Effectiveness of an intervention in patients with chronic obstructive pulmonary disease (COPD) to improve inhalation technique over time

05 May 2022
Clinical Research Results Abstract Background: Aim: The objective of this study is to evaluate the efficacy of two educational interventions to improve the inhalation techniques in patients with Chronic Obstructive Pulmonary Disease (COPD) and to determine which is the most effective. Methods: Partial randomized controlled trial (comprehensive cohort design). Subjects: 465 COPD patients using inhalation therapy; non-probabilistic sampling. Intervention: Five cohorts; three randomized: (A) written instructions, (B) inhalation technique training with an instructor, (C) usual clinical practice; and two non-randomized (patient preference): (A) written instructions, (B) inhalation technique training with an instructor. Follow-up: baseline, 1, 3, 6 and 12 months. Variables: correct inhalation technique (CIT), dyspnea, quality of life (EuroQol-5D, St George), spirometry, smoking habit, previous inhalation technique training, sex, age, educational level, cognitive level, COPD treatment. Descriptive (mean and standard deviation; absolute and relative frequency, 95% confidence interval), bivariate and multivariate analysis. Efficacy of interventions: Number needed to treat (NNT) and relative risk (RR). Results: Baseline: 7.1% CIT, per device: 8.3% pressured-metered-dose-inhaler (pMDI), 8.7% Handihaler, 14.4% Accuhaler, 18.5% Turbuhaler. Factors associated with CIT: sex (p=0.053), educational level (p=0.07), use of long-action beta-2-adrenergic (p=0.063), inhaled corticoids (p=0.015), MiniMental Test (p=0.018), training (p=0.57 explanation, p=0.053 demonstration). Multivariate results (global classification 74.4%, specificity 76.6%, sensitivity 46.7%): inhaled corticoids (OR=3.94), training and explanation (OR=0.413), sex (OR=2.967), time since last training (OR=0.991). CIT at follow-up/arm trial: baseline: A:8.4%, B:6.7%, C:11.6%; 1 month: A:18.8%, B:41.1%, C:17.6%; 3 months: A:20.2%, B:55.1%, C:14%; 6 months: A:14.3%, B:34.8%, C:15.1%; 12 months: A:19%, B:47.2%, C:16.3%. NNT=2.44 (CI95% 1.87-3.5) at 3 months and NNT = 3.22 (CI95% 2.27-5.52) at 12 month follow-up in B cohort with meaningful association (p<0.0001). Discussion: Receiving an educational intervention with instructor about the CIT improves the rate of patients performing the technique correctly and it is advised that a repetition of this training is performed again at 3 months. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest Authors declare no competing interest.This clinical research is of great relevance in the context of strategies seeking to improve COPD patients’ use of inhalers by training patients through an instructor and it portrays an answer to one of the most interesting questions to the IPCRG audience as it compares different interventions and show meaningful association between the instructor-led educational intervention and improvement in inhalation technique. It also states that the intervention should be repeated at 3 months in order to maximize the improvement.ISRCTN Registry Identifier ISRCTN15106246. Funded by: PI 0492/09 y EC10-193. References and Clinical Trial Registry Information

Resource information

Respiratory conditions
  • COPD
Type of resource
Malaga 2022
Virginia Patricia Aguiar-Leiva, Instituto CUDECA de Estudios e Investigación en Cuidados Paliativos, Fundación CUDECA, Málaga, España. Instituto de Investigación Biomédica de Málaga-IBIMA Grupo CA-15.