만성폐쇄성폐질환자의 흡입기 사용 평가 체크리스트 개발

Development of Inhaler Technique Evaluation Checklist for Patients with Chronic Obstructive Pulmonary Disease

Purpose: This study aimed to develop and validate a standardized, practical checklist for evaluating inhaler techniques in patients with chronic obstructive pulmonary disease (COPD) across three major inhaler types: pressurized metered-dose inhalers (pMDI), dry powder inhalers (DPI), and soft mist inhalers (SMI). Methods: A preliminary checklist was developed for each inhaler type based on the literature review, with 14 items for the pMDI, 15 for the DPI, and 13 for the SMI, each scored binarily. Content validity index (CVI) was assessed by ten experts using an item-CVI threshold of 0.8. Inter-rater reliability was evaluated via direct and video-based assessments of 40 outpatients with COPD using placebo inhalers. The internal consistency was measured using Kuder-Richardson Formula 20 (KR-20) . Stepwise performance rates were used to identify the device-specific errors. Results: The final checklist maintained the same number of items as the preliminary version. Basedonexpertfeedbackforbetterfeasibility, the 5-second criterion in the “Inhale deeply” step was excluded. The CVI was .90, with 93% of items scoring ≥.80. Inter-rater agree- ment was high (r=.83), and overall internal consistency was acceptable (KR-20=.64), with the highest for the pMDI (KR-20=.76). Performance analysis revealed low exhalation and breath-holding scores despite good preparation adherence. Conclusion: The checklist demonstrated good validity and reliability, with practical applicability across different inhaler types. It not only facilitates accurate and efficient identification of inhaler technique errors but also serves as a foundation for individualized education, ultimately enhancing self-management and overall quality of care in COPD management. Further research is needed to evaluate the impact of checklist use on the clinical outcomes of patients with COPD.