Effectiveness of one-to-one feedback methods of teaching with proper metered-dose inhaler technique and correcting errors in chronic obstructive lung disease patients

Objective:To determine the most common mistakes made during the use of a metered-dose inhaler(MDI),and the effect of the repeated trainings performed with demonstration method by providing one-to-one feedback on these mistakes.Methods:This is a quasi-experimental study with a control group.A total of 100 chronic obstructive pulmonary disease(COPD)patients(50 in the control group and 50 in the experimental group)were included in the research.“Patient Information Form(PIF)”(to determine the descriptive characteristics of patients)through the face-to-face interview method,using“MDI Skill Assessment Form”(MDISAF)(it is composed of 10 skill steps about the use of MDI)through observation method was used.Patients in both the groups were asked to use MDI and their abilities regarding use of MDI were assessed.Then in the intervention group,usage of MDI was explained by a nurse via demonstration and placebo MDI.Trainings were repeated on days 1,3,and 5 as from hospitalization of the patient.In the intervention group,three methods were used in this study:“face-to-face training,”“one-to-one,”and“with feedbacks and repeated.”Routine training regarding use of MDI was given by the nurses in the clinic to patients in the control group.The use of an MDI was assessed using MDISAF before training and after the training on the first,third and fifth days of hospitalization.On the seventh day,the last measurement was performed.Percentage,chi square,and mean were used to assess the data.Results:After repetitive training with one-to-one feedback,several differences between the groups in favor of the experimental group were found in 7 of the 10 skill levels of the MDI.There was a significant difference after“training”between the groups in the third,fourth,fifth,sixth,seventh,eighth and ninth MDI steps in posttest measurement(P<0.05).Evaluating the skills of the groups to use MDI from pretest to posttest,it was determined that while the intervention group made less mistakes in steps in which mistakes were made mostly,the control group continued to make mistakes.Conclusions:Inhaler technique intervention with repeated,face to face,and one-to-one feedback trainings can significantly enhance the MDI techniques in COPD patients.The patients in the intervention group made less mistakes during MDI application and their application skills improved.It may be asser ted that the training provided to the intervention group was effective for using the device correctly,while the training provided in the clinic for the control group was inadequate.

Addition of Inhalation Training Devices and Smartphone Application to Verbal Counseling for Asthmatic Patients

Background:One of the main issues with pressurized metered dose inhalers(pMDI)is that some patients find it difficult to use it properly.Methods:This study was carried out to compare the effect of traditional verbal counseling and that of adding an inhalation training device,such as Flo-Tone or Clip-Tone,along with a smartphone application on the incidence of inhalation technique mistakes and the pulmonary function of asthmatic adults and children.Results:The lung function of those in the advanced counseling group significantly improved on the second visit(p<0.001),whereas for those in the verbal counseling group,their lung function only improved on the third visit(p<0.001).For both the groups,the mean number of mistakes in regard to the steps in inhalation technique decreased significantly(p<0.001),with an overall higher percentage in the advanced counseling group.Conclusion:The use of training devices and smartphone applications in addition to traditional verbal counseling for teaching asthmatic adults and children the correct inhalation technique steps using pMDI resulted in a significant improvement in pulmonary function and a significant reduction in the number of inhalation technique mistakes,compared to traditional verbal counseling alone.

Inhaler use in chronic obstructive pulmonary disease patients: a meta-analysis

Objective: To evaluate errors in the use of inhalation techniques in patients with chronic obstructive pulmonary disease(COPD), and to provide evidence for improving the effectiveness of drugs.Methods: A meta-analysis was performed after searching for literature at Pub Med, Embase, Web of Science, Cochrane Library, CINAHL, China National Knowledge Infrastructure(CNKI), Wan Fang, VIP, and Sion Med databases which were published from January 2011 to October 2020, addressing errors in the use of inhalation technologies for the treatment of COPD. After reviewing the literature, extracting per tinent information, and evaluating the risk of bias for the included studies, statistical analysis was performed using Stata 15.1.Results: Thir teen papers(12 in English and 1 in Chinese), representing 2527 patients, met the search criteria and were included in the meta-analysis. The results showed that the combined effect size of COPD patients making at least one operational error was 76%(95% CI: 0.69–0.83). The error rate varied with inhaler type;the combined effect size error for powered inhalers was 66%(95% CI: 0.57, 0.74), 67%(95% CI. 0.57, 0.77) for metered-dose inhalers(MDI), and 51%(95% CI: 0.38, 0.64) for soft mist inhalers(SMI).Conclusions: More than 75% of patients with COPD were unable to consistently use inhalers correctly, with the highest error rate for MDI. Therefore, health care providers must continue to educate patients on proper use of inhaler, ensuring their correct use and reducing the risk of acute COPD exacerbations.