Efficacy of two educational interventions about inhalation techniques in patients with chronic obstructive pulmonary disease (COPD). TECEPOC: study protocol for a partially randomized controlled trial (preference trial)

Abstract

BackgroundDrugs for inhalation are the cornerstone of therapy in obstructive lung disease. We have observed that up to 75 % of patients do not perform a correct inhalation technique. The inability of patients to correctly use their inhaler device may be a direct consequence of insufficient or poor inhaler technique instruction. The objective of this study is to test the efficacy of two educational interventions to improve the inhalation techniques in patients with Chronic Obstructive Pulmonary Disease (COPD).MethodsThis study uses both a multicenter patients´ preference trial and a comprehensive cohort design with 495 COPD-diagnosed patients selected by a non-probabilistic method of sampling from seven Primary Care Centers. The participants will be divided into two groups and five arms. The two groups are: 1) the patients´ preference group with two arms and 2) the randomized group with three arms. In the preference group, the two arms correspond to the two educational interventions (Intervention A and Intervention B) designed for this study. In the randomized group the three arms comprise: intervention A, intervention B and a control arm. Intervention A is written information (a leaflet describing the correct inhalation techniques). Intervention B is written information about inhalation techniques plus training by an instructor. Every patient in each group will be visited six times during the year of the study at health care center.DiscussionOur hypothesis is that the application of two educational interventions in patients with COPD who are treated with inhaled therapy will increase the number of patients who perform a correct inhalation technique by at least 25 %. We will evaluate the effectiveness of these interventions on patient inhalation technique improvement, considering that it will be adequate and feasible within the context of clinical practice.Trial registrationCurrent Controlled Trials ISRTCTN15106246

A Tablet-Based Multimedia Education Tool Improves Provider and Subject Knowledge of Inhaler Use Techniques

“…Patients with COPD are often older and can have cognitive or memory impairments that contribute to incorrect inhaler technique. 9 Further, there are multiple different types of inhalers for respiratory medications, and each has a unique delivery technique. 22 Providing patients with inhaler education before initiation of therapy is critical, but written instruction alone is often inadequate.…”

“…23 Verbal education with assessment of inhaler technique followed by re-assessment of correct technique at subsequent visits improves inhaler technique. 9,24 Patients who receive inhaler education at regular intervals make fewer mistakes in inhaler technique compared with those who only receive instruction at the time of prescription. 25 As previously noted, in our study, there was no improvement in the subjects' clinical symptoms over a long-term follow-up period.…”

“…[1][2][3][4][5][6][7] Factors associated with incorrect use include age, cognitive impairment, number of prescribed inhalers, and inadequate/poor inhaler technique education. 8,9 Health-care providers' knowledge of correct inhaler use technique is critical for patient education. The percentage of healthcare providers who do not use inhalers correctly is significant (12-98%) and varies by profession.…”

Estimación del porcentaje de pacientes con EPOC adiestrados en consulta para el manejo de inhaladores. Estudio ADEPOCLE

“…Emplean una media de 1,88 (1,64-2,16) de dispositivos inhaladores, de los que tan solo los utilizan de forma correcta el 57%. Estos datos son concordantes con los observados en otros estudios, en los que el manejo adecuado de los inhaladores, aunque es muy variado, se sitúa entre el 23-70% (19,20), llegando al 83% en grupos entrenados previamente (21)(22)(23).…”

Assessment of Inhalation Technique in Clinical and Functional Control of Asthma and Chronic Obstructive Pulmonary Disease

“…This finding is consistent with other studies previously published which highlight the utility of continuous and systematic review of inhalation technique among patients in consultation. [19][20][21][22] Thus, it seems that the establishment of a query surveillance program set for asthma and COPD in Primary Health Care could be presented as one solution to this reality, allowing coverage of a greater number of patients in the general population. Although different approach strategies can be used, 23 more studies are needed to determine the effectiveness of surveillance programs covering practical aspects, such as the time required in each medical visit for the review and the teaching of technique to the patient, thereby promoting adherence.…”