Abstract
Inhalation therapy is the basis of the pharmacological management of asthma and COPD. Most patients are trained on the correct use of inhalers by health professionals but after that do patients continue to take them correctly at home remains largely unknown. Video recording of the inhalation technique using a smartphone can be used to evaluate the inhaler technique at home. Through this pilot study, we aimed to understand whether inhaler training given to patients in the outpatient clinic translates into good inhalation practices at home by a video application platform using a smartphone. We recruited 70 newly diagnosed asthma and COPD patients and a pulmonologist trained them to use their inhaler until they were able to use it correctly. Videos of inhaler use were captured by a relative or a friend at home and then sent to an independent reviewer via WhatsApp on Days 1, 7, 14 and 28 (±2). Each step of the inhaler technique was evaluated based on a predetermined checklist with a rating scale of 0 to 10 (10 for all steps done correctly). Out of 70 patients recruited, 30 (42%) sent all videos. We found that, although all patients performed all the steps correctly in the clinic, none of them performed all steps correctly at home even on Day 1 itself of the inhaler use. On Day 1, the steps score reduced from 10 to 6.9 with a downward trend until Day 28. The most common mistakes from Day 1 onwards were incorrect inspiratory flow rates and not gargling after the inhaler use. Also, most patients showed partially effective inhalation as per our scoring method. Remote video monitoring of inhaler use in the home environment is possible with a mobile video application that gives us a better insight into the most common inhaler mistakes performed by patients at home. Inhaler errors start appearing immediately on Day 1 after the training, and incorrect inspiratory flow rates and forgetting to do gargles are common errors. Early detection of inhaler errors at home may be possible through this method.
Highlights
Inhalation therapy is the cornerstone in the management of asthma and chronic obstructive pulmonary disease (COPD)
Inhalation therapy is mostly delivered by two types of inhaler devices, a pressurized metered-dose inhaler and a dry powder inhaler (DPI)
While assessing inhaler errors done in each device group over 4 weeks, in the DPI group (n = 10) we found 50–70% of the patients doing the important step of quick and deep inhalation incorrectly and 80% not gargling after the inhaler use (Table 1a)
Summary
Inhalation therapy is the cornerstone in the management of asthma and chronic obstructive pulmonary disease (COPD). They produce the therapeutic response at a fraction of the dose used by the oral route, have a quicker onset of action, and lesser side effects than oral medications. The physician, nurse assistant, or pharmacist often teaches the correct use of inhaler devices to their patients, the quality of teaching varies from place to place and from individual to individual How much of this training the patient retains is not known but is often determined by the quality of training, inhaler type, age, gender, education status, and socioeconomic status[1,2]. After receiving training in the outpatient clinic, little is known about how in reality patients take their inhalers at home or what errors do they make in their home environment
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