Training in Use of Inhaler Devices Seen to Help Older Patients

Training in Use of Inhaler Devices Seen to Help Older Patients
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Training in the handling of inhaler devices improved treatment and eased clinical symptoms in older people with chronic obstructive pulmonary disease (COPD), a study found.

COPD patients with evidence of cognitive decline also benefitted from the eight-day training course.

The study, “Training improves the handling of inhaler devices and reduces the severity of symptoms in geriatric patients suffering from chronic-obstructive pulmonary disease,” was published in the journal BMC Geriatrics.

Problems with vision and cognition can be common in the elderly, as is a loss of sensitivity in the fingers. Older COPD patients may find it difficult to manage the inhaler devices often used to treat pulmonary obstruction. Mistakes can compromise the adequate delivery of the medicine to the lungs, affecting the treatment’s effectiveness and a person’s willingness to adherence to it.

Researchers with the geriatrics department of Protestant Hospital Göttingen-Weende, in Germany, set up a training program to help older patients with manipulating inhaler devices.

Their study enrolled 38 COPD patients, 65 or older (median age, 79), who used at least one inhaler device regularly and independently, typically in the home. All participated in “an 8 day systematic training aiming at improving the adherence to the prescribed treatment protocols and reducing the number and severity of inhaler handling mistakes,” the researchers wrote.

Daily counseling and video demonstrations on ways of handling the device formed the core of the training.

Training opened with patient interviews and evaluations that included assessments of a person’s use of an inhaler and cognitive abilities. Sixteen people had scores on the Mini Mental State Exam (MMSE) — a short test whose measures include a person’s sense of time and location, basic math and language skills, and memory — suggesting cognitive impairment, the researchers noted.

Over the next six days, patients watched “intensive” video clips — each less than three minutes long — on proper inhaler use, tailored to each person’s devise.

On day eight, they were encouraged to use their inhalers for six to seven minutes under the supervision of a trainer.

The frequency of errors in manipulating inhaler devices was assessed using the German Airway League’s recommendations at the study’s start and again after the training intervention.

A median of three mistakes in inhaler use were made by all but two of these 38 people prior to training.

After the intervention, the median number of mistakes was o.5, a significant drop, regardless of the type of inhaler used — metered dose inhaler, dry-powder inhaler, or a soft mist inhaler.

Specifically, after the program 19 patients (50%) inhaled without any errors, and 13 patients (34.2%) made one mistake, for  84.2% of participants making one or no mistakes in using an inhaler.

The most common errors found were an insufficient exhalation prior to inhaling the treatment, and failure to hold the breath for 5–10 seconds after an inhalation.

These results suggest “the 8 day-intervention led to a strong improvement of the handling of the inhaler devices,” the researchers wrote.

Mistakes at the study’s beginning were higher in patients with more severe cognitive impairment, as determined by lower MMSE scores (range, 0 to 30 points). But people with and without cognitive difficulties benefitted from the training program.

The most significant decrease was seen in two people with moderate cognitive decline (MMST scores of 25 and 26), who reduced by four the number of mistakes made. This suggested that training may be particularly effective in COPD patients with mild cognitive decline.

No differences in training benefits were seen to be affected by a patient’s age.

A COPD Assessment Test (CAT score) was used to assess health-related quality of life. CAT scores range from zero to 40, with higher scores indicative of greater disease impact. A five-point median CAT score reduction was seen, from 19.5 (day 1) to 14.5 (day 8), suggesting the training program, by improving treatment delivery, may ease symptom severity.

Spirometry tests were used to evaluate pulmonary function. The volume expired by forced expiration in one second (FEV1), the forced vital capacity (FVC), and FEV1/FVC ratio were measured. Results showed a small increase in median FEV1 (1235 mL on day 1 to 1315 mL post-training) and FVC (1720 mL to 1850 mL), but these changes were not considered statistically significant.

Participants with a COPD-like pulmonary obstruction (an FEV1/FVC ratio less than 70%) were then separately analyzed. A lesser median number of errors, from 2 to 0.5, was noted, as well as an improvement in the CAT score (median reduction of 3.5).

“In COPD, intensive training for 8 days improved the handling of inhalers and reduced clinical symptoms in geriatric patients,” the researchers wrote.

“The strong reduction of mistakes observed in the present study irrespective of the age and cognitive status of the patient suggests that the daily combination of video material, physical demonstration and verbal instructions is most effective,” the team concluded.

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Patrícia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.
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