Valerie G. Press|Vineet M. Arora|Kristin Constantine Trela|Richa Adhikari|Frank J. Zadravecz|Chuanhong Liao|Edward T. Naureckas|Steven R. White|David Meltzer|Jerry A. Krishnan
Effectiveness of Interventions to Teach Metered-Dose and Diskus Inhaler Techniques. A Randomized Trial
General Department of Preventive Medicine|University of Michigan–Ann Arbor|University of Illinois at Chicago|Chicago Department of Public Health|University of Chicago|Pulmonary and Critical Care Associates|Pulmonary and Critical Care Associates|University of Illinois at Chicago
rationalethe effective approach teaching respiratory inhaler technique unknownobjectives evaluate relative effects two different educational strategies teachtogoal instruction vs brief verbal instruction adults hospitalized asthma chronic obstructive pulmonary disease methodswe conducted randomized clinical trial two urban academic hospitalsparticipants received teachtogoal brief instruction hospital followed 90 days dischargeinhaler technique assessed using standardized checklists misuse defined 75 steps less correct 9 12 stepsthe primary outcome metereddose inhaler misuse 30 days postdischargesecondary outcomes included diskus technique acute care events 30 90 days associations adherence health literacy site patient risk nearfatal eventmeasurements main results 120 participants 73 female 90 african americanbefore education metereddose inhaler misuse similarly common teachtogoal brief intervention groups 92 vs 84 respectively p 02metereddose inhaler misuse significantly less common teachtogoal group brief instruction group 30 days 54 vs 70 respectively p 011 immediately education 11 vs 60 respectively p 0001 90 days 48 vs 76 respectively p 0003similar results found diskus deviceparticipants differ across education groups regard rescue metereddose inhaler use diskus device adherence 30 90 daysacute care events less common among teachtogoal participants brief intervention participants 30 days 17 vs 36 respectively p 002 90 days 34 vs 38 respectively p 06participants low health literacy receiving teachtogoal instruction less likely brief instruction participants report acute care events within 30 days 15 vs 70 respectively p 0008no differences existed site patient risk 30 90 days p 005 conclusionsin adults hospitalized asthma chronic obstructive pulmonary disease inhospital teachtogoal instruction inhaler technique reduce inhaler misuse 30 days associated fewer acute care events within 30 days dischargeinpatient treatmenttogoal education may important first step toward improving selfmanagement health outcomes hospitalized patients asthma chronic obstructive pulmonary disease especially among patients lower levels health literacyclinical trial registered wwwclinicaltrialsgovnct01426581