Misuse of respiratory inhalers in hospitalized patients with asthma or COPD.
BACKGROUND
Patients are asked to assume greater responsibility for care, including use of medications, during transitions from hospital to home. Unfortunately, medications dispensed via respiratory inhalers to patients with asthma or chronic obstructive pulmonary disease (COPD) can be difficult to use.


OBJECTIVE
To examine rates of inhaler misuse and to determine if patients with asthma or COPD differed in their ability to learn how to use inhalers correctly.


METHODS
A cross-sectional and pre/post intervention study at two urban academic hospitals.


METHODS
Hospitalized patients with asthma or COPD.


METHODS
A subset of participants received instruction about the correct use of respiratory inhalers.


METHODS
Use of metered dose inhaler (MDI) and Diskus devices was assessed using checklists. Misuse and mastery of each device were defined as <75% and 100% of steps correct, respectively. Insufficient vision was defined as worse than 20/50 in both eyes. Less-than adequate health literacy was defined as a score of <23/36 on The Short Test of Functional Health Literacy in Adults (S-TOFHLA).


RESULTS
One-hundred participants were enrolled (COPD n = 40; asthma n = 60). Overall, misuse was common (86% MDI, 71% Diskus), and rates of inhaler misuse for participants with COPD versus asthma were similar. Participants with COPD versus asthma were twice as likely to have insufficient vision (43% vs. 20%, p = 0.02) and three-times as likely to have less-than- adequate health literacy (61% vs. 19%, p = 0.001). Participants with insufficient vision were more likely to misuse Diskus devices (95% vs. 61%, p = 0.004). All participants (100%) were able to achieve mastery for both MDI and Diskus devices.


CONCLUSIONS
Inhaler misuse is common, but correctable in hospitalized patients with COPD or asthma. Hospitals should implement a program to assess and teach appropriate inhaler technique that can overcome barriers to patient self-management, including insufficient vision, during transitions from hospital to home.
Department of Medicine, University of Chicago, Instructor, Section of Hospital Medicine, Chicago, IL 60637, USA. vpress@medicine.bsd.uchicago.edu
Valerie G
VG
Press
Vineet M
VM
Arora
Lisa M
LM
Shah
Stephanie L
SL
Lewis
Krystal
K
Ivy
Jeffery
J
Charbeneau
Sameer
S
Badlani
Edward
E
Nareckas
Edward
E
Naurekas
Antoinette
A
Mazurek
Jerry A
JA
Krishnan
D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods; D004868:Equipment Failure; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers / Q000592:standards / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy*; D012648:Self Care / Q000379:methods / Q000592:standards
J Med Syst. 1999 Oct;23(5):349-56
10587915
Patient Educ Couns. 1997 Dec;32(1 Suppl):S87-95
9516764
Am J Respir Crit Care Med. 1998 Jun;157(6 Pt 1):1810-7
9620910
J Hosp Med. 2007 Sep;2(5):314-23
17935242
Patient Educ Couns. 1999 Sep;38(1):33-42
14528569
Pharm World Sci. 2005 Oct;27(5):393-8
16341746
Arch Intern Med. 2005 Sep 12;165(16):1842-7
16157827
Arch Intern Med. 2007 Jul 23;167(14):1503-9
17646604
Ann Intern Med. 2004 Oct 5;141(7):533-6
15466770
Am J Emerg Med. 1996 Jul;14(4):380-4
8768160
J Am Geriatr Soc. 2004 Nov;52(11):1817-25
15507057
Chest. 2005 Jan;127(1):335-71
15654001
Eur Respir J. 1999 Nov;14(5):1034-7
10596686
Chest. 1998 Oct;114(4):1008-15
9792569
Chest. 2003 Sep;124(3):834-43
12970006
Ann Allergy Asthma Immunol. 2001 Apr;86(4):421-4
11345285
Eur J Clin Pharmacol. 1996;49(4):255-9
8857069
Eur Respir J. 2004 Jun;23(6):932-46
15219010
Am J Respir Crit Care Med. 2008 Aug 15;178(4):332-8
18511702
Respir Med. 2003 Oct;97(10):1126-33
14561020
Patient Educ Couns. 2007 Jul;67(1-2):157-68
17451909
Am J Respir Crit Care Med. 2005 Oct 15;172(8):980-6
16081544
Acta Biomed. 2007 Dec;78(3):233-45
18330086
Mayo Clin Proc. 2008 May;83(5):529-35
18452681
Chest. 1994 Mar;105(3):715-7
8131531