Training improves the handling of inhaler devices and reduces the severity of symptoms in geriatric patients suffering from chronic-obstructive pulmonary disease

Abstract

Purpose Elderly patients with impaired vision, cognitive decline or motor/sensory disturbances of their fingers suffering from chronic-obstructive pulmonary disease (COPD) encounter difficulties in handling inhaler devices used as the cornerstones of treatment of pulmonary obstruction. Many elderly patients make severe mistakes which impede adequate drug delivery to the bronchioles. This multimodal training program was designed to reduce the number of handling mistakes of inhaler devices. Methods From October 1, 2016 to September 30, 2017, a prospective intervention study was conducted in 38 in-patients > 65 years (median age 79 years) with previously diagnosed COPD. The effect of an 8-day intervention comprising daily counselling and video demonstration according to the recommendations of the German Airway League on the frequency of mistakes during handling of inhaler devices, the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC) and the perception of symptoms (COPD Assessment Test, CAT) were studied. Measurements on days 1 and 8 were compared by Wilcoxon signed rank test. Results The number of handling mistakes per patient decreased as a consequence of the intervention from 3.0 (0–7) to 0.5 (0–6) [median (minimum-maximum; p < 0.0001)]. The CAT Score decreased from 19.5 (14/24) to 14.5 (10.75/21) [median (25./75. percentile; p < 0.0001) indicating a substantial reduction of clinical symptoms. Conversely, FEV1 and FVC only slightly increased (difference statistically not significant). At study entry, the number of handling mistakes was inversely correlated with the Mini Mental Status Test (MMST) score (p = 0.01). The reduction of the number of handling mistakes during the intervention was not correlated with the MMST. Conclusion In COPD, intensive training for 8 days improved the handling of inhalers and reduced clinical symptoms in geriatric patients. Patients with cognitive abnormalities also benefitted from this intervention. Trial registration German Clinical Trials Registry DRKS00023196, date of registration September 29, 2020 (retrospectively registered).

Effectiveness of one-on-one coaching in improving pressurized metered dose inhaler (pMDI) technique among COPD patients: a prospective clinical study

“…However, despite the lesser benefit observed in those with cognitive impairment, the difference was not statistically significant, and patients with mild cognitive impairment and dementia still appeared to benefit meaningfully. This corroborates findings in a study that found that an 8-day inhaler training program in the geriatric population led to an improved technique and CAT scores regardless of cognitive abilities [ 15 ].…”

Switching COPD patients from the disposable to the new reusable Respimat soft mist inhaler: a real-world study from Switzerland

“…At follow up, most of the patients had a better ability to use the Respimat and only a small proportion of patients were indicated for further training. Those results underline the findings of previous studies that adequate training improves user capabilities 9,11,12,29,34,35 . In the present survey, placebo inhaler was the preferred training material for both physicians and patients.…”

“…It enables "hands-on" training on the real-world device and thus, possible handling errors can directly be addressed during training. Previous studies also showed a good acceptance of placebo inhaler use for training of device handling 35 . Video films/demo cards were also recommended for patient education on inhaler usage.…”

“…Video films/demo cards were also recommended for patient education on inhaler usage. A recent study by Luley et al 35 showed that device handling was markedly improved in elderly patients after an intensive video-assisted training of 8 days. Generally, several studies showed that a multimedia training approach accompanied by verbal comments was more effective than an exclusive written or verbal explanation 35,36 .…”

<p>Use of Web-Based Videos in a Community Pharmacy to Optimize Inhalation Technique</p>

“…15 The videos used in our present study can be understood by most patients and significantly improve inhalation technique under different settings. 9,11,16 Accordingly, data from previous studies suggest that education of inhaler technique by video leads to an objective improvement and can even be as effective as instruction in person. [17][18][19] However, as there was still a considerable number of patients not being able to use their inhaler correctly after having watched the video, assessment of the inhalation technique by a qualified person is still indispensable.…”