Effectiveness of Interventions to Teach Metered-Dose and Diskus® Inhaler Technique: A Randomized Trial.
Ann Am Thorac Soc. 2016 Mar 21;
Authors: Press VG, Arora VM, Trela KC, Adhikari R, Zadravecz FJ, Liao C, Naureckas E, White SR, Meltzer DO, Krishnan JA
RATIONALE: The most effective approach to teach respiratory inhaler technique is unknown.
OBJECTIVES: To evaluate the relative effects of two different educational strategies (teach-to-goal instruction versus brief verbal instruction) in adults hospitalized with asthma or chronic obstructive pulmonary disease.
METHODS: A randomized clinical trial was conducted at two urban academic hospitals. Participants received teach-to-goal or brief instruction in the hospital and were followed for 90 days after discharge. Inhaler technique was assessed using standardized checklists; misuse was defined as 75% or fewer of steps correct (≤9/12 steps). The primary outcome was MDI misuse 30 days post-discharge. Secondary outcomes included Diskus® technique, acute-care events at 30 and 90 days, and associations with adherence, health literacy, site, and patient risk (near fatal event).
MEASUREMENTS AND MAIN RESULTS: Of 120 participants, 73% were female and 90% were African American. Prior to education, MDI misuse was similarly common in the teach-to-goal and brief intervention groups (92 vs 84%, p=0.2). MDI misuse was not significantly less common in the teach-to-goal versus brief instruction group at 30 days (54 vs 70%, p=0.11), but was immediately post-education (11 vs 60%, p<0.001) and at 90 days (48 vs 76%, p=0.003). Similar results were found with the Diskus® device. Participants did not differ across education group with rescue MDIs use or Diskus® device adherence at 30 or 90 days. Acute-care events were less common among teach-to-goal participants at 30 days (17 vs 36%, p=0.02), but not at 90 days (34 vs 38%, p=0.6). Participants with low health literacy receiving teach-to-goal were less likely than brief instruction participants to report acute-care events within 30 days (15% vs. 70%, p=0.008). No differences existed by site or patient risk at 30 or 90 days (p>0.05).
CONCLUSIONS: In adults hospitalized with asthma or COPD, in-hospital teach-to-goal instruction for inhaler technique did not reduce inhaler misuse at 30 days, but was associated with fewer acute-care events within 30 days after discharge. Inpatient treatment-to-goal education may be an important first step toward improving self-management and health outcomes for hospitalized patients with asthma or COPD, especially among patients with lower levels of health literacy. Clinical trial registered with ClinicalTrials.gov (NCT01426581).
PMID: 26998961 [PubMed - as supplied by publisher]