Virtual vs In-Person Education for Inhaler Use in Asthma, COPD

Hospitalized patients with asthma or COPD who received virtual inhaler use education via a tablet was as effective as in person education.

Hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD) who received virtual inhaler use education via a tablet demonstrated it to be as effective as in-person education, according to study results published in JAMA Network Open.

Education on inhaler use was administered via either virtual or in person methods. Virtual education consisted of a handheld tablet with self-assessment questions before demonstration, narrated video demonstration of the correct technique, and self-assessment questions after demonstration, whereas in-person education consisted of iterative rounds of inhaler technique assessment and education by trained staff. The primary study outcome was the percentage of patients in each group who demonstrated correct inhaler technique after education against a priori noninferiority limit of -10%. Proper technique was defined as completing ≥9 of 12 steps correctly.

Among the 118 study participants, 59 were randomly assigned to each education group. The mean age was 54.5 years, and 64% of participants were women. The most commonly missed steps at baseline were emptying the lungs (step 4), emptying lungs away from the device (step 5), and breathing normally between puffs (step 11). In the primary study outcome, the correct inhaler technique increased similarly before vs after education in the virtual (67%) and in-person (66%) groups. When the researchers adjusted for baseline inhaler technique, the difference was equivalent to the noninferiority limit (-10%; 95% CI lower bound, -22%).

“Larger-scale pragmatic studies are needed to determine whether [virtual teach-to-goal] will improve long-term inhaler technique skills and/or patient outcomes when used across health care and home settings and to evaluate feasibility and potential cost-savings of wide-scale implementation,” the researchers wrote.

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Press VG, Arora VM, Kelly CA, Carey KA, White SR, Wan W. Effectiveness of virtual vs in-person inhaler education for hospitalized patients with obstructive lung disease. JAMA Netw Open. 2020;3(1):e1918205.