Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD

Press, Valerie G.; Arora, Vineet M.; Shah, Lisa M.; Lewis, Stephanie L.; Ivy, Krystal; Charbeneau, Jeffery; Badlani, Sameer; Naurekas, Edward; Mazurek, Antoinette; Krishnan, Jerry A.

doi:10.1007/s11606-010-1624-2

Cited by 160 publications

(174 citation statements)

References 29 publications

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“…Inhaler technique was assessed by a trained RA using detailed checklists for MDI (12-steps) and Diskus® (10 steps). 15 Misuse was defined as <75% of steps correct for each device (<9/12 steps for MDI; <8/10 steps for Diskus®). 15 Because inadequate health literacy is associated with poor inhaler technique, 24,25 participants' health literacy was measured using the Short Test of Functional Health Literacy in Adults (STOFHLA), 26,27 a 36-item written comprehension test (scores: range 0-36); less-than-adequate: <23/36; adequate: ≥23/36.…”

Section: Study Proceduresmentioning

confidence: 99%

“…1) The TTG intervention was chosen based on preliminary results from prior work that demonstrated its success as a hospital-based approach for teaching the use of respiratory inhalers. 15,16 A variety of alternative comparators were considered, including usual care. Because usual care may vary by institution and provider, a standardized but limited educational strategy, dubbed "brief intervention" (BI) was chosen.…”

Section: Interventionmentioning

confidence: 99%

“…15 The first step of the TTG intervention utilized trained, masked RAs to evaluate participants' baseline inhaler technique. The RA left the room and a trained research educator (RE) provided a demonstration of correct inhaler use, followed by reassessment of participants' technique (i.e., "teachback").…”

Section: Ttg Interventionmentioning

confidence: 99%

“…13,14 However, studies that we and others have conducted have found that the vast majority of patients hospitalized with asthma or COPD misuse their inhalers. 15,16 Improving patients' ability to use inhalers may help prevent adverse events post-hospital discharge, including hospital readmissions. [17][18][19] Although a handful of randomized trials have demonstrated beneficial effects of hospital-based patient selfmanagement education for asthma, [20][21][22][23] these studies employed multi-faceted, time-intensive interventions that were compared to usual care.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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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 metereddose 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 healthrelated events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education.

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Section: Study Proceduresmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

Section: Ttg Interventionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…This is salient because research has shown that poor vision can be a separate barrier to self-management, such as the ability to open medication containers, 4 and among hospitalized patients, appropriate inhaler technique. 2 Given these findings, it is important to understand the role of vision for self-management strategies, with respect to assessing health literacy level and/or whether poor vision compounds health risks associated with low health literacy.…”

mentioning

confidence: 99%