Delphi study comprising 18 inhaler experts reduced the item pool to 23 items. A further panel of 34 inhaler experts then assessed each item for relevancy with all items reaching the I-CVI threshold of
≥0.78, and modified kappa value (k*) of >0.74. Lastly, 62 panellists assessed item clarity, with the remaining items achieving an excellent scale-level CVI average of 0.8, indicating high overall agreement.
The resulting assessment score consists of 10 content-validated items scored dichotomously and summatively within the dimensions of ‘inhaler preparation’, ‘body and head positioning’ and ‘medication delivery’.
Conclusion
The collaborative and iterative processes involved in the development of this score, has identified core competencies and critical skills essential for effective inhaler use, and established its content validity. The Portsmouth Inhaler Technique (PIT) Score provides healthcare professionals with a standardised and validated method for assessing inhaler technique in both adults and children across device types, addressing a desperate need in clinical practice.
| Date of Award | 28 Jun 2025 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | Mitch Lomax (Supervisor), Anoop Chauhan (Supervisor) & Heather MacKenzie (Supervisor) |