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J Gen Intern Med. 2012 Oct;27(10):1317-25. Epub 2012 May 17.

Teaching the use of respiratory inhalers to hospitalized patients with asthma or COPD: a randomized trial.

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  • 1Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, MC 5000, W328, Chicago, IL 60637, USA. vpress@medicine.bsd.uchicago.edu

Abstract

BACKGROUND:

Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population.

OBJECTIVE:

To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD).

DESIGN:

A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD.

PARTICIPANTS:

Hospitalized adults (age 18 years or older) with asthma or COPD.

INTERVENTIONS:

Participants were randomized to brief intervention [BI]: single-set of verbal and written step-by-step instructions, or, teach-to-goal [TTG]: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back).

MAIN MEASURES:

The primary outcome was metered-dose inhaler (MDI) misuse post-intervention (<75% steps correct). Secondary outcomes included Diskus® misuse, self-reported inhaler technique confidence and prevalence of 30-day health-related events.

KEY RESULTS:

Of 80 eligible participants, fifty (63%) were enrolled (BI n=26, TTG n=24). While the majority of participants reported being confident with their inhaler technique (MDI 70%, Diskus® 94%), most misused their inhalers pre-intervention (MDI 62%, Diskus® 78%). Post-intervention MDI misuse was significantly lower after TTG vs. BI (12.5 vs. 46%, p=0.01). The results for Diskus® were similar and approached significance (25 vs. 80%, p=0.05). Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI (1 vs. 8, p=0.02).

CONCLUSIONS:

TTG appears to be more effective compared with BI. Patients over-estimate their inhaler technique, emphasizing the need for hospital-based interventions to correct inhaler misuse. Although TTG was associated with fewer post-hospitalization health-related events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education.

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