Inhaler Education with Teach-to-Goal Methods Improved Technique Among Older Adults with Asthma, COPD

Among older adults with asthma or chronic obstructive pulmonary disease (COPD), those educated on metered-dose inhaler (MDI) use with teach-to-goal modalities experienced a lower rate of posteducation MDI misuse than those educated by brief interventions, according to a recent study published in Respiratory Medicine.

However, patients with low health literacy may benefit less from MDI education interventions, according to researchers led by Kristin C. Trela, MD, an anesthesiologist in the department of anesthesiology and critical care at the University of Chicago Medicine.

Asthma and COPD guidelines recommend self-management assessment and inhaler education during all clinical visits, and assessment is critical for identifying inhaler misuse among patients. “Whether age-related factors impede the efficacy of educational interventions for inhaler technique among older patients is unknown,” wrote Trela and colleagues.

To examine factors associated with MDI misuse before and after inhaler education among younger (aged <65 years) and older (≥65 years) populations, investigators analyzed 394 adult inpatients with asthma or COPD (mean age, 51.9 years) across 5 prospective interventional studies conducted from 2007 to 2017.

Participants were assigned to 1 of 3 MDI education interventions: brief intervention (BI), teach-to-goal (TTG), or virtual TTG (V-TTG). Visual acuity, health literacy, and MDI technique pre/post education were assessed using validated assessments, according to Trela et al.

The team did not observe any significant difference in baseline MDI misuse by age, vision, or health literacy levels. Posteducation misuse was lower among participants who received TTG or V-TTG education at baseline, and those with high health literacy.

Age and visual acuity were not shown to be significantly associated with increased rates of MDI misuse, although age was correlated with low health literacy, according to investigators.

“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,” concluded Trela and colleagues.


Reference: Trela KC, Zajac P, Zhu M, Press VG. Health literacy and type of education intervention predicting post-education metered-dose inhaler misuse. Respir Med. Published online July 14, 2022. doi:10.1016/j.rmed.2022.106930.