Background:
Medications delivered through respiratory inhalers are the mainstay of treatment for patients with obstructive lung disorders (OLDs) such as asthma and chronic obstructive pulmonary disease (COPD). Unfortunately, respiratory inhalers are often used incorrectly, reducing their effectiveness in patients with OLDs. Guidelines for OLDs therefore recommend evaluating and teaching appropriate use of respiratory inhalers at all points of care. However, it remains unclear what is the most effective strategy to instruct patients about respiratory inhaler technique. Teach‐to‐goal (TTG) employs initial assessment, instruction, and reassessment with repeated rounds of instruction until mastery is confirmed. Our objective was to evaluate a TTG intervention to teach respiratory inhaler technique to hospitalized patients with OLD exacerbations, a group at high risk for morbidity and mortality.
Methods:
Patients were eligible to enroll if they were 18 years or older, hospitalized with a physician diagnosis of asthma or COPD exacerbation at 1 of 2 urban academic medical centers, and reported using a metered dose inhaler (MDI) prior to hospitalization. Respiratory inhaler technique was graded using a 12‐step checklist, with scores ranging from 0 to 12 (higher scores indicating better technique). Signed rank tests were performed using Stata 10.
Results:
Of the 30 patients enrolled, 23 were female (77%), 16 had asthma (51%), 19 were <65 years (63%), 26 were African American (87%), and 25 had had another hospitalization for OLD in the last 12 months (83%). The median (range) score for respiratory inhaler technique prior to teaching was 7 (2‐12). Only 1 patient (3%) had perfect inhaler technique (12 of 12 steps correct) prior to teaching, and 6 patients (20%) had fewer than 6 steps correct. Of the 29 participants who needed at least 1 round of instruction (score <12), 28 agreed to receive the TTG intervention, 23 of whom (82%) had perfect inhaler technique after 1 round of teaching. There was significant improvement in inhaler technique after 1 round of TTG instruction (median change in score was 4.5, range 0‐10, P < 0.0001). Of the 5 participants (18%) who needed a second round of instruction, there was significant improvement with instruction (median change in score was 2, range 2‐6, P = 0.04). After 2 rounds of instruction, 28 of 28 participants (100%) demonstrated perfect inhaler technique.
Conclusions:
In this high‐risk population of hospitalized patients with OLD exacerbations, nearly all patients needed teaching about appropriate respiratory inhaler technique. TTG was effective in teaching respiratory inhaler technique in this population. Approximately 20% needed more than 1 round of teaching, emphasizing the importance of assessing comprehension regarding appropriate respiratory inhaler technique. Further studies are needed to compare TTG to alternate strategies for educating patients about respiratory inhaler technique.
Author Disclosure:
V. Press, none; L. Shah, none; S. Lewis, none; K. Ivy, none; A. Mazurek, none; J. Charbeneau, none; J. Krishnan, none.