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Coaching, Participation in Clinical Trials May Improve Inhaler Technique of Patients With COPD

Wallace Stephens
Abstracts presented at the 2019 American Thoracic Society International Conference suggest that participation in clinical trials and 1-on-1 coaching may improve inhaler technique of patients with chronic obstructive pulmonary disease or other respiratory disorders. 
Participation in clinical trials and coaching may improve inhaler technique of patients with chronic obstructive pulmonary disease (COPD), according to 2 abstracts presented at the 2019 American Thoracic Society (ATS) International Conference, held May 17-22 in Dallas, Texas.

In the first abstract, researchers conducted a prospective study to investigate whether 1-on-1 coaching could improve inhaler technique of patients with COPD.

“Incorrect use of inhalers among asthma and COPD patients is very prevalent. Although various educational interventions have been reported, no single intervention is considered standard of care. Data also lacks on COPD-exclusive populations,” researchers said. “Hence, we aimed to conduct a COPD-specific investigation of active one-on-one coaching as the educational intervention to improve inhaler technique and COPD symptoms management.”

Researchers used the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria to enroll COPD patients with metered-dose inhalers in their treatment regimen. A total of 59 patients, who were 64.4% female and had a mean age of 62.9 ± 6.7 years, participated in the study. The baseline median COPD Assessment Test (CAT) score was 24 and the baseline mean forced expiratory volume in 1 second was 1.39L ± 0.54.

Patients’ inhaler technique was assessed and scored during regular follow-up visits. Active 1-on-1 coaching that followed 12-step ATS instructions was provided. Adequate inhaler technique was defined as correctly completing at least 75% of the steps. They also compared CAT scores between baseline and follow-up.

Researchers found the median number of errors in inhaler technique was 4 out of 12. Inadequate inhaler technique was demonstrated by 29 patients, or 49%. The median follow-up period was 3 months and 11 participants completed their follow-up visits. Of those 11, 6 demonstrated incorrect inhaler use at baseline. Researchers found that 4 out of 6, or 66.7%, improved their technique. However, the improvement wasn’t determined to be statistically significant due to the small sample size. They also found that CAT scores showed a mean decrease of 4.27.

“Our study exhibits that poor inhaler technique among COPD patients is very prevalent. Active 1-on-1 coaching can improve inhaler technique and lead to improvement in symptoms control,” researchers concluded.

In the second abstract, researchers conducted a study to evaluate whether participation in clinical trials could improve inhaler technique.

“During clinical participation, inhaler technique is frequently reviewed, potentially improving long-term inhaler usage technique,” researchers said. “We postulated that asthma and COPD patients who previously have participated in clinical trials would have better inhaler technique compared to those that had not.”

Researchers reviewed all respiratory patients who attended lung function testing at the Lung Clinical Research Unit at the University of Cape Town Lung Institute. A total of 361 patients, including 156 males and 205 females, were included in the review. Of the total, 208 were asthma patients with a mean age of 46.2 years and 140 were COPD patients with a mean age of 61.5 years. Acceptable inhaler technique, defined as 2 or fewer mistakes, was demonstrated by 66% of participants.

A standardized inhaler checklist was used to ensure pressure metered-dose inhaler technique was routinely and systematically reviewed during each visit. Researchers retrospectively evaluated the inhaler review checklists along with patients’ basic demographics, history of inhaler usage, and previous participation in clinical trials from their medical notes.

Researchers found that:
  • 81.9% of patients who previously participated in clinical trials demonstrated acceptable inhaler technique
  • 61.0% of patients who never previously participated in a clinical trial demonstrated acceptable inhaler technique
While there was no statistically significant difference between asthma and COPD patients in error frequency, 56.8% of female participants, compared to 43.2% of male participants, demonstrated poor inhaler technique.

“It was evident in this study that previous trial participants had a higher frequency of acceptable inhaler technique compared with those never participating in a clinical trial. Long term inhaler technique may be improved by clinical trial participation,” researchers concluded.


1. Kim JS, Choundhary S, Li H, Hashweh N, Santosh S, Charbek E. Effects of one-on-one coaching in improving inhaler technique and symptoms control of chronic obstructive pulmonary disease (COPD) Patients. Presented at 2019 American Thoracic Society International Conference; May 17-22, 2019, Dallas, TX. Abstract A3316. Accessed June 10, 2019.

2. Zobair THA, Leite M, Van Zyl Smit R. Asthmatic and chronic obstructive pulmonary disease patients who participate in clinical trials have better inhaler technique. Presented at 2019 American Thoracic Society International Conference; May 17-22, 2019, Dallas, TX. Abstract A1329. Accessed June 10, 2019.

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