YouTube™ as an Instructional Source for Appropriate Metered Dose Inhaler Use

A metered-dose inhaler (MDI) is commonly used for treatment and management of asthma, chronic obstructive pulmonary disease, and other respiratory diseases.  When used appropriately, an MDI is highly efficacious in aiding patients with respiratory disease. To date, the content, comprehensiveness, and accuracy of YouTube™ videos covering a wide variety of topics have been mixed.  The purpose of this study was to evaluate English language MDI instructional videos available on YouTube™.  The YouTube™ platform was searched using the following terms to identify English-language videos, including: (1) asthma inhaler use, (2) asthma inhaler, (3) metered dose inhaler how to use, and (4) metered dose inhaler technique.  A total of 58 unique videos composed the final sample and were evaluated independently by both the first and second authors using standardized evaluation sheets. Overall video quality and audio quality were assessed.  Using established MDI instruction criteria, each video was evaluated for inclusion of each demonstrated step: (1) remove cap and shake inhaler, (2) exhale slowly and fully, (3) place mouthpiece between lips, (4) actuate MDI at onset of inhalation, (5) inhale at less than maximal rate, (6) hold breath for at least 5 second, and (7) recap mouthpiece. The visual and audio quality data of the videos indicates that the majority of videos that were rated should not impair the viewer from seeing and hearing how to use an MDI. 72.4% of the videos were rated as “good” visual quality and 74.1% of the videos were rated as “good” audio quality. Additionally, the majority of the videos include steps (1), (2), (3), (4), and (6), which is a good indication that YouTube is a reliable source of patient information regarding how to use an MDI. The frequencies for MDI5 and MDI7 are much lower than the rest of the MDI protocol, especially for MDI7. Most videos recognize the other steps of the protocol without much disparity, but the lower inclusion rates of step (5), inhaling at a less than maximal rate, and step (7), recapping the mouthpiece, could hinder a viewer’s understanding of how to correctly use an MDI.  However, most of the videos still teach viewers how to use an MDI with a satisfactory degree of accuracy.  Most clinicians in the United States could confidently refer asthma patients to YouTube to find instructions on how to correctly use a metered-dose inhaler (MDI).  For example, physicians could provide patients with links to accurate and high-quality videos.  This gives patients an opportunity to learn how to use their inhaler in the comfort of their own home rather than in the clinician’s office. This prevents patients from feeling rushed and it gives them the ability to replay the video as many times as needed.  This study is specifically limited to MDIs, but could be used as a foundation for future studies on whether YouTube and other social media sites can be considered reliable sources of patient information on various topics.