Effect of Inhaler Technique Education on Acute Exacerbations and Disease Control in Patients with Asthma and COPD

Abstract

Inhaled therapy is the most widely used treatment for patients with asthma and chronic obstructive pulmonary disease(COPD) but most of them do not use their inhalers correctly. Inhaler technique education may improve clinical outcomes. The objectives of this study were to: (1) evaluate the effect of inhaler technique education, and (2) investigate factors associated with incorrect inhaler technique among patients with asthma or COPD who had history of severe exacerbations in Sawanpracharak hospital. A quasi-experimental study was conducted in 42 patients with asthma or COPD who had history of severe exacerbations. Inhaler technique was assessed at baseline. All patients were trained on how to use the inhaler with placebo devices provided by pulmonologist every 3 months for 1-year follow-up. Severe exacerbations and hospitalizations, ACT, CAT and mMRC were recorded. Among 42 patients, 21 were asthma (50%) and, 25 were COPD (64.1%) with mean age of 61.35±15.83 years. A total of 38 patients (90.48%) used inhaler devices incorrectly at baseline. After receiving inhaler technique education, percentage of incorrect inhaler technique decreased from 90.48% to 17.95% (p<0.05). Severe exacerbations reduced from 4.21±5.23/year to 1.14±2.59/year (p<0.05) and hospitalizations reduced from 2.02±3.41/year to 0.59±1.74/year (p<0.05). ACT for asthma and CAT for COPD patients were significantly improved but there was no significant difference in mMRC. Patients who never received inhaler technique education by physician are associated with incorrect inhaler technique (OR=11.25, 95% CI 1.26-123.24; p<0.05). Incorrect inhaler technique is common in this study. Inhaler technique education provided by pulmonologist during OPD visit could reduce inhaler technique errors, severe exacerbations, hospitalizations and symptoms. This study demonstrates the importance of inhaler technique education during OPD visit. Physician should evaluate and provide instructions on correct inhalation technique. Careful monitoring and inhaler technique education are important for asthma and COPD treatment, particularly in frequent exacerbators.