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

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ABSTRACT

BACKGROUND

Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population.

OBJECTIVE

To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD).

DESIGN

A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD.

PARTICIPANTS

Hospitalized adults (age 18 years or older) with asthma or COPD.

INTERVENTIONS

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).

MAIN MEASURES

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.

KEY RESULTS

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).

CONCLUSIONS

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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Acknowledgements

Contributors

We would like to thank the members of the Data and Safety Monitoring Board. In addition, we would like to thank the research staff of the University of Chicago Asthma and COPD Center and the University of Chicago Data and Biostatistics Management Core. Finally, we would like to thank Nicole Babuskow for her essential help with this project.

Funding

Dr. Press reports receiving funding from the Institute for Translational Medicine, University of Chicago CTSA from the National Center for Research Resources (UL1RR024999). Dr. Krishnan reports funding from the National Institutes of Health [HL101618] and the Agency for Healthcare Research and Quality [HS016967].

Prior Presentations

Prior poster presentations include the 2010 and 2011 Society of General Internal Medicine Annual Meetings in Minneapolis, Minnesota and Phoenix, Arizona respectively, the 2010 Society for Hospital Medicine Annual Meeting in Washington, DC, the 2011 Midwest Society of General Internal Medicine Regional Meeting in Chicago, Illinois, and the 2011 Midwest Society of Hospital Medicine. Prior oral presentations include the 2011 American Thoracic Society International Meeting in Denver Colorado.

Conflict of Interest

Dr. Shah is employed with a for profit company, Clinovations; Dr. Naureckas has provided expert testimony for Cook County; none of the other authors have conflicts of interest to disclose related to employment, consultancies, honoraria, stock, expert testimony, patents, royalties or any other relationships.

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Authors and 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

    Valerie G. Press MD, MPH

  2. Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA

    Vineet M. Arora MD, MAPP

  3. Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, USA

    Lisa M. Shah MD, MAPP

  4. Clinovations, LLC, Washington, DC, USA

    Lisa M. Shah MD, MAPP

  5. Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Stephanie L. Lewis BA, Jeffery Charbeneau MS & Jerry A. Krishnan MD, PhD

  6. Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA

    Edward T. Naureckas MD

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  1. Valerie G. Press MD, MPH
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  2. Vineet M. Arora MD, MAPP
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  3. Lisa M. Shah MD, MAPP
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  5. Jeffery Charbeneau MS
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  6. Edward T. Naureckas MD
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  7. Jerry A. Krishnan MD, PhD
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Corresponding author

Correspondence to Valerie G. Press MD, MPH.

Additional information

Registry Number: Clinicaltrials.gov NCT01456494

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Press, V.G., Arora, V.M., Shah, L.M. et al. Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial. J GEN INTERN MED 27, 1317–1325 (2012). https://doi.org/10.1007/s11606-012-2090-9

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  • DOI: https://doi.org/10.1007/s11606-012-2090-9

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