Why This Course is Important

Technique

• Patients who cannot use their inhaler devices properly, face an increased risk (odds ratio 1.86) of a COPD exacerbation resulting in hospitalization. Therefore, ensuring patients can use their inhaler devices properly before they go home, can help them stay at home longer (reduce readmission risk).
• Using a checklist can help the provider identify and correct inhaler technique in a standardized way. Patients who are still making errors after 2 attempts should be referred to a respiratory therapist or pharmacist.

Non-adherence

• Patients who are non-adherent (don't use inhalers as often as prescribed) also have increased risk of hospitalization (odds ratio 1.73). This non-adherence can be intentional and is usually due to one of two factors:
1. The patient does not perceive a need for their inhaler, and does not believe that they have COPD (not recognizing the symptoms that they have) or
2. The patient does not perceive a benefit from their inhaler and does not understand how their condition can be improved by regular use of their inhalers
• Asking brief questions of the patient while assessing their technique can identify and address potential misunderstandings which could help reduce risk of non-adherence.
• Understanding how the inhaler helps them and the importance of using it properly could also motivate the patient to master proper technique.
• Non-adherence could also be because of concerns regarding the use of the inhaler (concerns about potential side effects, cost or difficulty with use). - By routinely asking patients if they have any concerns or how confident they are about using their inhaler(s), will help identify these issues so they can be addressed.

Action Plan

• In addition, use of an action plan to self-treat a COPD exacerbation as soon as symptoms begin decreases the risk of hospital admission. Briefly reviewing this concept, could also motivate the patient/family to request/follow an action plan (given to them by a physician).