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Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD

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An Erratum to this article was published on 25 February 2011

ABSTRACT

BACKGROUND

Patients are asked to assume greater responsibility for care, including use of medications, during transitions from hospital to home. Unfortunately, medications dispensed via respiratory inhalers to patients with asthma or chronic obstructive pulmonary disease (COPD) can be difficult to use.

OBJECTIVES

To examine rates of inhaler misuse and to determine if patients with asthma or COPD differed in their ability to learn how to use inhalers correctly.

DESIGN

A cross-sectional and pre/post intervention study at two urban academic hospitals.

PARTICIPANTS

Hospitalized patients with asthma or COPD.

INTERVENTION

A subset of participants received instruction about the correct use of respiratory inhalers.

MAIN MEASURES

Use of metered dose inhaler (MDI) and Diskus® devices was assessed using checklists. Misuse and mastery of each device were defined as <75% and 100% of steps correct, respectively. Insufficient vision was defined as worse than 20/50 in both eyes. Less-than adequate health literacy was defined as a score of <23/36 on The Short Test of Functional Health Literacy in Adults (S-TOFHLA).

KEY RESULTS

One-hundred participants were enrolled (COPD n = 40; asthma n = 60). Overall, misuse was common (86% MDI, 71% Diskus®), and rates of inhaler misuse for participants with COPD versus asthma were similar. Participants with COPD versus asthma were twice as likely to have insufficient vision (43% vs. 20%, p = 0.02) and three-times as likely to have less-than- adequate health literacy (61% vs. 19%, p = 0.001). Participants with insufficient vision were more likely to misuse Diskus® devices (95% vs. 61%, p = 0.004). All participants (100%) were able to achieve mastery for both MDI and Diskus® devices.

CONCLUSIONS

Inhaler misuse is common, but correctable in hospitalized patients with COPD or asthma. Hospitals should implement a program to assess and teach appropriate inhaler technique that can overcome barriers to patient self-management, including insufficient vision, during transitions from hospital to home.

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Acknowledgements

Contributors

We would like to thank The University of Chicago Asthma and COPD Center and the Department of Medicine Data Management and Statistics Core.

Prior Presentations: Prior poster presentations include the 2009 American Thoracic Society International Meeting in San Diego, the 2009 Society of Hospital Medicine Annual meeting in Chicago IL, and the 2009 and 2010 Society of General Internal Medicine Annual Meetings in Miami, Fl and Minneapolis, MN, respectively. Oral presentations include the 2009 Midwest Society of General Internal Medicine and the 2010 American Thoracic Society International Meeting in New Orleans, LA.

Conflict of Interest

Dr. Press reports receiving funding from the Institute for Translational Medicine, University of Chicago CTSA from the National Center for Research Resources (UL1RR024999) and the American Cancer Society (PSB 08-08). Dr. Arora reports receiving funding from the American Board of Internal Medicine, Agency for Healthcare Research and Quality (R03HS018278), the National Institute of Aging (K23AG033763), and the Accreditation Council of Graduate Medical Education. Dr. Krishnan reports receiving funding from the National Institutes of Health (HL101618) and the Agency for Healthcare Research and Quality (HS016967). Potential conflicts of interest exist for Dr. Shah who is employed with a for profit health care policy firm (Avalere Health, LLC); for Dr. Badlani who has received honoraria for lectures given (Merck Pharmaceuticals and PharmEd Consultants); and for Dr. Naurekas, who has provided expert testimony (once for a plaintiff on Alveolar Hemosiderosis and once for Cook County on thrombotic thrombocytopenic purpura). All other authors do not have any conflicts of interest to disclose related to employment, consultancies, honoraria, stock, expert testimony, patents, royalties or any other relationships.

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Authors and Affiliations

  1. Department of Medicine, University of Chicago, Instructor, Section of Hospital Medicine, Chicago, IL, 60637, USA

    Valerie G. Press MD, MPH & Sameer Badlani MD

  2. Department of Medicine, University of Chicago, Section of General Internal Medicine, Chicago, USA

    Vineet M. Arora MD, MAPP

  3. Avalere Health, LLC, Washington, DC, USA

    Lisa M. Shah MD, MA

  4. Department of Medicine, University of Chicago, Asthma and COPD Center, Section of Pulmonary and Critical Care, Chicago, USA

    Stephanie L. Lewis BA, Krystal Ivy BA, Jeffery Charbeneau MS, Edward Naurekas MD, Antoinette Mazurek MS & Jerry A. Krishnan MD, PhD

  5. Mercy Hospital and Medical Center, Chicago, USA

    Sameer Badlani MD

  6. Department of Health Studies, University of Chicago, Chicago, USA

    Jerry A. Krishnan MD, PhD

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  1. Valerie G. Press MD, MPH
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Correspondence to Valerie G. Press MD, MPH.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s11606-011-1671-3

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Press, V.G., Arora, V.M., Shah, L.M. et al. Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD. J GEN INTERN MED 26, 635–642 (2011). https://doi.org/10.1007/s11606-010-1624-2

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