In-Person or Video-Based Inhaler Education for Patients With Asthma: Is One Better Than the Other?

A phase IV noninferiority trial evaluating the difference between video-based and face-to-face inhaler education for patients with asthma did not find a difference in the endpoints that were analyzed. The results were published in PLoS One.

Inhalers are commonly used to deliver asthma medications directly into the lungs, thereby bypassing first-pass metabolism. This is advantageous because it not only allows a higher concentration of the drug to reach the lungs, but it also reduces the probability of systemic adverse events.

One issue with inhalers is that unlike tablets, the device requires proper technique to deliver the medication to the patient. Proper guidance from healthcare professionals is paramount but is costly and time consuming. A basic video that patients can review and learn from is suggested to be able to obtain similar results as face-to-face education while being more cost-effective. Park et al designed their noninferiority trial to evaluate if there were any asthma end point differences between the 2 modes of patient education.

Read more about inhaler education struggles among providers

Patients with partly controlled or well-controlled asthma were randomly assigned to either receive video-based or face-to-face education. The drug used for these patients was Fluterol (fluticasone propionate and salmeterol xinafolate), a dry powder inhaler. Asthma end points that were observed were change in baseline of forced expiratory volume at 1 second (FEV₁) at 4 and 12 weeks, asthma control test (ACT) scores, inhaler technique scores, and adherence scores.

At the end of both the 4-week and 12-week period, FEV₁ significantly improved in both video-based and face-to-face education groups (P <.01). Similarly, ACT, inhaler technique, and adherence scores significantly improved in both groups (P <.01). The authors did not observe any significant differences in superiority between either method. Additionally, no adverse events directly pertaining to the educational methods were observed for either technique.

However, subgroup analysis in stratified patients with well-controlled asthma that were 60 years or older identified 1 difference between the 2 education methods: video-based education significantly improved FEV₁ but face-to-face education did not. The authors hypothesize that video-based education allowed the video to be replayed multiple times as needed without the patient feeling guilty about asking a healthcare provider.

Aside from this subgroup of patients 60 years or older, trial results did not find a significant difference between face-to-face and video-based education for all asthma end points analyzed. Although these results may not hold true for patients with poorly-controlled asthma who may require more intensive education, patients with well-controlled or partly-controlled asthma may be suitable to receive video-based education rather than face-to-face education as an effective method to save time and reduce healthcare costs.

Reference

Park HJ, Byun MK, Kwon JW, et al. Video education versus face-to-face education on inhaler technique for patients with well-controlled or partly-controlled asthma: a phase IV, open-label, non-inferiority, multicenter, randomized, controlled trial [published online August 1, 2018]. PLoS One. doi: 10.1371/journal.pone.0197358.