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Many COPD patients use inhalers incorrectly; short courses can improve technique

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September 29, 2021

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In a new study, a high proportion of COPD patients misused their pressurized metered dose inhalers, but inhalation techniques improved with short clinical training, reported researchers in BMC Pulmonary Medicine.

The percentage of patients who used their inhaler incorrectly was 43.5% before individual clinic coaching and improved to 12.9% after training (P <.001 depending on the results.>

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“The confidence of patients with COPD in their inhalation technique has been shown to be directly linked to their adherence to treatment and their state of health” Jin Sun Kim, MARYLAND, a resident physician in the division of pulmonary care, intensive care and sleep medicine at the School of Medicine at the University of Saint Louis, Saint Louis, and colleagues have written. “Unfortunately, the literature reports a high prevalence of poor inhalation technique in patients with COPD and asthma.”

The prospective study included 101 patients with COPD (mean age, 63.7 years; 40% male) who used pressurized metered-dose inhalers. Researchers evaluated patients’ inhalation techniques and provided one-on-one training on the active inhaler using the 12-step instructions from the American Thoracic Society. After clinical training, the researchers evaluated the inhalation technique of all patients.

The researchers obtained follow-up data on 62 patients (61%) in the study.

In addition to the overall improvement in abuse, the number of errors decreased from an average of 3.1 before inhaler training to 1.7 after the training period (P <.001 the number of patients to be treated avoid misuse was according results.>

In a sensitivity analysis, individuals lost to follow-up were assumed to have continued to abuse the inhaler if they demonstrated initial misuse, and those with correct use were assumed to have continued to use the inhaler correctly. With these data, the percentage of patients with inhaler misuse increased from 45.5% to 26.7% (P <.001 with a number needed to treat patients avoid misuse.>

Additionally, researchers observed a higher likelihood of pressurized MDI abuse in people with impaired cognitive function (42%) and dementia (62%) compared to people with normal cognition (36 %). These patients were also less likely to demonstrate improvement in inhalation technique after the training period.

“More research is needed to determine if other teaching methods, inhaler choices or other interventions may be appropriate for patients based on cognitive function given the high co-morbidity of COPD and disorders neurocognitive, ”the researchers wrote.


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