Tailored metered-dose inhaler education improves technique for patients with asthma, COPD

Tailored metered-dose inhaler education was more effective compared with brief intervention for improving asthma patients’ inhaler techniques, but those with low health literacy may benefit less, researchers reported in Respiratory Medicine.

“Currently, the United States is experiencing growth in its geriatric population, which includes a growing population at-risk for COPD and/or asthma. Unfortunately, inferior asthma outcomes are evident amongst older patients as they experience more asthma-related urgent care than middle-aged or younger adults,” Kristin C. Trela, MD, anesthesiologist in the department of anesthesiology and critical care at the University of Chicago Medicine, and colleagues wrote. “Additionally, inhaler misuse is among one of the most significant self-management issues for both asthma and COPD disease control among older patients.”

The study included 394 adult inpatients with asthma or COPD (mean age, 51.9 years; 67% women) across five prospective interventional studies conducted from 2007 to 2017. Participants were assigned to one of three education interventions: brief intervention (n = 63) where participants received one round of simple verbal instructions without pre- or post-education assessments or demonstrations, teach-to-goal (n = 189) with a parent-centered teach-back method with a trained educator performing rounds of assessment and education using demonstrations or virtual teach-to-goal (n = 142). Visual acuity, health literacy and metered-dose inhaler technique before and after the education intervention were evaluated.

Researchers reported no significant difference in baseline metered-dose inhaler misuse by age, vision or health literacy levels.

Nearly forty-seven percent of patients with low health literacy had continued metered-dose inhaler misuse compared with 23.9% of patients with high health literacy (P < .001).

Patients with better baseline metered-dose inhaler technique, patients who received teach-to-goal or virtual teach-to-goal education and patients with high health literacy experienced lower post-education misuse.

Patients who received teach-to-goal education with low health literacy had three times higher misuse rates (33.3% vs. 11.6%; P = .001) and those who received virtual teach-to-goal education with low health literacy had 2.5 times higher misuse rates (50% vs. 19.7%; P = .004) compared with patients with adequate health literacy. Patients with high health literacy who received brief intervention did not have significant differences in misuse rates (90.9% vs. 65.8%; P = .1).

Higher health literacy and higher baseline metered-dose inhaler technique score decreased the odds of misuse after education by 0.29 and 0.68, respectively, compared with patients with low health literacy or poor baseline metered-dose inhaler technique. Participants who received teach-to-goal or virtual teach-to-go education experienced a decreased odds of misuse by 0.05 and 0.08, respectively, compared with patients who received brief intervention.

“Future work should explore the relationship between age, health literacy and vision in more detail with a larger proportion of patients 65 and over, compared to our data. Further development with other multivariate logistic models may help explain the overlap between age, vision and health literacy to better understand this finding,” the researchers wrote. “Lastly, creating patient-centered education specifically for patients with poor visual acuity and poor health literacy should be a priority, as they are the most vulnerable to post-education inhaler misuse and thus continued clinical consequences from inadequate medication administration.”