Discrepancies in Predictive Factors of Inhaler Technique vs. Adherence

ABSTRACT

Background: Inhaled medications effectively treat Chronic Obstructive Lung Disease (COPD) through reduction of symptoms and improvement in patient outcomes, however inhaler misuse and nonadherence to treatment plans remain significant barriers to achieving optimal disease control. We investigated predictors for completion of a novel at-home self-management support program to better understand factors that promote treatment adherence and retention of inhaler technique. Methods:Hospitalized adults with COPD were enrolled in this study. Participants received inhospital inhaler education in the form of Virtual Teach-to-Goal (V-TTG). Inhaler technique was assessed using a validated checklist where inhaler misuse was categorized as getting less than or equal to 9 steps out of 12 correct. A validated questionnaire assessed the participants' quality of life (QoL) regarding their respiratory health. Upon discharge, participants were instructed to complete the V-TTG assessment at home and return for a 30-day follow up. Amendments were made to the IRB as the study progressed to further investigate the low completion rates of the VTTG module at home and to facilitate virtual follow-up options due to COVID-19 restrictions. Binary and multivariable logistic regression models were used to predict correct pre-intervention inhaler technique given external factors such as participant zip code, type of housing, and whether they had a caregiver. Results:The majority of participants were Black (97%) and female (57%), with an average age of 63 years (range 43-79, S.D. ± 8.4). Of 70 participants, 24 completed the study by attending the 30-day follow-up (34%), and there was no significant change in inhaler misuse rates from baseline to 30-day follow up (p = 0.09). No predictors for program completion, external factors, and/or QoL measures were found to be predictive of maintained inhaler technique at the 30-day follow-up or for attending the 30-day follow-up in either binary or multi-variable logistic regression. Conclusions: These findings highlight the challenge of maintaining inhaler skills and adherence to treatment plans through self-supported, home-based interventions. There was no single parameter, or combination of parameters, predictive of attending the 30-day follow-up or adequate inhaler technique at follow-up. Research that further explores the role that personal and societal characteristics play in both treatment adherence and retention of inhaler technique is needed to improve our understanding of how to effectively engage patients in complex self-management.