Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial
Journal of General Internal Medicine,
Press VG et al. – Teach–to–goal (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.Methods
- 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).