Authors (including presenting author) :
Choi HTN(1), Wong LYL(1), Lau WM(1), Cheung LP(1), Yee KS(2)
Affiliation :
(1) Pharmacy Department, Our Lady of Maryknoll Hospital (2) Department of Tuberculosis and Chest, Wong Tai Sin Hospital
Introduction :
Chronic obstructive pulmonary disease (COPD) and asthma are two leading causes of mortality, high healthcare utilization and economic burden worldwide. Over 60% of patients are not using their inhalers correctly, leading to therapy failure and poor disease control. There is a need to identify a more effective inhaler training method to improve the situation.
Objectives :
Only written inhaler training materials are currently used in Our Lady of Maryknoll Hospital (OLMH). This study aims to examine the impact on patient’s inhaler technique after video training, and to compare that against reading written instructions.
Methodology :
This prospective, randomized, assessor-blinded, controlled study was conducted in OLMH from Feb-Jul 2018. Eligible patients of chest specialist outpatient clinic with COPD or asthma, and using at least one inhaler were randomly assigned to receive training with video or written instructions (control) in 1:1 ratio. Inhaler technique was assessed with a 9-steps scoring checklist at baseline and post-training by a blinded assessor. The same blinded assessor would provide subsequent counselling if patient’s inhaler technique was inadequate after training. The outcomes were inhaler technique score pre- and post-training, and time required in re-assessment and subsequent counselling.
Result & Outcome :
Mean baseline technique score was 6.22 for metered-dose inhaler (MDI) (n=33); 6.67 for Respimat (n=27); and 6.71 for capsule-based inhaler (n=28). Inhaler technique scores were significantly improved in video group post-training for all inhalers (MDI: +1.88, p<0.001, Respimat: +2.08, p<0.001, capsule-based inhaler: +1.86, p<0.001). In contrast, improvement was insignificant for all inhalers in control. Mean time required for re-assessment and subsequent counselling was 1.5 minutes/case in video group and 7.1 minutes/case in control, with significant difference of 5.8 minutes/case for MDI, 5.2 minutes/case for Respimat and 5.6 minutes/case for capsule-based inhaler (p<0.001). In conclusion, baseline inhaler technique was unsatisfactory, implying a need for a more effective training method. Patients’ inhaler technique was significantly improved after video training, and less counselling time was required in video group. Incorporation of videos for patient education is effective and time-saving in improving patients’ inhaler technique. Introducing video training as a mean of patient education could be considered.
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