title: Study protocol for a randomized, controlled trial comparing the efficacy of two educational interventions to improve inhalation techniques in patients with chronic obstructive pulmonary disease (COPD): TIEPOC Study.
abstract: BACKGROUND
  An appropriate inhalation technique and adherence to treatment are both critical determinants of the success of chronic obstructive pulmonary disease (COPD) management. We have observed that up to 75% of patients do not use a successful inhalation technique. Knowledge evaluation and frequent reassessment of inhaler use, together with education of patients and healthcare professionals, can significantly improve the benefits that patients with COPD will derive from inhaler therapy. The objective of this study is to test the efficacy of two educational interventions to improve inhalation techniques in patients with COPD.
  
  
  METHODS
  Multicenter randomized controlled trial with 296 patients diagnosed with COPD selected by a non-probabilistic method of sampling from seven Spanish Primary Care Centers. The patients will be divided into three groups by block randomization. The three groups are: 1) control; 2) Intervention A; and 3) Intervention B. The control group will comprise patients with no explanations or written information; the Intervention A group will comprise patients to whom we give written information only; and the Intervention B group will comprise patients to whom we give written information plus instructor training. Every patient in each group will be visited four times during the year of the study at the health centers.
  
  
  CONCLUSIONS
  Our hypothesis is that the application of educational interventions (A or B) in patients with COPD who use inhaler therapy will increase the number of patients who perform a correct inhalation technique by at least 25%. We will evaluate the effectiveness of these interventions on patient inhalation technique improvement, where feasible within the context of clinical practice.
authors.affiliation: Primary Health Care Centre of Vélez-Sur, Health Area Málaga Este-Axarquía, Vélez Málaga (Málaga), Spain;
authors.forename: José
authors.initials: J
authors.lastname: Leiva-Fernández
authors.affiliation: Multiprofessional Family and Community Medicine Teaching Unit of Primary Care Trust Málaga, Málaga, Spain;
authors.forename: Francisca
authors.initials: F
authors.lastname: Leiva-Fernández
authors.affiliation: Multiprofessional Family and Community Medicine Teaching Unit of Primary Care Trust Málaga, Málaga, Spain;
authors.forename: Rubén L
authors.initials: RL
authors.lastname: Vázquez-Alarcón
authors.affiliation: Chair of Health Economics & Rational Use of Drugs, School of Medicine, University of Málaga, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: García-Ruiz
authors.affiliation: Multiprofessional Family and Community Medicine Teaching Unit of Primary Care Trust Málaga, Málaga, Spain;
authors.forename: Daniel
authors.initials: D
authors.lastname: Prados-Torres
authors.affiliation: Multiprofessional Family and Community Medicine Teaching Unit of Primary Care Trust Málaga, Málaga, Spain;
authors.forename: Pilar
authors.initials: P
authors.lastname: Barnestein-Fonseca
keywords: COPD; educational intervention; inhalation techniques; patient empowerment; self-management; treatment adherence