Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial
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Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population.
To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD).
A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD.
Hospitalized adults (age 18 years or older) with asthma or COPD.
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).
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.
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).
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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- Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial
Journal of General Internal Medicine
Volume 27, Issue 10 , pp 1317-1325
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- respiratory inhalers
- hospitalized patients
- health literacy
- Industry Sectors
- Author Affiliations
- 1. Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, MC 5000, W328, Chicago, IL, 60637, USA
- 2. Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
- 3. Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, USA
- 4. Clinovations, LLC, Washington, DC, USA
- 5. Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- 6. Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA