Inhaler mastery and retention after stepwise training in cognitively impaired older COPD

Area of Science:

• Geriatric Medicine
• Pulmonology
• Pharmacology

Background:

• Older patients with Chronic Obstructive Pulmonary Disease (COPD) and cognitive impairment frequently make errors using inhaler devices.
• Inhaler technique errors in this population can be mitigated through simplified device designs and structured educational interventions.

Purpose of the Study:

• To assess the effectiveness of structured training in improving inhaler technique mastery and retention in elderly COPD patients with cognitive impairment.
• To compare the usability and learnability of a multidose dry powder inhaler (mDPI), a capsule-based DPI (cDPI), and a pressurized metered-dose inhaler (pMDI) in this patient group.

Main Methods:

• A prospective, crossover study involving device-naïve COPD patients aged 70 years or older with moderate cognitive impairment (Mini Mental State Examination score 10-24).
• Participants demonstrated technique with mDPI, cDPI, and pMDI after reading instructions, followed by a standardized stepwise training program.
• Co-primary endpoints included technique mastery post-reading and post-training; secondary endpoints included time to mastery, 1-month retention, and patient satisfaction.

Main Results:

• Initially, correct technique was low (mDPI: 29%, cDPI: 13%, pMDI: 7%) after reading instructions, with significantly more errors for pMDI and cDPI compared to mDPI.
• All patients achieved mastery after training, with significantly faster learning times for mDPI (3.1 min) versus cDPI (8.5 min) and pMDI (9.1 min).
• One month post-training, 85% retained correct technique, with significantly higher retention for mDPI (97%) compared to pMDI (77%), and mDPI also had higher satisfaction scores.

Conclusions:

• Structured training empowers elderly COPD patients with cognitive impairment to achieve and maintain correct inhaler technique.
• The multidose dry powder inhaler (mDPI) demonstrated superior ease of learning, faster mastery, and better long-term retention, making it a preferred choice for geriatric COPD care.