Inhaler device technique can be improved in older adults through tailored education: findings from a randomised controlled trial

To investigate the effects of inhaler device technique education on improving inhaler technique in older people with asthma. In a randomised controlled trial, device technique education was provided to a sample of 123 adults aged >55 years who had a doctor diagnosis of asthma. The active education group received one-on-one technique coaching, including observation, verbal instruction and physical demonstration at baseline. The passive group received a device-specific instruction pamphlet only. Inhaler technique, including the critical steps for each device type, was assessed and scored according to Australian National Asthma Council (NAC) guidelines. Device technique was scored objectively at baseline and again at 3 and 12 months post education. The majority of participants demonstrated poor technique at baseline. Only 11 (21%) of the active intervention group and 7 (16%) of the passive group demonstrated 100% correct technique. By 3 months 26 (48%) of the active group achieved adequate technique. Improvement in technique was observed in the active group at 3 months (P<0.001) and remained significant at 12 months (P<0.001). No statistically significant improvement was observed in the passive group. The provision of active device technique education improves device technique in older adults. Passive education alone fails to achieve any improvement in device technique. Individual coaching rather than written information is important to improve the inhaler technique of older adults with asthma. Management of asthma symptoms requires the correct use of inhalers to administer drugs effectively but many people with asthma, particularly those who are older, do not use their inhalers properly. In an Australian study, Melanie Crane and colleagues showed that in 123 adults with asthma over age 55, most did not demonstrate correct inhaler technique. Participants who then received one-on-one coaching on proper inhaler use improved their technique while those who received only passive education via an instructional booklet showed no improvement in technique. The findings suggest that active teaching of inhaler use is necessary to achieve proper inhaler technique in older adults.