Video education versus face-to-face education on inhaler technique for patients with well-controlled or partly-controlled asthma: A phase IV, open-label, non-inferiority, multicenter, randomized, controlled trial.

Hye Jung Park,You Sook Cho,Yi Yeong Jeong,Woo Kyung Kim,Sook Young Lee,Myung-Goo Lee,Sang-Pyo Lee,Ji-Hyun Lee,Byoung Whui Choi,Dong-Ho Nahm,Jae-Woo Kwon,Min Kwang Byun,Jeong-Hee Choi,Thomas Penzel

doi:10.1371/journal.pone.0197358

Abstract

BackgroundEducation on inhaler technique is critical for effective asthma treatment. However, traditionally used face-to-face education is time-consuming, costly, and often laborious. The current study evaluated the efficacy of a newly developed video-based inhaler technique education method.MethodsA total of 184 subjects with well-controlled or partly-controlled asthma were enrolled from 12 hospitals in South Korea from 30 November 2015 to 01 June 2016. Subjects were randomly divided into two groups in a 1:1 ratio; a control group that received face-to-face education, and a study group that received video education. All subjects received fluticasone propionate plus salmeterol xinafoate (Fluterol® 250/50 inhalation capsules) for 12 weeks. The primary outcome measure was forced expiratory volume in the 1st second (FEV1) at 12 weeks. The secondary outcome measures were change in FEV1 at 4 weeks, change in asthma control test (ACT) score, and changes in various inhaler technique parameters. These measures were assessed with a non-inferiority margin of 10% between the control group and the study group.ResultsFEV1 was significantly improved at 12 weeks in the control group and the study group. After adjustment, FEV1 improvement was not significantly inferior in the study group compared to the control group. The secondary outcome measures, including change in FEV1 at 4 weeks, ACT score, and various parameters pertaining to inhaler technique and satisfaction at 4 and 12 weeks did not differ significantly in the two groups. In subgroup analysis of elderly subjects and subjects with well-controlled asthma, FEV1 was significantly improved at 12 weeks in the study group but not the control group.ConclusionThe newly developed video education technique investigated functioned as a suitable substitute for face-to-face education on inhaler technique (dry powder inhalation capsule) in patients with stable asthma, particularly in elderly patients and patients with well-controlled asthma.

Highlights

Asthma is a chronic inflammatory airway disease, the prevalence of which is increasing worldwide with changes of environment and genetic interaction [1,2,3,4]
The secondary outcome measures, including change in forced expiratory volume in the 1st second (FEV1) at 4 weeks, asthma control test (ACT) score, and various parameters pertaining to inhaler technique and satisfaction at 4 and 12 weeks did not differ significantly in the two groups
The newly developed video education technique investigated functioned as a suitable substitute for face-to-face education on inhaler technique in patients with stable asthma, in elderly patients and patients with well-controlled asthma

Summary

Introduction

Asthma is a chronic inflammatory airway disease, the prevalence of which is increasing worldwide with changes of environment and genetic interaction [1,2,3,4]. Inhalers are the most common way to deliver asthma medications. Inhaled medications include corticosteroids, which are the most effective control drugs [5,6,7], and long-acting β2 agonists, which are used as additional therapy for poorly controlled asthma. Many patients have a false perception of their inhaler technique [10,15]. Inhaler misuse should be corrected, because it leads to poorly controlled asthma [11,16,17]. The 2016 report published by the Global Initiative for Asthma encourages clinicians to check for inaccurate inhaler use and provide adequate education [17,18]. Education on inhaler technique is critical for effective asthma treatment. The current study evaluated the efficacy of a newly developed video-based inhaler technique education method

Methods

Results

Conclusion