Factors associated with appropriate inhaler use in patients with COPD – lessons from the REAL survey
David Price, Dorothy L Keininger, Boomi Viswanad, Matthias Gasser, Susann Walda, and Florian S Gutzwiller
Int J Chron Obstruct Pulmon Dis 2018;13:695–702
Self-management of chronic obstructive pulmonary disease (COPD) is dependent upon patients’ ability to self-administer inhaled medication on a daily basis, yet between 28% to 68% of patients may be using their inhalers incorrectly. The Real-life Experience and Accuracy of inhaLer use (REAL) study was a qualitative survey conducted by David Price from the University of Aberdeen (and supported by Novartis), enrolling 764 COPD patients from nine countries. Approximately 30% of respondents reported not receiving any training on inhaler use, but those who did receive training were significantly more confident that they were receiving a full medication dose. Among trained patients, the strongest preference was for technique to be demonstrated personally – 83% said this technique was ‘very helpful’, compared with 58% for video, 51% for instructions and 34% for leaflets. A total of 29% of patients had not had their inhaler technique checked in the past two years, but those who had been checked were more confident that they received the full doses. When results were stratified by inhaler device, patient confidence was higher with Breezhaler® vs Ellipta® or Respimat® (p=0.001 for both), but the difference between Breezhaler and Genuair® did not appear to be significant. This study underlined the importance of teaching inhaler technique in increasing patients’ confidence and capacity to self-manage, and provided evidence that this teaching should be delivered in person wherever possible.