Recent survey points to the need for better education for COPD patients on how to use inhalers.

Chronic obstructive pulmonary disease (COPD) is a respiratory disorder that affects millions of patients and leads to substantial morbidity, mortality, disability, impaired quality of life, and increased health care costs. As the COPD Outcomes-based Network for Clinical Effectiveness & Research Translation (CONCERT) explains:

“Chronic Obstructive Pulmonary Disease (COPD) is a respiratory disorder that affects about 300 million patients worldwide and 30 million patients in the US alone.  COPD carries a substantial burden in human suffering. Dyspnea and other respiratory symptoms are common and can be disabling. Respiratory infections and exposure to environmental triggers lead to episodic deteriorations (acute exacerbations of COPD; AE-COPD) and result in over 700,000 hospitalizations and 100,000 deaths each year in the U.S. alone. 

“Deaths from COPD are increasing and are likely to become the 3rd leading cause of death, ahead of cerebrovascular accidents, in the U.S. by 2020. In addition, the financial burden of COPD is enormous, with various estimates suggesting annual healthcare expenditures in the U.S. of $30 to $70 billion each year. Moreover, the health and economic burden of COPD is growing despite the availability of an increasing evidence-base from randomized clinical trials that have established the efficacy of numerous therapies that reduce morbidity and mortality from COPD (i.e., smoking cessation, pharmacotherapy, lung volume reduction surgery, long-term oxygen therapy, and non-invasive positive pressure ventilation).”

COPD inhalers are often prescribed to manage COPD exacerbations. The 2017 Recommendations of the Global Initiative for Obstructive Lung Disease (usually referred to as GOLD) emphasize the importance of making sure patients know how to properly use their inhalers:

Inhaler technique should be demonstrated for all patients and technique confirmed before concluding a medication is not working.

However, in a recent survey, “The Role of Inhalation Delivery Devices in COPD: Perspectives of Patients and Health Care Providers,” researchers from the American College of Chest Physicians surveyed 513 healthcare providers managing COPD and 499 patients with COPD across the United States and found that both patients and healthcare providers place less importance on inhaler devices than medication in the treatment of chronic obstructive pulmonary disease (COPD):

Our findings unveil important HCP and patient perspectives about the role of inhalation devices in COPD treatment. Of note, both groups place more importance on the actual medication than its delivery device.  

Moreover, the researchers found significant gaps in the training and education of patients on proper inhaler use:

Interestingly, although most HCPs did not report consistently checking device technique in newly diagnosed patients, the majority reported providing individualized one-on-one training, although less often by PCPs. Furthermore, patients did not identify education as a significant impediment to proper device use, but most patients reported undergoing some type of device training, particularly if treated by PUDs. However, the educational experiences reported by patients were well short of universal, in relative contradistinction to the high educational efforts reported by HCPs. Greater efforts toward device education were associated with patients’ higher satisfaction with their COPD management, suggesting the benefits of education extend beyond a patient’s comfort level with device use.

Unfortunately, rather than resort to better education when faced with patients with frequent exacerbations, the majority of healthcare providers (HCPs) (87%) reported that they were much more likely to change or add medications than to switch to a different inhaler while maintaining the same medication:

The majority of HCPs (87%) reported that they were much more likely to change or add medications than to switch to a different inhalation device with the same medication in patients with established COPD experiencing frequent exacerbations. Hospitalists (46%) and PUDs (41%) were reported to be the most likely to determine which medications and devices a patient is prescribed upon hospital discharge. The majority of PCPs and NPPs maintained the treatment plan provided upon discharge, whereas 50% of PUDs devised a new one.

This research underscores the need for better training and education on proper inhaler usage. Physicians should be ascertaining whether the medication prescribed is in fact being delivered in the correct way before increasing the dosage or changing medications. As Nicola A. Hanania, MD, MS and her colleagues concluded about the survey:

In summary, our study uncovers several gaps in HCP and patient understanding of the role of inhalation devices in COPD management. It also highlights potential unmet needs and opportunities for future interventions to coordinate professional and patient-directed education to further promote proper device selection and use in COPD management.

• Respiratory Compromise