Elsevier

Heart & Lung

Volume 50, Issue 2, March–April 2021, Pages 323-328
Heart & Lung

The effect of video presentation showed in the outpatient clinic waiting area on the success of inhaler device use in chronic respiratory diseases

https://doi.org/10.1016/j.hrtlng.2021.01.009Get rights and content

Highlights

  • As shown in many studies, about half of patients cannot use their inhaler devices correctly. This is associated with drug wastage, increased treatment costs, and inadequate disease control.

  • We thought of a simple, inexpensive method that do not require not extra-personnel that may increase patients' device success.

  • In this method, without any intervention to the patients, only the video is played on the television in the waiting room.

Abstract

Background/Aim

Nonadherence to inhalation therapy and incorrect inhalation technique is an important problem for optimal disease management in patients with chronic respiratory disease. The aim of the study is to investigate the effectiveness of an inexpensive and effortless method which would be able to improve the inhalation technique of patients.

Materials and methods

The video showing the correct use of inhaler devices was played continuously for 3 months in the waiting room of the chest diseases polyclinic, on the big screen TV. The patients, who were not prompted to watch the video, were divided into two groups, as those who visited the outpatient clinic before (n = 300, Group 1) and after (n = 300, Group 2) the video playback began. Patients' ability to use their own inhaler devices was observed without intervention, scored according to the standard 'Ability of Inhaler Device Use' scale and the two groups were compared.

Results

The inhaler use skill of the patients in the second group was significantly higher except for the Turbuhaler. In Group 2, among the “video watchers” subgroup, there was significant improvement in all device types.

Conclusion

Presentation of the use of inhaler devices on the screens in the waiting area of the outpatient clinics of health facilities will provide significant benefits and allow reducing the failure of treatment due to incorrect/incomplete device usage.

Introduction

Chronic Respiratory Diseases (CRDs) are widely seen throughout the world and among all age groups, cause considerably mortality and morbidity, occupy a large place in the health expenditures of the countries and hence, constitute an important public health problem. While many conditions cause chronic respiratory diseases, the most common ones are Chronic Obstructive Pulmonary Disease (COPD) and asthma. Globally, there are approximately 360 million asthma patients and 175 million COPD patients, currently.1

The cost of follow-up and treatment of CRDs are quite high. In United States and Europe respectively, Asthma costs in an estimated $56 billion/€33.9 billion and COPD costs an estimated $49 billion/€48.4 billion each year. Inhaler treatment costs constitute a significant part of the treatment expenditures of CRDs.2., 3., 4., 5.

In the treatment of CRDs, the inhalation route is preferred because of the rapid onset of action, absent / very low systemic side effects, low-dose drug use, and the ability to reach high drug concentrations in the target organ. For these reasons, inhalation devices constitute the main step of treatment. However, inhalation therapy has some disadvantages. A device is needed to deliver the active substance to the lungs. For these devices, which can be simple or complex, to be used correctly by the patient, the patient must be informed and trained. In the studies conducted, it was found that when the patients were not trained, most of the patients used their inhaler devices incorrectly and/or incompletely. In many studies, misuse rates have been reported between 40 and 60%.6., 7., 8.

Improper use of the inhaler device results in inability to control the disease, more medication use, more side effects, frequent acute attacks/increased exacerbations, increased hospitalization, waste of drugs and a decrease in treatment success, while also causing an extra burden on the health expenses. For these reasons, it is imperative that the physicians/health professionals who prescribe and provide these medications train each patient. However, this is not always possible due to factors such as the high number of patients per physician and nurse, the intensity of workload, the level of perception of the patients, the lack of awareness of the health professionals in this regard, and the variety of inhaler devices available on the market. Failure to provide this training by the prescribing persons is the most important reason for misuse. There is a need for easy and inexpensive methods that can increase the ability of patients to use the inhaler device without imposing extra time and workload burdens on the health workers.8., 9., 10.

The purpose of this study was to determine whether placing monitors showing videos about the correct use of the inhaler devices in the waiting rooms of the Respiratory Diseases Polyclinic improves the patients' ability to use inhaler devices correctly.

Section snippets

Materials and methods

A total of 600 patients, 300 in each group, who visited the Chest Diseases Outpatient Clinic of Sakarya University Medical Faculty Training and Research Hospital between 04.12.2018 and 30.04.2019, were included in the study.

Patients who used inhaler devices for at least 6 months, volunteered to participate in the study and gave consent were included. Those with poor eyesight or hearing, disorientation and poor cooperation, a history of neurological and psychiatric disease and patients younger

Statistical analysis

Descriptive statistics were presented as numbers and percentages for categorical variables and points, and as standard deviations, minimum value, median and largest value for numerical data. Chi-square test were used for pair-wise and multiple group comparisons of categorical variables. In the comparison of two independent groups, T test and Mann Whitney U tests were utilized for normally and non-normally distributed numerical variables, respectively. Kruskal Wallis test was utilized to compare

Results

The first group consisted of 149 (49.7%) males and 151 (50.3%) females, while the second group consisted of 135 (45%) males and 165 (55%) females. There were no differences between the groups in terms of gender, age, educational background, diagnoses, training status, and device usage time (Table 1). Two hundred thirty patients (88.8%) in the first group and 195 (75.9%) in the second group stated that they received training for inhalers from their pulmonologist. The second most frequent

Discussion

We determined that the video screening in the outpatient clinic waiting room without intervening with the participants significantly increased the ability to use the inhaler device. This increase was observed regardless of the inhaler device type. When comparing both the mean scores of the two groups and the error rates made in the individual steps, a significant improvement was observed after the video show.

We think that video screening in the polyclinic waiting room improves the ability to

Conclusion

The impact of training on ability of inhaler device use is indisputable. Although it is highly effective when the physician/nurse who prescribes this treatment also trains the patient, in centers where this training cannot be given sufficiently due to the intense number of patients and workload, playing videos showing the correct use of inhaler devices in polyclinic waiting areas, a cheap method which does not require additional personnel and workload, has shown to significantly increase the

Author disclosure statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. No conflicts of interest exist.

Funding information

None.

References (24)

  • A. Duarte-de-Araújo et al.

    COPD: misuse of inhaler devices in clinical practice

    Int J Chron Obstruct Pulmon Dis

    (2019)
  • C. Gregoriano et al.

    Use and inhalation technique of inhaled medication in patients with asthma and COPD: data from a randomized controlled trial

    Respir Res

    (2018)
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