The importance of inhaler technique education in asthma and COPD: a long-term follow-up

Background: Our randomised controlled trial (RCT) evaluating the value of an inhaler-specific visual aid as adjunct to standard inhaler technique education, showed beneficial short-term (after 6-8 weeks) effects. Correct inhaler technique improved from 8% to 70% of patients with asthma or COPD. Aim: To evaluate the long-term effects of inhaler technique education in asthma or COPD. Methods: Patients who participated in our RCT and completed both visits (n=98) were invited for a 1-year follow-up (FU) visit as part of routine care. All patients had completed inhaler technique education, including the use of the visual aid at short-term FU. During long-term FU inhaler technique was (re)assessed using inhaler-specific checklists. Results: Inhaler technique was evaluated in 56 patients (mean age 64±12yrs, 52% male) with asthma (45%) or COPD (55%). Reasons for not attending long-term FU were: referral to primary care (n=13), unwilling (n=6), deceased (n=4), lost to follow-up (n=19). Inhaler technique was adequate in 37 patients (66%). The most common mistakes with incorrect technique (n=19) were: no complete exhalation before inhalation (n=10, DPI), no 5 times in- and exhaling through the mouthpiece (n=5, MDI with spacer). Incorrect technique occurred more in COPD (48%) as compared to asthma (16%). Patients with incorrect technique were significantly older (69yrs) as compared to patients with adequate technique (62yrs). Conclusion: This study demonstrates positive long-term effects of thorough inhaler technique education. Yet, the number of patients who inhaled incorrectly stresses the importance of monitoring and (repeatedly) educating correct inhaler technique, particularly in older COPD patients.