Patients with chronic obstructive pulmonary disease who received training during hospitalisation showed improved inhaler technique at discharge.

Patients often use inhaled medications incorrectly, which can lead to decreased symptom control and increased exacerbations (NEJM JW Gen Med Sep 15 2016 and Chest 2016; 150: 394-406). Hospitalisation offers an opportunity both to assess and to re-educate patients on critical inhaler-use techniques. Swiss investigators performed a single-centre prospective cohort study of 93 patients with chronic obstructive pulmonary disease (COPD) who were admitted for exacerbations (62%) or other reasons. Intervention patients received the following:

• standardised assessment of inhaler technique and peak inspiratory flow on admission
• a written guide to assist physicians in inhaler selection
• patient education (and teach-back) by a respiratory therapist to correct inhaler technique errors.

Control patients received standard care (i.e. assessment and training in inhaler technique only if recommended by the treating physician). All patients were assessed for inhaler technique and peak inspiratory flow at discharge.

Compared with control patients, intervention patients made significantly fewer critical errors in inhaler technique (57% vs 19%) and had fewer episodes of insufficient peak inspiratory flow (16% vs 3%) at the time of hospital discharge.

Comment: Incorrect inhaler technique was common among these hospitalised patients with COPD; I suspect that findings would be similar in other clinical settings. This study demonstrated that inhaler technique can be improved dramatically with structured training during an inpatient stay. Although standardised training might not be feasible in all hospitals, clinicians can order inhaler training by a respiratory therapist or personally can assess, educate and solicit teach-back on inhaler use for patients with COPD.

Daniel D. Dressler, MD, MSc, MHM, FACP, Professor of Medicine, Emory University School of Medicine, Atlanta, USA.

Grandmaison G, et al. An in-hospital intervention to reduce the proportion of misused inhalers at hospital discharge among patients with COPD: a non-randomised intervention study. Swiss Med Wkly 2024; 154: 3394.

This summary is taken from the following Journal Watch titles: General Medicine, Hospital Medicine.