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. 2022 Feb 23;19(5):2591.
doi: 10.3390/ijerph19052591.

The Inhaler Technique Questionnaire (InTeQ): Development and Validation of a Brief Patient-Reported Measure

Catalina Lizano-Barrantes  1   2   3 , Olatz Garin  1   2   4 , Alexandra L Dima  5   6 , Eric van Ganse  6   7   8 , Marijn de Bruin  9 , Manon Belhassen  8 , Karina Mayoral  1   4   10 , Àngels Pont  1   4 , Montse Ferrer  1   2   4
Affiliations

The Inhaler Technique Questionnaire (InTeQ): Development and Validation of a Brief Patient-Reported Measure

Catalina Lizano-Barrantes et al. Int J Environ Res Public Health. .

Abstract

There is a need for instruments designed for patients with asthma to self-report their performance of inhaling steps. We aimed to develop an accessible and easy-to-use patient-reported tool for inhaler technique assessment, which could also serve as a training and monitoring resource for any type of inhaler device, and to evaluate its feasibility, validity, and reliability in adults with asthma. The development was based on literature review and pilot testing with clinicians and patients. The Inhaler Technique Questionnaire (InTeQ) asks about the frequency of performing five steps when using inhalers (on a five-point Likert scale). We analyzed data from adults with persistent asthma (n = 361). We examined the measurement model using Mokken scaling analysis, construct validity by assessing hypotheses on expected discrimination among known groups, and reliability based on internal consistency and reproducibility. Means of the InTeQ items were in the range of 0.23-1.61, and coefficients of homogeneity were above the cutoff point, demonstrating the unidimensionality of the scale. Known groups' global score differences were statistically significant between patients reporting having "Discussed in detail" or having "Not discussed/Only in general" the inhaler technique with their healthcare providers (p = 0.023). The Cronbach's alpha coefficient was 0.716, and the intraclass correlation coefficient was 0.775. The InTeQ is a feasible, valid, and reliable instrument for self-reporting inhaler technique on any type of device.

Keywords: asthma; inhalation technique; measurement instruments; patient-reported outcomes.

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Conflict of interest statement

E.V.G. and M.B. reports personal fees from PELyon, outside the submitted work. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Distribution of InTeQ items (frequency of performing step during the last 4 months). FRTU: frequent reliever treatment use; non-FRTU: non-frequent reliever treatment use.
Figure 2
Figure 2
Comparison of inhalation technique between French and British participants. *: significant at p < 0.05 (0.008 and 0.001, respectively).
Figure 3
Figure 3
Comparison of inhalation technique between inhaler device types. DPI: dry powder inhaler; MDI: metered-dose inhaler; BA-MDI: breath-actuated metered-dose inhaler; DPI + MDI: more than one type of device.
Figure 4
Figure 4
Alluvial plot showing the prevalence of correct inhaler technique. White vertical bars correspond to each InTeQ item; “A” indicates patients responding “Always”; “O” indicates patients responding other options (“Often–Sometime–Rarely–Never”). Gray bars on the right correspond to the number of items to which patients responded “Always”: the lowest horizontal band is patients that did not respond “Always” to any item, while the top, dark-blue band is patients who responded “Always” to every item. Width of the horizontal bands is proportional to the flow of patients’ responses.
See this image and copyright information in PMC

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