A44-49 Reducing Inhaler Technique Decay in a Pulmonary Clinic Setting: A Quality Improvement Initiative

Abstract Background Inhalation drug therapy remains the cornerstone of effective management for patients with asthma and chronic obstructive pulmonary disease (COPD).¹ Suboptimal inhaler technique can impede medication delivery to the lungs, resulting in inadequate disease control.² A systematic review reported that more than 75.9% of patients performed at least 20% of inhaler device steps incorrectly.³ Although both verbal instruction and the use of technique aids have been shown to improve inhaler technique, these benefits tend to diminish within 6–8 weeks.4 A clinical trial demonstrated a significant reduction in inhaler errors following individualized re-training at three months.2 This quality improvement aims to reduce the rate of inhaler technique decay by 50% over a six-month period in a pulmonary clinic setting Methods Clinic support staff received training in proper inhaler technique based on the American Thoracic Society (ATS) 12-step inhaler technique guidelines.6 The intervention followed a four-step educational model: (1) patients demonstrated their usual inhaler technique; (2) clinic support staff observed performance and documented errors using the 12-step checklist; (3) patients viewed a 100-second instructional video demonstrating correct technique;7 and (4) clinicians reviewed the identified errors and provided individualized verbal feedback and hands-on technique training during the same visit. Follow-up assessments were conducted at one and three months to reinforce correct technique. Data were collected to evaluate the proportion of patients demonstrating correct inhaler technique before and after the intervention. Results The quality improvement project was implemented from April 2025 through June 2025 but was suspended due to institutional staffing changes. During this period, a total of twelve patients participated in the intervention. Of these, ten patients demonstrated correct performance of all twelve inhaler technique steps without error, while two patients made at least one error that was subsequently identified, coached, and corrected. Ongoing follow-up assessments are planned to evaluate the sustained impact and long-term benefits of the intervention. Conclusion The process for reviewing inhaler technique was successfully standardized in our clinic to mitigate deterioration of inhaler skills among the patient population. The primary aim was not achieved, largely due to several contributing factors, including external influences such as modifications to the clinic’s staffing model. Notably, the patient population demonstrated a relatively high baseline proficiency in inhaler technique compared with findings from previous studies. This observation may be attributed to the higher levels of educational attainment and the predominantly middle- to upper-socioeconomic status characteristic of the population served in the Austin area. This abstract is funded by: None