Effects of Repeated Instruction on Inhalation Therapy, Medication Adherence and Health Status in Chronic Obstructive Pulmonary Disease

Abstract

Objectives: The aim of this study was to systematically assess the impact of repeated instructional interventions on enhancing inhaler technique, medication adherence and quality of life for individuals with COPD. Method: This was a single-centre, randomized pre-post interventional study design that was applied in three consecutive weeks during September, 2024 to March, 2025. The study participants included 128 patients diagnosed with COPD defined as per GOLD guideline. Study participants randomly assigned to intervention (64 participants) and control group (64 participants). Primary outcomes were improvement in the inhaler technique assessed by 12-item checklist and medication adherence assessed by Medication Adherence Report Scale (MARS-5). Secondary outcome was enhancement of health-related quality of life assessed by COPD assessment tool (CAT). Result: The inhaler score was calculated as the proportion of the number of correct steps to the total number of steps. Participants in the intervention group exhibited significant improvement across all steps (P < 0.00), whereas participants in the control group continued to make almost similar errors (P = 0.167). Overall, participants reported poor adherence prior instruction program in both group with mean (SD) of 11.8 (2.4) and 11.7 (2.3) respectively. The score has significantly improved post program to mean (SD) of 18.8 (1.67) among intervention participants, while among control participants the mean (SD) slightly reduced to 11.5 (2.22). Repeated instruction and proper adherence to the medication significantly improved the quality of life, as assessed by the CAT mean (SD) from 28.2 (6.5) to 15.9 (4.3) (P < 0.001) in the intervention group. While in the control group mean (SD) of CAT score slightly increased from 27.8 (6.3) to 28.2 (6.1). Conclusion: An individualized repeated instruction intervention, in stable patients with COPD, in real-world clinical practice conditions, improves inhaler technique and adherence to the inhaled treatment and ultimately improves health related quality of life.