Health literacy and type of education intervention predicting post-education metered-dose inhaler misuse

Asthma and chronic obstructive pulmonary disease (COPD) guidelines recommend self-management assessment and inhaler education at all care-visits. Assessment is vital for identifying inhaler misuse. Whether age-related factors impede the efficacy of educational interventions for inhaler technique among older patients is unknown. We aimed to study factors associated with metered-dose inhaler (MDI) misuse pre/post-inhaler education among younger (< 65) and older inpatient populations (≥ 65).

Adult inpatients with asthma or COPD enrolled across five studies between 2007 and 2017, who were eligible for, consented, and assigned to one of three education interventions (Brief Intervention [BI], Teach-to-Goal [TTG], Virtual Teach-to-Goal [V-TTG]) were included. Participants' visual acuity, health literacy, and MDI technique pre/post education were assessed using validated assessments. Binary logistic regression was used to investigate factors that increased odds of inhaler misuse.

Across the five studies, 394 unique participants were enrolled with a mean age of 51.9 years (SD±15). There was no significant difference in baseline MDI misuse by age, vision, or health literacy levels. Post-education misuse use was lower among patients with better baseline MDI technique, those who received TTG or V-TTG education, and those with high health literacy. Neither age nor visual acuity were significantly associated with increased rates of misuse, although age was correlated with low health literacy.

MDI education with teach-to-goal modalities is more effective than brief intervention; however, patients with low health literacy (disproportionately affecting older patients) may benefit less from these interventions. Further investigation into tailored inhaler education is needed.