B24-06 Patient Impairments in Cognitive Function, Manual Dexterity, and Inhalational Ability Affect Inhaler Technique in Chronic Obstructive Pulmonary Disease

Abstract Rationale Despite worldwide use of handheld inhalational devices in the treatment of chronic obstructive pulmonary disease (COPD) for decades, evidence is limited about which patient factors affect inhaler technique. Objectives 1. To determine the prevalence of impairments in cognitive function, manual dexterity, and inhalational ability in out-patients with COPD; and 2. to assess whether these patient factors are associated with inhaler technique. Methods The Impairments that Affect Correct Inhaler Use in COPD (INHALE) observational study was conducted by the COPD Foundation at nine United States sites (ClinicalTrials.gov, ID NCT06135324). After signing consent, stable out-patients with COPD returned 2-21 days later bringing in, but not using their handheld maintenance inhaler(s) that morning. Spirometry and peak inspiratory flow against a medium-low resistance (PIFr) were measured. An investigator observed/graded inhaler technique when patients used “their inhaler(s) as you would at home” as “satisfactory” or “not satisfactory” based on standard 5-item checklist. Inhaler technique was judged as “acceptable” (4 or 5 items satisfactory) or “unacceptable” (two or more items not satisfactory). The COPD Assessment Test, Mini-Mental State Examination (to assess cognitive function) and the Functional Dexterity Test (to assess manual dexterity) were administered. Spirometry was repeated 30 minutes after patient inhalation. Results Of 503 patients, age was 70 ± 6 years, 55% were male, and post-bronchodilator forced expiratory volume in one second was 46 ± 15 % predicted. 71% had acceptable inhaler technique. Overall, 10.3% had cognitive impairment, 34.8% had non-functional manual dexterity, and 20.5% had suboptimal PIFr. Chi-squared testing showed that cognitive function (p = 0.0001), manual dexterity (p = 0.0152), and PIFr (p = 0.004) were significantly associated with inhaler technique. Logistic regression analyses for unacceptable inhaler technique as the dependent variable showed: cognitive impairment (odds ratio: 3.09; p = 0.0004) and COPD Assessment Test total score (odds ratio of a 2-point increase: 1.07; p = 0.033) were significantly associated with all inhalers (Table); both cognitive impairment (odds ratio: 3.71; p = 0.004) and a suboptimal PIFr (odds ratio: 1.23; p = 0.013) were significant for DPIs; and non-functional manual dexterity was significant (odds ratio: 1.90; p = 0.015) for pMDIs/SMIs combined. Conclusions Patient impairments in cognitive function, manual dexterity, and inhalational ability were each significantly associated with inhaler technique in stable out-patients with COPD. Cognitive impairment and suboptimal PIFr were significantly associated with unacceptable inhaler technique for DPIs, whereas non-functional manual dexterity was significantly associated with unacceptable inhaler technique for pMDIs/SMIs combined. This abstract is funded by: Theravance Biopharma and Viatris