Getting patients with COPD to properly use their inhalers is one of the greatest challenges to effective delivery of medication. Cognitive function, hand dexterity and breathing ability play an important role in this process.
That’s according to the paper, “Inhaler Technique in Chronic Obstructive Pulmonary Disease: Patient Impairments and Bronchodilation,” published in the Annals of the American Thoracic Society.
The multicenter, prospective, cohort study enrolled stable outpatients with COPD based on their use of handheld maintenance bronchodilators. Researchers recorded participants’ demographic information along with information on their inhaled COPD medications and delivery systems during their first visit.
Patients returned anywhere from two to 21 days later and were instructed to bring, but not use, their inhalers on the day of their second visit. For that visit, spirometry and flow against a medium-low resistance were measured and patients were told to use their inhalers as they do at home. They were then observed and critiqued on their usage via a standardized checklist.
Of the 503 patients in the study, the median age was 70 years and the majority (55%) were male. While most of them (71%) demonstrated acceptable inhaler technique, researchers determined that cognitive impairment, nonfunctional manual dexterity and suboptimal peak inspiratory flow were associated with unacceptable inhaler technique.
In patients with acceptable inhaler technique, researchers found that greater increases in lung function at 30 minutes after inhalation were achieved than in those with unacceptable technique. They also found that instructing a person to hold their breath for up to 10 seconds was the only technique that improved acute bronchodilation.
“Proper inhaler technique remains one of the most important and modifiable factors in COPD treatment. Our findings reinforce that selecting the right inhaled medication delivery system requires more than understanding a person’s lung function alone,” said lead author Donald Mahler, MD, of the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, in a press release. “Health care providers should consider cognitive function, manual dexterity and inhalation ability when choosing and reviewing inhaled therapies to ensure people receive the greatest possible benefit from their prescribed treatments.”
