Comparison of Inhaler Device Techniques Before and After Training in Patients with Chronic Obstructive Pulmonary Disease

Introduction: In the treatment of Chronic Obstructive Pulmonary Disease (COPD), the administration of drugs with an inhaler is often used. Improper usage of inhaler devices can result in suboptimal therapeutic effects which in turn can lead to the prescription of additional dose or drug with a higher tendency of developing side-effects. Very often patients are prescribed inhaler medications without adequate education on device usage. Aim: To compare the techniques of inhaler devices usage, before and after training in patients with COPD. Materials and Methods: An institutional-based, prospective study was conducted among COPD patients attending the Department of Pulmonary Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from March 2020 to September 2020. A total of 250 patients who met the diagnostic criteria recommended by Global initiative for chronic Obstructive Lung Disease (GOLD), previously on inhaler medications using pressurised Meter Dose Inhaler (pMDI), pMDI with spacer, Rotahaler (R) or Revolizer (R), were included in the present study. The investigator employed a device-specific checklist to evaluate inhaler device usage by the participants. This checklist was scored, while the patient was observed utilising the inhaler device. Following which, each patient was educated regarding inhaler device usage by a doctor or nurse. For each correct and incorrect step, the patient received a score of "1" and "0" respectively. For each patient, the total score for all the steps was calculated and was compared with the total score of post-training visit. The maximum score for pMDI was 11, for pMDI with spacer was 13 and for both Rotahaler (R), and Revolizer (R) was 8. The minimum score for all the inhalation devices was 0. The R software was used for statistical analysis and descriptive statistics were represented in the form of tables, percentages, and frequencies. A p-value of < 0.05 was considered statistically significant. Results: A total of 250 patients using various inhalers (pMDI=54; pMDI with Spacer=80; Rotahaler (R)=67, Revolizer (R)=49) with mild to very severe COPD.The mean age of the participants was found to be 58.26 years (SD 6.48). Before training, only 1.25% (1/80) patients using pM DI with spacer were able to complete all the steps whereas none of the patients using pMDI, Rotahaler (R), and Revolizer (R) were able to complete all the steps accurately. After training, 31.25% (25/80) of patients using pMDI with spacer, 11.94% (8/67) patients using Rotahaler (R), and 44.89% (22/49) of patients using Revolizer (R) were able to accurately complete all the steps whereas none of the patients using pMDI were able of complete all the steps. Conclusion: The majority of patients committed errors, both handling, and inhalational steps. When trained, the error percentage was reduced significantly among patients using all types of inhalers. Patients using Revolizer (R) conducted the least of handling errors, whereas those using pMDI committed the maximum handling errors. Patients using Revolizer (R) had erred the least with inhalation errors, whereas those using Rotahalerk had erred the most with the inhalational errors.