The effects of repeated inhaler device handling education in COPD patients: a prospective cohort study

Abstract

Inhaler education for chronic obstructive pulmonary disease (COPD) patients improves inhaler technique and adherence. However, the effects of such education on the quality of life and inhaler satisfaction remain unclear. Here, we evaluated inhaler handling and adherence, and changes in quality of life and inhaler satisfaction, after repeated education for COPD patients. We prospectively enrolled COPD patients who had used inhalers for over 1 month and evaluated the effects of repeated education. Three visits were made over 6 months; an advanced practice nurse evaluated inhaler technique and adherence, and instructed the patients in inhaler technique during face-to-face sessions. Inhaler technique and adherence were assessed at every visits, and the modified Medical Research Council (mMRC) test, COPD Assessment Test (CAT), EuroQol-5D (EQ-5D), Patient Health Questionnaire (PHQ-9), and Feeling of Satisfaction with Inhaler questionnaire (FSI-10) were administered before (visit 1) and after two educational sessions (visit 3). A total of 261 COPD patients (308 inhalers) were included. Education significantly reduced the proportion of critical errors after two educational sessions (visit 3), from 43.2 to 8.8% (p < 0.001). The proportion of highly compliant patients increased after two visits, from 81.6% to 87.7% (p = 0.005). The FSI-10 score improved significantly after education, from 44.36 ± 4.69 to 47.64 ± 4.08 (p < 0.001); the scores on the other instruments (mMRC, CAT, EQ-5D, and PHQ-9) did not improve. Repeated face-to-face inhaler education by an advanced practice nurse significantly improved inhaler satisfaction, technique, and adherence. However, inhaler education did not significantly improve quality of life.

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Association between medication adherence and health-related quality of life in patients with chronic obstructive pulmonary disease

“…However, amongst the above factors, instructions on how to use inhaler devices were provided at each visit and patients were trained constantly and precisely. Positive effects of constant training of inhaler devices on medication adherence has been proved in some cohort studies containing COPD patients [ 23 , 24 ], but we were not able to evaluate these effects due to limitations pertaining to our study design.…”

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“…The focus on pharmacist training in BufoSwitch is a timely reminder that asthma and COPD represent an area of medicine where, to a greater than normal extent, the success of a course of therapy is—quite literally—in the hands of patients. The importance of patient education in optimizing the delivery of inhaled medication has recently been reaffirmed in a prospective cohort study of nurse-based education in COPD patients in South Korea [ 45 ]. A similar message was delivered, through different conclusions, by the CRITIKAL study ( n = 3660) [ 15 ], in which critical errors in the use of different types of inhaler were associated with poor clinical outcomes.…”