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Training on Proper Inhaler Use Key Predictor of Adherence in COPD


Patients with chronic obstructive pulmonary disease (COPD) who were trained on appropriate inhaler use and who were checked on their use were significantly more likely to be adherent, study found.

While patient age is predictive of poor adherence to medication in patients with chronic obstructive pulmonary disease (COPD), there are also modifiable attributes that predict poor adherence that healthcare professionals can focus on improving, according to a study published in the International Journal of Chronic Obstructive Pulmonary Disease.

The study surveyed 764 patients from 9 countries—Brazil, Canada, France, Germany, Italy, Japan, the Netherlands, the United Kingdom, and the United States—using the Real-life Experience and Accuracy of inhaLer use (REAL) survey. The patients who participated in the 23-question survey had mild to very severe COPD and were between the ages of 40 and 75 years.

The survey gathered information about correct inhaler use, adherence, dosing accuracy, training, and other factors that influence adherence.

“There is increasing evidence that suggests correct inhaler technique is fundamental for effective therapy and that inhaler device type and mastery play important roles in improving adherence, clinical outcomes, health-related quality of life, and use of health care resources in patients with asthma and/or COPD,” the authors explained.

The researchers found that adherence was significantly lower in patients age 65 or younger compared with older patients. Otherwise, there was no difference in adherence between genders, disease severity, or time since diagnosis. There was also no significant difference in confidence of inhaling a full dose based on gender, age, disease severity, or time since diagnosis.

Patients who received appropriate inhaler training were more confident that they took the correct dose, but approximately 30% of respondents said they did not receive any training on inhaler use.

Following up on inhaler use was also important. The survey also found that 29% of patients had not been checked within previous 2 years to see if they were using their device correctly. Those who had been checked were more adherent than those who had not been checked. Patients who were checked were also more confident that they received the full dose of medication when they used their inhaler.

“The results presented are of significant importance as device attributes that lead to confidence of full dose received may improve treatment adherence by reducing the risk of overdosing or underdosing drug administration in patients,” the authors concluded.


Price D, Keininger DL, Viswanad B, Gasser M, Walda S, Gutzwiller FS. Factors associated with appropriate inhaler use in patients with COPD—lessons from the REAL survey. Int J Chron Obstruct Pulmon Dis. 2018:13;695-702. doi: 10.2147/COPD.S149404.

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