Baseline Questionnaire:
Name (optional) __________________________________________
Years in practice:
□ 1–5	□ 5–10	□ 10–15	□ >15
Appropriate number of asthma and/or COPD patients seen per week:
□ 1–10	□ 10–20	□ >20
Have you received hands on education on inhaler device use?
□ Yes	□ No
When and how was this taught (i.e. med school, CHE, one on one from an educator)? ______________________________________
Do YOU educate or check your own patient’s ability or technique on how to use their inhaler device appropriately and effectively?
□ No	Who does teach them? ________________________
□ Yes, I do my own teaching. I teach appropriate us of the:
□ Pressurized aerosol inhaler (pMDI)
□ Dry powder inhalers (Diskus, Twisthaler, Turbuhaler)
□ Space device
Does your education include how to tell if the device is empty and how to care for the device (cleaning, storing, etc...)?
□ Yes	□ No
If you do not educate patients on respiratory devices please indicate why (more than one answer is acceptable):
□ Too busy to teach
□ Pharmacist will take care of this
□ Patients are typically good at using devices
Other:□ _____________________________________________
Please indicate if you agree/disagree with the following statements:
MDI’s (+/− spacer) are better than powder devices in patients with low inspiratory flow (ex. Elderly COPD patients)
□ Agree	□ Disagree
With either a nebulizer, you know you’re getting the appropriate dose of medication every time.
□ Agree	□ Disagree
Most patients know how to use their device as they have been using it for years – usually it’s only the newly diagnosed patients that need some coaching.
□ Agree	□ Disagree
Please indicate what you feel your level of competency is in educating your patients on how to use and care for their inhaler device
□ Fully competent
□ Somewhat competent
□ Not competent
Other comments: __________________________________________