Journal of General Internal Medicine

, Volume 27, Issue 10, pp 1317–1325

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

  • Valerie G. Press
  • Vineet M. Arora
  • Lisa M. Shah
  • Stephanie L. Lewis
  • Jeffery Charbeneau
  • Edward T. Naureckas
  • Jerry A. Krishnan
Original Research

DOI: 10.1007/s11606-012-2090-9

Cite this article as:
Press, V.G., Arora, V.M., Shah, L.M. et al. J GEN INTERN MED (2012) 27: 1317. doi:10.1007/s11606-012-2090-9



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.


respiratory inhalersteach-to-goalhospitalized patientshealth literacyasthmaCOPD

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Valerie G. Press
    • 1
  • Vineet M. Arora
    • 2
  • Lisa M. Shah
    • 3
    • 4
  • Stephanie L. Lewis
    • 5
  • Jeffery Charbeneau
    • 5
  • Edward T. Naureckas
    • 6
  • Jerry A. Krishnan
    • 5
  1. 1.Section of Hospital Medicine, Department of MedicineUniversity of Chicago Medical CenterChicagoUSA
  2. 2.Section of General Internal Medicine, Department of MedicineUniversity of Chicago Medical CenterChicagoUSA
  3. 3.Division of General Internal Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreUSA
  4. 4.Clinovations, LLCWashingtonUSA
  5. 5.Population Health SciencesUniversity of Illinois Hospital and Health Sciences SystemChicagoUSA
  6. 6.Section of Pulmonary and Critical Care, Department of MedicineUniversity of ChicagoChicagoUSA