Effects of Repeated Education of Inhaler Device Handling by Advanced Practice Nurse in Teaching Korean Chronic Obstructive Pulmonary Disease Patients

Abstract

Objectives: The effects of inhaler education in chronic obstructive pulmonary disease (COPD) patients remain unclear. The objective of this study was to evaluate techniques and adherence in using inhaler devices and to investigate the effects of repeated education using inhaler device handling in COPD patients. Methods: We prospectively enrolled COPD patients who used their particular inhaler device for more than 1 month and evaluated the efficacy of repeated education for COPD. The educational intervention was 6-month education program of three visits, during which subjects were tested their inhaler technique and adherence, taught about inhaler technique face-to-face by advanced practice nurse. Inhaler technique, adherence, mMRC, COPD assessment tests (CAT), EuroQol-5D (EQ-5D), patient health questionnaire (PHQ-9), and feeling of satisfaction with inhaler questionnaire (FSI-10) were compared before and after education. Results: A total of 261 COPD patients performing a total of 308 inhaler devices were included in the study. 244 (93.5%) were men and the mean age was 69.8 ± 7.7. At least one errors were observed in 267 (86.7%) and at least one critical inhaler errors were observed in 43.2% (133/308). Education significantly decreased in percentage of incorrect techniques, incorrect critical techniques and poor adherence (86.7% vs 39.3%, p<0.001; 43.2% vs 8.8%, p<0.001; 2.3% vs 0.4%, p=0.009, respectively). FSI-10 for inhaler was significantly improved after education (44.4 ± 4.7 vs 47.7 ± 4.1, p<0.001). mMRC, CAT, EQ-5D and PHQ-9 were not significantly improved after education. Conclusions: Repeated face-to-face inhaler device handling education by advanced practice nurse significantly improved the inhaler technique, adherence and feeling of satisfaction with inhaler.