Evaluating inhaler use technique in COPD patients

Pothirat, Chaicharn; Chaiwong, Warawut; Phetsuk, Nittaya; Pisalthanapuna, Sangnual; Chetsadaphan, Nonglak; Choomuang, Woranoot

doi:10.2147/copd.s85681

Cited by 100 publications

(164 citation statements)

References 33 publications

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“…Some studies have shown that literacy rate of patients is not associated with the correct technique, 11,19 whereas other studies have shown that education level does have an impact on the inhaler technique. 4,7,13 There was also no significant difference in the technique between asthmatics and the COPD patients, which could be because the number of COPD patients (n=42) when compared to asthmatics (n=200) were less in our study. The improvement in asthmatics in the follow up visit was found to be more significant when compared to the COPD patients.…”

Section: Discussioncontrasting

confidence: 49%

“…9 Problems with inhaler techniques were recognised shortly after the launch of pMDIs in the 1960s and reviews show that incorrect inhaler technique is unacceptably frequent and has not improved over the past 40 years. 10 Furthermore, incorrect technique has been reported in up to 94% of patients 4,8,[11][12][13] and poor technique was estimated to be prevalent in an average of 50% of cases. 14 The main advantages of inhaler devices over oral tablets for chronic respiratory diseases include lower dose, rapid onset of action, desired local action and no gastric or systemic adverse drug reactions.…”

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confidence: 99%

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Sixty Years After Inhalational Devices- Where Do We Stand?

Gali¹,

Khan²,

Badam³

et al. 2017

jebmh

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BACKGROUNDBronchial asthma and chronic obstructive pulmonary disease are the Common Respiratory Diseases (CRD's). Drugs delivered through inhaler devices are the backbone for treatment of CRD's. Inhaler technique errors are common even after more than 60 years of introduction of these devices.The aim of the study is to explore the faulty inhaler techniques among patients with asthma and chronic obstructive pulmonary diseases. Health education has significant impact on improving the inhaler technique thereby achieving better disease control and also brings out regularity of inhaler usage by patients. MATERIALS AND METHODSAll the relevant information including patients profile and usage of inhalers was collected by a prepared questionnaire from 242 patients with asthma or COPD attending our OPD. The patient's inhaler technique was assessed using a standard checklist for proper use of a Metered-Dose Inhaler (MDI) or Dry Powder Inhaler (DPI). All the participants were asked to demonstrate their inhaler technique, which was assessed and documented. Education was given to all patients about the correct inhalational method and they were also counseled to adhere to it. Inhaler technique was reassessed in all the patients after a month and reinforcement of the correct technique was done. Statistical Analysis-Using the chi-square test, P-values of each variable like age, gender, education, duration of illness, etc. were derived. P value of less than 0.05 was considered significant. Settings and Design-This is a cross-sectional study with an interventional component done on 242 patients with bronchial asthma or COPD attending the pulmonology OPD in Apollo Institute of Medical Sciences and Research. RESULTSOut of 242 patients studied on baseline evaluation in the first visit, only 46 patients (19.008%) were able to do the technique correctly, which after education on the correct inhaler technique increased to 134 patients (55.37%) in the follow up visit done after a month. CONCLUSIONErrors in inhaler technique still persist in patients with chronic respiratory diseases and the best way to counter this is by effective patient and physician education.

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Section: Discussioncontrasting

confidence: 49%

mentioning

confidence: 99%

Sixty Years After Inhalational Devices- Where Do We Stand?

Gali¹,

Khan²,

Badam³

et al. 2017

jebmh

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“…A study conducted by Pothirat et al found that for the pMDI, the steps "breathe out gently to residual volume" and "shake inhaler thoroughly" were most frequently performed incorrectly. 24 For the pMDI with spacer, the step "breathe in and out through mouthpiece at least three times" was most frequently performed incorrectly.…”

Section: Agementioning

confidence: 99%

Incorrect inhaler techniques in Western India: still a common problem

Sodhi

2017

Int J Res Med Sci

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Background: To assess and evaluate the incorrect use of inhalers in patients with asthma and chronic obstructive pulmonary disease (COPD) in the outpatient department of pulmonary medicine at RUHS college of medical sciences Jaipur, Rajasthan, India.Methods: Patients visiting the outpatient department of respiratory medicine were asked to demonstrate the inhaler technique and were assessed by the physician.Results: The study included 200 patients with Asthma or COPD. Among patients with COPD, 80 (63.4%) were males and 46 (36.5%) were females. In the asthma group, there were 50 (67.5%) females and 24 (32.4%) males. Patients with COPD were in the age group between 46-82 years with a mean age of 64 years while patients with asthma were in the age group between 18-70 years with a mean age of 44 years. Only 28 (14%) patients could perform all steps correctly in use of inhaler devices. 172 patients (86%) were unable to use inhalers properly. Most common error for metered dose inhalers (MDIs) was in step 7 that is (i.e.) not holding breath for 10 seconds which was seen in 46 patients (51.7%). The most common error seen for dry powder inhalers (DPIs) was in step 5 i.e. exhalation to residual volume before inhalation seen in 50 patients (47.1%).Conclusions: This study revealed that majority of patients use the inhaler devices incorrectly. Proper education regarding inhaler use is crucial for effective treatment with use of these inhaler devices.

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“…Many patients use more than one inhaler and are thus required to learn multiple different sets of instructions. Over 90% of COPD patients do not use their inhalers correctly, [7][8][9][10] and errors in use are associated with worse symptoms and increased hospitalizations. 11 Because of this, COPD guidelines recommend inhaler teaching and review at clinic visits and on discharge from the hospital after an exacerbation.…”

Section: Introductionmentioning

confidence: 99%

Inhaler Training Delivered by Internet-Based Home Videoconferencing Improves Technique and Quality of Life

et al. 2017

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BACKGROUND: COPD is common, and inhaled medications can reduce the risk of exacerbations. Incorrect inhaler use is also common and may lead to worse symptoms and increased exacerbations. We examined whether inhaler training could be delivered using Internet-based home videoconferencing and its effect on inhaler technique, self-efficacy, quality of life, and adherence. METHODS: In this pre-post pilot study, participants with COPD had 3 monthly Internet-based home videoconference visits with a pharmacist who provided inhaler training using teach-to-goal methodology. Participants completed mailed questionnaires to ascertain COPD severity, self-efficacy, health literacy, quality of life, adherence, and satisfaction with the intervention. RESULTS: A total of 41 participants completed at least one, and 38 completed all 3 home videoconference visits. During each visit, technique improved for all inhalers, with significant improvements for the albuterol metered-dose inhaler, budesonide/formoterol metered-dose inhaler, and tiotropium dry powder inhaler. Improved technique was sustained for nearly all inhalers at 1 and 2 months. Quality of life measured with the Chronic Respiratory Questionnaire improved following the training: dyspnea (؉0.3 points, P ‫؍‬ .01), fatigue (؉0.6 points, P < .001), emotional function (؉0.5 points, P ‫؍‬ .001), and mastery (؉0.7 points, P < .001). Coping skills measured with the Seattle Obstructive Lung Disease Questionnaire improved (؉9.9 points, P ‫؍‬ .003). Participants reported increased confidence in inhaler use; for example, mean self-efficacy for using albuterol increased 3 points (P < .001). Inhaler adherence improved significantly after the intervention from 1.6 at the initial visit to 1.1 at month 2 (P ‫؍‬ .045). The pharmacist reported technical issues in 64% of visits. CONCLUSIONS: Inhaler training using teach-to-goal methodology delivered by home videoconference is a promising means to provide training to patients with COPD that can improve technique, quality of life, self-efficacy, and adherence.

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Evaluating inhaler use technique in COPD patients

Cited by 100 publications

References 33 publications

Sixty Years After Inhalational Devices- Where Do We Stand?

Sixty Years After Inhalational Devices- Where Do We Stand?

Incorrect inhaler techniques in Western India: still a common problem

Inhaler Training Delivered by Internet-Based Home Videoconferencing Improves Technique and Quality of Life

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