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 Nearly all of the sickest asthma patients who wind up hospitalized
when symptoms get out of control have no idea how to use inhalers to
deliver what’s known as rescue therapy – fast-acting steroids that
make it easier to breathe. The same is true of hospital patients
with another common breathing disorder, chronic obstructive
pulmonary disease (COPD).
But when researchers randomly assigned some patients with asthma and
COPD to receive personalized hands-on instruction with new inhalers
while they were in the hospital, 91 percent of them used the devices
correctly. Without this help, just 40 percent of patients operated
inhalers properly.
During their first month after leaving the hospital, only 17 percent
of patients in the education group had acute flare-ups, compared
with 36 percent of the group that didn’t receive the extra
instruction.
“The vast majority of patients do not get inhaler teaching in the
hospital setting, especially for rescue devices,” said lead study
author Dr. Valerie Press of the University of Chicago.
“Without good control, patients are at risk for more breathing
attacks, and possibly even more emergency room visits or
hospitalizations,” Press added by email.
The inhaler education program that Press and colleagues tested with
62 patients at two Chicago hospitals only takes a few minutes to
complete, she said. That’s long enough for doctors or nurses to
demonstrate how the devices work, watch patients try it themselves
and correct any mistakes until patients get it right.
They compared this to more typical and much briefer instruction
given to another 58 patients, consisting of clinicians listening to
the patients read inhaler instructions aloud and then talking in
general terms about their disease.
Some of the most vulnerable patients – people with low health
literacy who had a harder time understanding their disease –
appeared to benefit the most from the extra education, researchers
report in the Annals of the American Thoracic Society.
Among this subset of patients with low health literacy, just 15
percent of the patients who got extra education had an acute symptom
flare-up within the first month of leaving the hospital, compared
with 70 percent of the patients who didn’t get the added
instruction.
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Three months after leaving the hospital, patients who got
personalized inhaler education still fared better than those who did
not. At this point, 52 percent of patients in the education group
used inhalers correctly, compared with 24 percent for the group that
didn’t get extra help.
One limitation of the study is that the education was handled by
trained research staff and might not be as effective in a real-world
setting when clinicians need to fit this in along with all their
other duties, the authors note. They also studied outcomes with one
type of inhaler, and the findings might be different for other
devices.
Even so, the study results suggest that taking more time to educate
patients in the hospital might pay off, said Dr. Christopher
Moriates, a researcher at the University of California, San
Francisco, who wasn’t involved in the study.
“Many times the assumption seems to be that these patients use their
inhalers outside of the hospital so they already know how to do so,
but this study and others have shown this is not true and the vast
majority of these patients actively misuse their inhalers,” Moriates
said by email.
“The astonishing thing is these patients often spend a few days in
the hospital, receiving respiratory therapies multiple times each
day, so lack of effective inhaler teaching during hospitalization is
a foolishly squandered golden opportunity,” Moriates added.
SOURCE: http://bit.ly/1RleouP Annals of the American Thoracic
Society, online March 21, 2016.
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