Patient Education and Adherence to Aerosol Therapy

Abstract

SummaryNonadherence to prescribed medications results in disease instability and poor clinical control, with increases in hospital admissions, emergency room visits, school/work absenteeism, morbidity, and mortality. Poor patient adherence to therapy can be due to lack of cognition, competence, or contrivance. Patients who have not been trained or fail to understand use of drug and device combinations (cognition) often do not have the ability to use an aerosol device correctly (competence). Many patients have the competence to use the device correctly and know why they should RESPIRATORY CARE • JUNE 2015 VOL 60 NO 6 941 use the device in the way they were taught; however, they still contrive to use it in an ineffective and suboptimal manner that reduces its efficiency and effectiveness. Ensuring effective aerosol therapy and optimizing its role in disease management involve not only delivery of aerosolized medications to the lungs, but also understanding why, when, and how to use the medications, competence to use the device, motivation to adhere to therapy, and not contriving to use the device in a way that will prevent effective drug delivery. This paper explains some of the problems with patient education and adherence to aerosol therapy and suggests strategies to evaluate, monitor, and improve patient adherence effectively in primary care. Factors affecting patient adherence to prescribed medications, effective educational interventions, and strategies to promote patient adherence to aerosol therapy are also discussed.

Adherence to inhaled therapy and its impact on chronic obstructive pulmonary disease (COPD)

“…In patients with COPD, nonadherence to inhaled therapy is caused by several factors and could lead to high mortality and morbidity as well as hospitalizations and a reduced quality of life [ 14 , 17 – 21 ]. Thus, the consequences of nonadherence, clinically and economically, are neither completely obvious nor fully understood, but there is an association between nonadherence and increasing healthcare costs [ 17 , 19 , 22 , 23 ].…”

Preclinical Development of Orally Inhaled Drugs (OIDs)—Are Animal Models Predictive or Shall We Move Towards In Vitro Non-Animal Models?

“…This is due to the fact that, DPIs and pMDIs are breath-actuated and therefore not compatible with animal exposure; whereas for nebulizers modifications are needed in line with the animal model adopted. Thus, our manuscript, which focuses on the potential reduction and replacement of animals studies in OID development, does not discuss the impact of inhalers' performance on the effectiveness of inhalation therapies [34], a current challenge discussed in detail elsewhere [35][36][37][38][39][40][41][42][43][44].…”

The use of nebulized pharmacotherapies during the COVID-19 pandemic

“…If not accompanied by adequate training for the patient, switching from one device to another can be linked with poor adherence and technique. Suboptimal inhalation delivery could lead to exacerbations and increased healthcare utilization, 13 – 16 , 52 potentially increasing the risk of nosocomial SARS-CoV-2 exposure. In addition to those with suboptimal peak inspiratory flow, patients who have cognitive, neuromuscular, or ventilatory impairments may not benefit from handheld inhalers.…”

“… 11 , 12 In the home setting, the sudden switch from nebulized treatments to handheld devices could also result in poor medication adherence, resulting in loss of clinical control of disease symptoms, which can lead to severe exacerbations, resulting in emergency room visits or hospitalizations. 13 – 16 Ironically, this substantially increases the risk of exposure to nosocomial SARS-CoV-2.…”