Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD
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Patients are asked to assume greater responsibility for care, including use of medications, during transitions from hospital to home. Unfortunately, medications dispensed via respiratory inhalers to patients with asthma or chronic obstructive pulmonary disease (COPD) can be difficult to use.
To examine rates of inhaler misuse and to determine if patients with asthma or COPD differed in their ability to learn how to use inhalers correctly.
A cross-sectional and pre/post intervention study at two urban academic hospitals.
Hospitalized patients with asthma or COPD.
A subset of participants received instruction about the correct use of respiratory inhalers.
Use of metered dose inhaler (MDI) and Diskus® devices was assessed using checklists. Misuse and mastery of each device were defined as <75% and 100% of steps correct, respectively. Insufficient vision was defined as worse than 20/50 in both eyes. Less-than adequate health literacy was defined as a score of <23/36 on The Short Test of Functional Health Literacy in Adults (S-TOFHLA).
One-hundred participants were enrolled (COPD n = 40; asthma n = 60). Overall, misuse was common (86% MDI, 71% Diskus®), and rates of inhaler misuse for participants with COPD versus asthma were similar. Participants with COPD versus asthma were twice as likely to have insufficient vision (43% vs. 20%, p = 0.02) and three-times as likely to have less-than- adequate health literacy (61% vs. 19%, p = 0.001). Participants with insufficient vision were more likely to misuse Diskus® devices (95% vs. 61%, p = 0.004). All participants (100%) were able to achieve mastery for both MDI and Diskus® devices.
Inhaler misuse is common, but correctable in hospitalized patients with COPD or asthma. Hospitals should implement a program to assess and teach appropriate inhaler technique that can overcome barriers to patient self-management, including insufficient vision, during transitions from hospital to home.
Key wordsasthma pulmonary disease chronic disease hospital medicine health literacy
We would like to thank The University of Chicago Asthma and COPD Center and the Department of Medicine Data Management and Statistics Core.
Prior Presentations: Prior poster presentations include the 2009 American Thoracic Society International Meeting in San Diego, the 2009 Society of Hospital Medicine Annual meeting in Chicago IL, and the 2009 and 2010 Society of General Internal Medicine Annual Meetings in Miami, Fl and Minneapolis, MN, respectively. Oral presentations include the 2009 Midwest Society of General Internal Medicine and the 2010 American Thoracic Society International Meeting in New Orleans, LA.
Conflict of Interest
Dr. Press reports receiving funding from the Institute for Translational Medicine, University of Chicago CTSA from the National Center for Research Resources (UL1RR024999) and the American Cancer Society (PSB 08-08). Dr. Arora reports receiving funding from the American Board of Internal Medicine, Agency for Healthcare Research and Quality (R03HS018278), the National Institute of Aging (K23AG033763), and the Accreditation Council of Graduate Medical Education. Dr. Krishnan reports receiving funding from the National Institutes of Health (HL101618) and the Agency for Healthcare Research and Quality (HS016967). Potential conflicts of interest exist for Dr. Shah who is employed with a for profit health care policy firm (Avalere Health, LLC); for Dr. Badlani who has received honoraria for lectures given (Merck Pharmaceuticals and PharmEd Consultants); and for Dr. Naurekas, who has provided expert testimony (once for a plaintiff on Alveolar Hemosiderosis and once for Cook County on thrombotic thrombocytopenic purpura). All other authors do not have any conflicts of interest to disclose related to employment, consultancies, honoraria, stock, expert testimony, patents, royalties or any other relationships.
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