title: Teaching the use of respiratory inhalers to hospitalized patients with asthma or COPD: a randomized trial.
abstract: BACKGROUND
  Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population.
  
  
  OBJECTIVE
  To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD.
  
  
  METHODS
  Hospitalized adults (age 18 years or older) with asthma or COPD.
  
  
  METHODS
  Participants were randomized to brief intervention [BI]: single-set of verbal and written step-by-step instructions, or, teach-to-goal [TTG]: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back).
  
  
  METHODS
  The primary outcome was metered-dose inhaler (MDI) misuse post-intervention (<75% steps correct). Secondary outcomes included Diskus® misuse, self-reported inhaler technique confidence and prevalence of 30-day health-related events.
  
  
  RESULTS
  Of 80 eligible participants, fifty (63%) were enrolled (BI n=26, TTG n=24). While the majority of participants reported being confident with their inhaler technique (MDI 70%, Diskus® 94%), most misused their inhalers pre-intervention (MDI 62%, Diskus® 78%). Post-intervention MDI misuse was significantly lower after TTG vs. BI (12.5 vs. 46%, p=0.01). The results for Diskus® were similar and approached significance (25 vs. 80%, p=0.05). Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI (1 vs. 8, p=0.02).
  
  
  CONCLUSIONS
  TTG appears to be more effective compared with BI. Patients over-estimate their inhaler technique, emphasizing the need for hospital-based interventions to correct inhaler misuse. Although TTG was associated with fewer post-hospitalization health-related events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education.
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, MC 5000, W328, Chicago, IL 60637, USA. vpress@medicine.bsd.uchicago.edu
authors.forename: Valerie G
authors.initials: VG
authors.lastname: Press
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Shah
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Lewis
authors.forename: Jeffery
authors.initials: J
authors.lastname: Charbeneau
authors.forename: Edward T
authors.initials: ET
authors.lastname: Naureckas
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Krishnan
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D001249:Asthma; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers / Q000706:statistics & numerical data*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology