Healthcare Providers Struggle to Teach Patients With COPD Proper Inhaler Technique

Healthcare professionals showed a lack of knowledge about how to assess and teach proper inhaler technique (IT) to their patients with chronic obstructive pulmonary disease, asthma, or other respiratory diseases, according to a review of 55 studies examining their understanding of this issue.

The report, published ahead of print by Journal of Allergy and Clinical Immunology: In Practice, looked at studies published between 1975 and 2014. It is the first systematic review showing that a majority of healthcare professionals do not use the main inhaler types, pressurized metered dose (pMDI) and dry powder (DPI) inhalers, correctly.

Researchers were also surprised to learn that IT skills among healthcare professionals have worsened in recent years despite extensive training efforts, and they said there is an urgent need to design efficient training strategies aimed at providers.

Poor IT is common and is linked with a worsening of disease, control of symptoms, and severity; hospitalizations; and the need for oral steroids and antimicrobials. Not knowing how to use an inhaler properly is also an important adherence-related barrier, especially among elderly patients.

Correct technique depends on the inhaler type, so patients and providers need to have specific training in the use of any particular device.

According to clinical practice guidelines, all patients should be trained in proper inhaler use before receiving a prescription for a new device. Guidelines also recommend regular assessment of the patient's technique at each visit, and and assessment is recommended before deciding that current therapy is insufficient and dose escalation is required.

This review extracted data from 55 studies involving 6304 providers who performed 9996 tests. Just 15.5% of the providers showed proper IT (95% CI, 12-19.3). During 1975-1995, the rate was as high as 20.5% (95% CI, 14.9-26.8). This fell to 10.8% (95% CI, 7.3-14.8) during 1996-2014.

Providers had the highest rate of error with DPI devices:

• 89% showed deficient preparation (95% CI, 82-95)
• 79% showed not breathing out completely before inhalation (95% CI, 68-87)
• 76% showed no breath-hold (95% CI,
 67-84).

They were only slightly better showing how to use pMDIs: 


• 75% did not breathe out completely before inhalation (95% CI, 56-90)
• 64% demonstrated a lack of coordination (95% CI, 29-92)
• 63% did not show a postinhalation breath-hold (95% CI, 52-72).

Reference

Plaza V, Giner J, Rodrigo GJ, Dolovich MB, Sanchis J. Errors in the use of inhalers by healthcare professionals: a systematic review [published online January 31, 2018]. J Allergy Clin Immunol Pract. doi: 10.1016/j.jaip.2017.12.032.