Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma

To analyze whether there is improvement in adherence to inhaled treatment in patients with COPD and asthma after an educational intervention based on the teach-to-goal method. This is a prospective, non-randomized, single-group study, with intervention and before-after evaluation. The study population included 120 patients (67 females and 53 males) diagnosed with asthma (70.8%) and COPD (29.1%). The level of adherence (low and optimal) and the noncompliance behavior pattern (erratic, deliberate and unwitting) were determined by the Test of the adherence to Inhalers (TAI). This questionnaire allows you to determine the level of adherence and the types of noncompliance. Low Adherence (LowAd) was defined as a score less than 49 points. All patients received individualized educational inhaler technique intervention (IEITI). Before the IEITI, 67.5% of the patients had LowAd. Following IEITI, on week 24, LowAd was 55% (p = 0.024). Each patient can present one or more types of noncompliance. The most frequent type was forgetting to use the inhaler (erratic), 65.8%. The other types were deliberate: 43.3%, and unwitting: 57.5%. All of them had decreased on the final visit: 51.7% (p = 0.009), 25.8% (p = 0.002), 39.2% (p = 0.002). There were no significant differences in adherence between asthma and COPD patients at the start of the study. The only predicting factor of LowAd was the female gender. An individualized educational intervention, in ambulatory patients with COPD and asthma, in real-world clinical practice conditions, improves adherence to the inhaled treatment.

How Inhaler Technique is Assessed in Children and Young People: A Scoping Review Protocol

BackgroundAsthma is the most common chronic childhood condition. Unfortunately, many children have poorly controlled asthma. Current guidelines strongly recommend that all asthma review appointments must include an assessment of the patient’s inhaler technique. However, most guidelines do not provide information on how the healthcare professional should conduct this assessment. The aim of this scoping review is to explore the published literature on methods used to assess inhaler technique. MethodsThis scoping review will follow the frameworks founded by Arksey and O’Malley and the Joanna Briggs Institute guidelines. We will search MEDLINE, Embase, Cinahl and the Cochrane library for studies published from 1st January 1956 to 30th November 2021, on methods of assessing inhaler technique in children and young people aged 1 to 16 years of age with asthma. We will include randomised control trials, case control studies, cohort studies and retrospective studies which investigate methods used to assess inhaler technique in children and young people. We will include studies conducted in all areas where inhaler technique assessment occurs and studies conducted by all healthcare professionals who usually undertake inhaler assessments in practice. Two reviewers will complete all screening and data extraction independently. Data will be extracted onto a charting table and a descriptive summary of the results presented. DiscussionThis scoping review will provide a broad overview of currently used methods to assess inhaler technique in children and young people with asthma. The analysis of which will allow us to consider how these methods might be used in clinical practice and research settings. Scoping review registration Open Science Framework (osf.io/e47sa).

Interventional, Quasi-Experimental Study of a Chronic Obstructive Pulmonary Disease Education Care Plan for Hospital Discharge

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity, mortality, and reduced quality of life for patients. Proper use of inhaler devices is critical for effective drug delivery and prevention of COPD progression. The primary endpoint of this study was a mean percent increase in correct steps associated with inhaler technique after pharmacist education. The co-primary endpoint was a 25% increase in the proportion of patients correctly identifying the appropriate use of short-acting versus long-acting inhaler types. This was an interventional quasi-experimental study of patients hospitalized at a 491-bed tertiary academic medical center with a COPD exacerbation to assess a pharmacist-led COPD care plan. Eligible patients included general floor, adult patients admitted with a primary diagnosis of COPD exacerbation. The primary investigator recorded initial inhaler technique scores through a paper checklist, and provided education about device types and usage. Patients were reassessed within 48 h to determine if pharmacist education improved inhaler knowledge. A total of 67 patients received the COPD care plan before hospital discharge. At baseline, patients scored a median of 81.8% (67.5–97.0) of steps correct across all inhaler device types. After pharmacist education, patient scores increased to a median of 100% (90.9–100.0) (p < 0.0001). The proportion of patients correctly identifying when to use short-acting versus long-acting inhalers increased from 73.1% to 98.5% (p < 0.0001). Implementation of a pharmacist-led care plan for patients admitted for COPD exacerbation was associated with an increase in correct steps for appropriate inhaler technique and understanding of inhaler device types after pharmacist education.

Matching the Inhaler to the Patient in COPD

Selecting the most appropriate inhalation device from the wide range available is essential for the successful management of patients with chronic obstructive pulmonary disease. Although choice is good for healthcare professionals, knowing which inhaler to prescribe is a complex consideration. Among the key factors to consider are quality of disease control, inhaler technique, inhaler resistance and inspiratory flow, inhaler design and mechanisms of drug delivery, insurance and reimbursement restrictions, and environmental impact. In this article, we offer a simple, practical tool that brings together all these factors and includes hyperlinks to other published resources from the United Kingdom, Belgium, and The Netherlands.

Is there potential to use augmented reality technology to provide demonstrative inhaler technique education for asthma patients? A qualitative study (Preprint)

BACKGROUND Many people with asthma use incorrect inhaler technique resulting in sub-optimal disease management and increased health service utilisation. Novel ways of delivering appropriate instructions are needed. OBJECTIVE This study explores stakeholder perspectives on the potential use of augmented reality (AR) technology to improve asthma inhaler technique education. METHODS Based on existing evidence and resources, an information poster displaying the images of 22 asthma inhaler devices was produced. Using AR technology via a free smartphone application, the poster launched video demonstrations of correct inhaler technique for each device. Twenty‐one semi‐structured, one‐on‐one interviews with health professionals, people with asthma and key community stakeholders were conducted and data was analysed thematically using the Triandis model of interpersonal behaviour. RESULTS People with asthma believed they were competent with inhaler technique. However, health professionals and key community stakeholders identified that this perception was misguided and facilitates persistent incorrect inhaler use and sub‐optimal disease management. Delivering inhaler technique education using augmented reality was favoured by all participants, particularly around ease of use, with the ability to visually display inhaler techniques for each device. However, all participants identified some barriers, particularly for access and appropriateness of AR for older people. CONCLUSIONS Augmented reality technology may be a novel means to address poor inhaler technique among certain cohorts of asthma patients and serve as a prompt for health professionals to initiate review of inhaler devices. A randomised controlled trial design is needed to evaluate efficacy of this technology for use in the clinical care setting.