Effectiveness of an educational intervention on different types of errors occurring during inhaler therapy use in COPD patients during a Pulmonary Rehabilitation Program
Keywords:
COPD, inhaler, errors, educational interventionAbstract
Background: Inhaled drug therapy is an essential treatment in Chronic Obstructive Pulmonary Disease (COPD) patients as it reduces symptoms, exacerbation rate and mortality risk. Errors in inhaler use can affect drug delivery to the lungs and minimize treatment benefits. The aim of the study was to evaluate the effect of a nurse-lead educational intervention on inhaler use in a group of patients with COPD during a Respiratory Rehabilitation Program.
Methods: COPD patients attending a Respiratory Rehabilitation Unit for a pulmonary rehabilitation program participated in the educational training program. The nurse-lead educational intervention included a specific checklist used to evaluate each patient’s inhalation technique. Errors were scored and classified as device-
dependent, device-independent and critical one. Patients completed a pre and post-intervention survey to compare pre and post nurse-lead educational intervention results.
Results: One-hundred twenty-three COPD patients attending a Respiratory Rehabilitation Unit participated in the training program. A high frequency of total errors has been found at baseline (72.1%) whose critical errors represented 35%, irrespective of the severity of airway obstruction, the length of disease history and the educational level. The structured educational intervention resulted in changes on patients’ attitudes and skills on inhaler use with a significant reduction in the frequency of all types of errors (P-value < 0.01), particularly total and critical errors (35% and 12.9%, respectively), but not completely eliminated them.
Conclusions: Patient training in the use of the inhaler and regular review of the patient’s competence in using the devices by health care professionals remains a crucial aspect of effective inhalation therapy regardless of the disease trajectory. These interventions are feasible and may impact the ability to engage patients in the chronic care journey.
References
1. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary - PMC, 2023.
2. Martinez FJ, Rabe KF, Ferguson GT. Reduced all-cause mortality in the ETHOS trial of budesonide/glycopyrrolate/formoterol for chronic obstructive pulmonary disease. A randomized, double-blind, multicenter, parallel-group study. Am J Respir Crit Care Med 2021; 203: 553-64.
3. Lavorini F, Fontana GA, Usmani OS. New inhaler devices - the good, the bad and the ugly. Respiration 2014; 88: 3-15.
4. Chrystyn H, van der Palen J, Sharma R, Barnes N, Delafont B, Mahajan A, et al. Device errors in asthma and COPD: systematic literature review and meta-analysis. NPJ Prim Care Respir Med 2017; 27: 22.
5. Price DB, Román-Rodríguez M, McQueen RB, Bosnic-Anticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes. J Allergy Clin Immunol Pract 2017; 5: 1071-81.
6. Molimard M, Raherison C, Lignot S, Balestra A, Lamarque S, Chartier A, et al. Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients. Eur Respir J 2017; 49:1601794.
7. Usmani OS, Lavorini F, Marshall J, Dunlop WCN, Heron L, Farrington E, et al. Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes. Respir Res 2018; 19: 10.
8. Chrystyn H, van der Palen J, Sharma R, Barnes N, Delafont B, Mahajan A, et al. Device errors in asthma and COPD: systematic literature review and meta-analysis. NPJ Prim Care Respir Med 2017; 27: 22.
9. Zhang MW, Ho RC, Cheung MW, Fu E, Mak A. Prevalence of depressive symptoms in patients with chronic obstructive pulmonary disease: a systematic review, meta-analysis and meta-regression. Gen Hosp Psychiatry 2011; 33: 217-23.
10. Atlantis E, Fahey P, Cochrane B, Smith S. Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. Chest 2013; 144: 766–77.
11. Willgoss TG, Yohannes AM. Anxiety disorders in patients with COPD: a systematic review. Respir Care 2013; 58: 858-66.
12. Panagioti M, Scott C, Blakemore A, Coventry PA. Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9: 1289-306.
13. Halpin DMG, Mahler DA. Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD. BMJ Open Respir Res 2024; 11: e002211.
14. Vitacca M, Paneroni M, Fracassi M, Mandora E, Cerqui L, Benedetti G, et al. Inhaler technique knowledge and skills before and after an educational program in obstructive respiratory disease patients: a real-life pilot study. Pulmonology 2023; 29:130–37.
15. Collier DJ, Wielders P, van der Palen J, Heyes L, Midwinter D, Collison K, et al. Critical error frequency and the impact of training with inhalers commonly used for maintenance treatment in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2020; 15:1301-13.
16. Sulku J, Janson C, Melhus H, Ställberg B, Bröms K, Högman M, et al. Changes in critical inhaler technique errors in inhaled COPD treatment - a one-year follow-up study in Sweden. Respir Med 2022; 197: 106849.
17. Plaza V, Giner J, Rodrigo GJ, Dolovich MB, Sanchis J. Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. J Allergy Clin Immunol Pract 2018; 6(3):987-995.
18. Van der Palen J, Thomas M, Chrystyn H, Sharma RK, van der Valk PD, Goosens M, et al. A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices. NPJ Prim Care Respir Med 2016; 26: 16079.
19. W H Kocks J, Wouters H, Bosnic-Anticevich S, van Cooten J, Correia de Sousa J, Cvetkovski B, et al . Factors associated with health status and exacerbations in COPD maintenance therapy with dry powder inhalers. NPJ Prim Care Respir Med 2022; 32: 18.
20. Leving MT, Bosnic-Anticevich S, van Cooten J, de Sousa JC, Cvetkovski B, Dekhuijzen R, et al. Clinical recommendations for dry powder inhaler use in the management of COPD in primary care. NPJ Prim Care Respir Med 2022; 32: 59.
21. Leving M, Wouters H, de la Hoz A, Bosnic-Anticevich S, Dekhuijzen R, Gardev A, et al. Impact of PIF, inhalation technique and medication adherence on health status and exacerbations in COPD: protocol of a real-world observational study (PIFotal COPD Study). Pulm Ther 2021; 7: 591-606.
22. Cho-Reyes S, Celli BR, Dembek C, Yeh K, Navaie M. Inhalation technique errors with metered-dose inhalers among patients with obstructive lung diseases: a systematic review and meta-analysis of U.S. Studies. Chronic Obstr Pulm Dis 2019; 6: 267-80.
23. Braido F, Lavorini F, Blasi F, Baiardini I, Canonica GW. Switching treatments in COPD: implications for costs and treatment adherence. Int J Chron Obstruct Pulmon Dis 2015; 10: 2601-8.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Mattioli 1885 has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.