Many patients with COPD use inhalers incorrectly; short trainings can improve technique

In a new study, a high proportion of patients with COPD used their pressurized metered dose inhalers incorrectly, but inhaler techniques improved with short trainings in the clinic, researchers reported in BMC Pulmonary Medicine.

The percentage of patients who used their inhaler incorrectly was 43.5% before one-on-one coaching in the clinic and improved to 12.9% after training (P < .001), according to the results.

“Confidence of COPD patients in their inhaler technique has shown to be directly related to their treatment adherence and health status,” Jin Sun Kim, MD, resident physician in the division of pulmonary, critical care and sleep medicine at Saint Louis University School of Medicine, Saint Louis, and colleagues wrote. “Unfortunately, the literature reports a high prevalence of poor inhaler technique in COPD and asthma patients.”

The prospective study included 101 patients with COPD (mean age, 63.7 years; 40% men) who used pressurized metered dose inhalers. Researchers assessed patient inhaler techniques and provided one-on-one active inhaler training using the 12-step American Thoracic Society instructions. After in-clinic training, the researchers assessed all patients’ inhaler technique.

Researchers obtained follow-up data on 62 patients (61%) in the study.

In addition to the overall improvement in misuse, number of errors decreased from a mean of 3.1 before inhaler training to 1.7 after the training period (P < .001). The number needed to treat to prevent one misuse was 3.3 patients, according to the results.

In a sensitivity analysis, individuals lost to follow-up were assumed to have continued inhaler misuse if they demonstrated misuse at baseline, and those with correct use were assumed to have continued correct inhaler use. With these data, the percentage of patients with inhaler misuse decreased from 45.5% to 26.7% (P < .001), with a number needed to treat of 5.3 patients to prevent one misuse.

In addition, researchers observed a higher likelihood of pressurized metered dose inhaler misuse among individuals with impaired cognitive function (42%) and dementia (62%) compared with individuals with normal cognition (36%). These patients were also less likely to demonstrate inhaler technique improvement after the training period.

“Further research is needed to determine whether alternative means of teaching, inhaler choices or other interventions can be tailored to patients based on cognition function considering the high comorbidity of COPD and neurocognitive disorders,” the researchers wrote.