Hospitalized patients with COPD misuse nearly 70% of inhalers
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Key takeaways:
- When a patient made a critical error in inhalation technique and/or had insufficient peak inspiratory flow, they had inhaler misuse.
- In the assessed study population, 82.3% used a minimum of one misused inhaler.
Inhaler misuse was high in hospitalized patients with COPD, with 69.4% of all inhalers at admission found to be misused, according to results published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.
“As a hospital physician, these findings prompt me to systematically evaluate the inhalers used by COPD patients, regardless of their reason for hospitalization,” Gaёl Grandmaison, MD, assistant physician in internal medicine at University and Hospital of Fribourg in Switzerland, told Healio.
“In response to these findings, we have implemented a systematic and standardized assessment of inhaler use among our patients, aiming to correct inhalation techniques or replace the inhaler if necessary,” Grandmaison continued. “This intervention has significantly reduced the number of improperly used inhalers at hospital discharge.”
In a cross-sectional study, Grandmaison and colleagues evaluated 96 patients (mean age, 71.6 years; 63% men) in the internal medicine division of Fribourg Hospital with a diagnosis of COPD to find out how many patients in this population misuse inhalers via physiotherapist assessments and the In-Check Dial G16 (Alliance Tech Medical) over 9 months.
Researchers cited inhaler misuse when a patient made a critical error in inhalation technique and/or had insufficient peak inspiratory flow (PIF).
The total cohort had 160 inhalers, and nearly 70% (111 inhalers) had been misused. In the entire study population, 82.3% of patients used a minimum of one misused inhaler.
“Numerous studies have highlighted the significant issue of improper inhaler use in outpatient settings,” Grandmaison said. “Our study confirms that this problem is also widespread.”
A critical error in inhalation technique was behind more instances of inhaler misuse than insufficient PIF (105 inhalers; 65.6% vs. 22 inhalers; 13.8%), and this was also reflected in the proportions of patients who used a minimum of one inhaler with a critical error (81.3%) and had insufficient PIF (21.9%).
In an effort to determine if targeted teaching can change the prevalence of inhaler misuse, researchers had physiotherapists carry out up to three teaching sessions and reassessed the number of inhalers with critical errors after each one.
With each additional session, fewer inhalers had been used with critical errors (one session, 33 inhalers; two sessions, 15 inhalers; three sessions, nine inhalers).
Five patients had cognitive disorders that inhibited them from reaching an adequate inhalation technique, according to researchers. A lack of coordination between inhaler activation and inspiration (n = 4) was another factor preventing adequate inhalation technique, followed by fine motor disorders and the inability to hold one’s breath sufficiently (each n = 2).
Researchers further assessed how many inhalers were unsuitable, meaning they “cannot be used optimally, either because of an insufficient PIF or because of an inability to use an inhaler optimally despite specific teaching,” and found 27 (16.9%). Use of at least one unsuitable inhaler was noted in 25% of the study population.
“Suboptimal inhaler use is associated with poor disease control, more frequent hospitalizations and increased costs,” Grandmaison told Healio. “The prevalence of improperly-used inhalers is alarming, and strategies to address this issue are urgently needed.”
Among those hospitalized with a COPD exacerbation, 62.2% of the inhalers in this subgroup had been misused, whereas in the group of those hospitalized without an exacerbation, 85.7% of inhalers had been misused.
Additionally, those hospitalized for a respiratory compliant misused 65.9% of the inhalers in this subgroup, which was lower than the 82.4% of misused inhalers in the group not hospitalized for a respiratory compliant.
“These results underscore the critical importance of assessing inhalation technique and providing appropriate therapeutic education,” Grandmaison told Healio. “They also highlight the need to evaluate a patient’s inspiratory capacity and ensure that the chosen inhaler matches their specific needs.”
With both this study and the study mentioned above on the intervention that lowered the number of improperly used inhalers at discharge completed, Grandmaison plans to continue researching the intervention.
“The next step is to evaluate the impact of such an intervention on symptom control and disease progression,” he said. “Additionally, our goal is to adapt the strategy developed in our department for use in outpatient care.”
References:
- Grandmaison G, et al. Swiss Med Wkly. 2024;doi:10.57187/s.3394.
- Inhaler misuse leads to mismanagement of COPD symptoms, increased exacerbations. https://www.copdfoundation.org/About-Us/Press-Room/Press-Releases/Article/2017/Inhaler-misuse-leads-to-mismanagement-of-COPD-symptoms-increased-exacerbations.aspx. Published Aug. 20, 2024. Accessed Aug. 20, 2024.