Only 15% of YouTube videos for asthma education discussed all steps of correct inhaler use

How to Use a Metered Dose Inhaler (MDI) (albuterol, Xopenex, Flovent, Symbicort, Dulera, Alvesco, Qvar) - CDC video:

Only 15% of YouTube videos for asthma education discussed all steps of correct inhaler use - Our #WISC14 abstract. Are you going to the WAO International Scientific Conference 2014 (WISC) 2014? Share your abstract below in the comments section.

The full WISC program is available online. It would be great to see you during any of the sessions I will participate in - see the list here:

Also, I will be filming the next edition of the WAO TV videos.

The full text of the abstract is below. Dr Joshi from Cornell did a great job:

Quality of YouTube videos for patient education on how to use asthma inhalers

Sunday, 7 December 2014: 17:50 - 18:10
Exhibition Hall-Poster Area (Sul America). Smita Joshi, MD , Department of Medicine, Weill Cornell Medical College, New York, NY; Ves Dimov, MD , University of Chicago, IL

Background: Inhalers are crucial to the delivery of asthma medications, however their effectiveness is dependent on proper inhaler technique. This study evaluates YouTube videos on their content and ability to inform viewers on how to effectively use an asthma inhaler.

Methods: The website was queried for the search phrase “how to use asthma inhaler”. The resulting videos were assessed for duration, number of views, number of likes and dislikes, source of video, and content. Content was analyzed for proper inhaler usage. Specifically, videos were assessed whether they discussed the following 9 important steps of inhaler use: removing the cap, priming the inhaler, shaking the inhaler, breathing out before inhaler use, dispensing the medication, taking a deep/slow breath (or several breaths in the pediatric patient using a spacer), holding one’s breath (unless patient took several breaths with a spacer), waiting before taking a repeat dose, and rinsing the mouth after inhaler use.

Results: The search phrase returned 12,400 videos that were sorted by the default filter of “relevance”. The 20 videos on the first page of the results were analyzed since these are the videos patients are most likely to view by visitor statistics. On average, the videos were 2 minutes and 33 seconds long, with 31,589 views, 47 likes and 5 dislikes. Eight videos were from health care organizations, 5 from a professional society, 2 from health care professionals, and 5 from nonprofessional educational groups. Only 15% of YouTube videos (3 videos) discussed all 9 steps of correct asthma inhaler use. The 3 videos were from health care organizations. The most steps were discussed by videos from health care organizations (average 7.25 steps) and professional societies (average 7 steps). Videos from nonprofessional educational groups (average 4.6 steps) and health care professionals (average 4.5 steps) discussed the least number of steps. Only 50% of videos (10 videos) discussed the use of a spacer.

Conclusions: The quality of YouTube videos on asthma inhaler use varies considerably. In our analysis, only 15% of videos discussed all steps of correct asthma inhaler use. Videos from health care organizations and medical societies were more comprehensive than those from nonprofessional educational groups and health care professionals not posting on behalf of a medical organization. There is a need for more reliable and accurate patient education videos on YouTube.

Should all patients with asthma get the pneumococcal vaccine?

Should all patients with asthma get the pneumococcal vaccine?

The simple answer is yes, unless there are contraindications. The explanation is below.

The CDC considers asthmatics at increased risk of pneumococcal disease and therefore have suggested that all asthmatics ages 19 to 64 receive pneumococcal vaccine (Pneumovax 23). The Pneumovax 23 package insert states that anyone who is at “increased risk” receive the vaccine. CDC recommendation is based upon a study that showed that asthmatics are at increased risk. CDC website states that asthmatics ages 19 to 64 receive the vaccine.

What is the recommended age range for patients with asthma get the pneumococcal vaccine?

Ages 19-64.

Which pneumococcal vaccine should patients with asthma get?

Pneumovax 23.

Should patients with asthma receive Prevnar 13?

As of 2014, the answer is no. Patients should receive Pneumovax 23.

Can you please explain when and why the recommendations for vaccination were changed for people with asthma and for cigarette smokers?

The 1997 CDC recommendations for the use of PPSV exclude asthma in the chronic pulmonary disease category because no data on increased risk of pneumococcal disease among people with asthma were available when the recommendation was issued. In 2008, the Advisory Committee on Immunization Practices (ACIP) reviewed new information that suggests that asthma is an independent risk factor for pneumococcal disease among adults. ACIP also reviewed new information that demonstrates an increased risk of pneumococcal disease among smokers. Consequently, ACIP recommends to include both asthma and cigarette smoking as risk factors for pneumococcal disease among adults age 19 through 64 years and as indications for PPSV23.

In its September 2010 publication of updated recommendations for prevention of invasive pneumococcal disease among adults, ACIP recommends vaccinating adult asthmatics with PPSV23. Should I give PPSV23 to people with mild, intermittent asthma or exercise-induced asthma? Why isn't PPSV23 recommended for asthmatic children?

PPSV23 is recommended for adults 19 years and older with all types of asthma. Available data do not indicate that asthma alone increases the risk of invasive pneumococcal disease among people younger than 19 years, so PPSV23 is not currently recommended for people younger than 19 years with asthma. For more information, go to

For whom is the 23-valent pneumococcal polysaccharide vaccine (PPSV23) recommended?

PPSV23 vaccine is recommended for all people who meet any of the criteria below:

1. All adults age 65 yrs and older

2. Age 2 through 64 yrs with any of the following conditions:
a. cigarette smokers age 19 yrs and older
b. chronic cardiovascular disease (e.g., congestive heart failure, cardiomyopathies; excluding hypertension)
c. chronic pulmonary disease (including COPD and emphysema, and for adults ages 19 years and older, asthma)
d. diabetes mellitus
e. alcoholism
f. chronic liver disease, cirrhosis
g. candidate for or recipient of cochlear implant
h. cerebrospinal fluid (CSF) leak
i. functional or anatomic asplenia (e.g., sickle cell disease, splenectomy)
j. immunocompromising conditions (e.g., HIV infection, leukemia, congenital immunodeficiency, Hodgkin's disease, lymphoma, multiple myeloma, generalized malignancy) or on immunosuppressive therapy
k. solid organ transplantation; for bone marrow transplantation, see
l. chronic renal failure or nephrotic syndrome

Is pneumococcal polysaccharide vaccine (PPSV23) contraindicated in pregnancy? Our patient has asthma and is pregnant.

No. According to the 2014 adult immunization schedule, PPSV23 is recommended in pregnancy if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications).


Indications for pneumococcal vaccine (Pneumovax 23) in asthma. AAAAI
Ask the Experts: Pneumococcal Vaccines (PCV13 and PPSV23)
Adult vaccine schedule - CDC (PDF)
Image source: Streptococcus pneumoniae from Wikipedia, the free encyclopedia, public domain.

Top Asthma Articles for October 2014

Here are my suggestions for some of the top articles about asthma published recently:

What is the best spacer? AeroChamber, toilet paper roll (?!), paper towel roll, rolled paper, plastic bottle spacer, bottle-holding chamber, nebulizer reservoir tubing? Paper towel roll was the best in this study:

Infant wheeze: Among children with 3-4 risk factors, 38% had asthma at school age

Study: job strain is probably not an important risk factor for severe asthma exacerbations

Severe refractory asthma: 2013 update in ERS (free full text)

Yoga for asthma: a systematic review and meta-analysis - Yoga was not helpful as asthma therapy.

Free but basic app: Spirometry Android medical app review

Refractory asthma: mechanisms, targets, and therapy - 2014 free full text review in EAACI journal Allergy

Neutrophils from allergic asthmatic patients release metalloproteinase-9 upon direct exposure to allergens

Weight reduction in obese patients with asthma improves outcomes by mechanisms not related to airway inflammation

Outdoor air pollution and asthma: In-vehicle exposure during commuting with open windows can be very high.

Air pollution decreases children's lung function by 1-3% (FEV1)

Smoke-free legislation is associated with substantial reductions in preterm births and admissions for asthma

Almost half of all children have at least one episode of wheeze before 6 years of age. Daily inhaled corticosteroids are associated with a small but statistically significant effect on growth

Asthma Impact on the Nation - CDC Infographic

New test determines Free IgE Levels in Serum from Patients Treated with Omalizumab

The articles were selected from Twitter @Allergy and RSS subscriptions. Some of the top allergy accounts on Twitter contributed links. I appreciate the curation provided by @Aller_MD @IgECPD @DrAnneEllis @mrathkopf.

Please feel free to send suggestions for articles to AllergyGoAway AT gmail DOT com and you will receive an acknowledgement in the next edition of this publication.

Children with highest exposure to allergens and bacteria during first year of life were least likely to have wheeze and allergic sensitization

The Urban Environment and Childhood Asthma study examined a birth cohort at high risk for asthma (n = 560) in Baltimore, Boston, New York, and St Louis.

Cumulative allergen exposure over the first 3 years was associated with allergic sensitization, and sensitization at age 3 years was related to recurrent wheeze. Reduced exposure to house dust bacterial content in the first year was associated with higher risk of atopy and atopic wheeze.
In contrast, first-year exposure to cockroach, mouse, and cat allergens was negatively associated with recurrent wheeze (odds ratio, 0.60, 0.65, and 0.75, respectively). Exposure to high levels of both allergens and bacteria (Firmicutes and Bacteriodetes) in the first year of life was associated with lower risk of atopy or wheeze.

Concomitant exposure to high levels of certain allergens and bacteria in early life might be beneficial. These findings suggest new preventive strategies for wheezing and allergic diseases.


Effects of early-life exposure to allergens and bacteria on recurrent wheeze and atopy in urban children. Susan V. Lynch et al. Journal of Allergy and Clinical Immunology
Volume 134, Issue 3, Pages 593–601.e12, September 2014.

Image source:, public domain.

Anaphylaxis - top articles for October 2014

Here are my suggestions for some of the top articles about anaphylaxis from the last 4-6 weeks:

The new-generation, sublingual epinephrine tablets have similar bioavailability to epinephrine injected IM in thigh

Epinephrine auto-injector "pandemic"

Patient perceptions of epinephrine auto-injectors: exploring barriers to use

Effect of instruction: not sufficiently skilled to use EpiPen after only one instruction session with a specialist

How easy to use is Auvi-Q epinephrine autoinjector? 95% of children were successful on first attempt (mean age 11)

The AAAAI Anaphylaxis Wallet Card is a practical, concise anaphylaxis education mini-handout for pediatric residents

Tick bites and red meat allergy: Large numbers of patients with IgE Ab to alpha-gal continue to be identified. Two distinct forms of anaphylaxis: immediate-onset anaphylaxis during first exposure to intravenous cetuximab and delayed-onset anaphylaxis 3–6 h after ingestion of mammalian food products (e.g. beef and pork).

Prevention of anaphylaxis in healthcare settings - know the high risk areas listed here:

Anaphylaxis in the young adult population: The most common trigger is food

Foods are the most common triggers for anaphylaxis, followed by drugs, insect stings, and idiopathic causes

Anaphylaxis: underdiagnosed, underreported, and undertreated. Epinephrine, the first-line treatment, was used in less than 50% of cases

Serum basal tryptase may be a good marker for predicting risk of anaphylaxis in children with food allergy

The articles were selected from my Twitter stream @Allergy and RSS subscriptions. Some of the top allergy accounts on Twitter contributed links. I appreciate the curation provided by @Aller_MD @AllergyNet @IgECPD4 @DrAnneEllis @mrathkopf

Please feel free to send suggestions for articles to and you will receive acknowledgement in the next edition of this publication.
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