Effectiveness of an educational intervention on different types of errors -occurring during inhaler therapy use in COPD patients during a -Pulmonary Rehabilitation Program

Abstract

Background: Inhaled drug therapy is an essential treatment in Chronic Obstructive Pulmonary Disease (COPD) patients as it reduces symptoms, exacerbation rate and mortality risk. Errors in inhaler use can affect drug delivery to the lungs and minimize treatment benefits. The aim of the study was to evaluate the effect of a nurse-lead educational intervention on inhaler use in a group of patients with COPD during a Respiratory Rehabilitation Program.

Methods: COPD patients attending a Respiratory Rehabilitation Unit for a pulmonary rehabilitation program participated in the educational training program. The nurse-lead educational intervention included a specific checklist used to evaluate each patient's inhalation technique. Errors were scored and classified as device- dependent, device-independent and critical one. Patients completed a pre and post-intervention survey to compare pre and post nurse-lead educational intervention results.

Results: One-hundred twenty-three COPD patients attending a Respiratory Rehabilitation Unit participated in the training program. A high frequency of total errors has been found at baseline (72.1%) whose critical errors represented 35%, irrespective of the severity of airway obstruction, the length of disease history and the educational level. The structured educational intervention resulted in changes on patients' attitudes and skills on inhaler use with a significant reduction in the frequency of all types of errors (P-value < 0.01), particularly total and critical errors (35% and 12.9%, respectively), but not completely eliminated them.

Conclusions: Patient training in the use of the inhaler and regular review of the patient's competence in using the devices by health care professionals remains a crucial aspect of effective inhalation therapy regardless of the disease trajectory. These interventions are feasible and may impact the ability to engage patients in the chronic care journey.

Figure 1

Prevalence of device-dependent errors before (T0) and after (T1) educational training session. Columns represent the number of device-dependent errors according to the device used; lines represent the relative percentage.

Figure 2

Prevalence of critical errors before (T0) and after (T1) educational training session. Columns represent the number of critical errors according to the type of inhaler used; lines represent the relative percentage.