Patients who have been hospitalized for a flare of their COPD, which doctors call an exacerbation, are usually given instructions about their medications at the time of discharge. Following these instructions has been shown to reduce readmissions and poor outcomes. That’s what makes the following information so astounding. Recent studies have shown that 30% to 60% of patients do not fill or pick up their discharge medications. More surprising is the fact that only 6% of discharged patients used their inhaler medications regularly 80% of the time. An equally troubling fact was that poor inhaler technique was found in over 55% of the patients studied. These patients either used their inhaler regularly, but did not use it properly (25%), or many did not even use their inhaler regularly and used it incorrectly when they did (30%). The reasons for these problems were mainly two fold. One was cognitive impairment of the patient. They did not understand the instructions or were unable to carry them out. This is not through lack of intelligence, but impaired thinking associated with a severe lung disease such as COPD.
The other main factor was the inability to take in a deep enough breath because of so-called dynamic hyperinflation, better known as air trapping. Knowing these problems exist can help guide treatment approaches to help patients with severe COPD adhere to their important inhaler medications. Reminders about medications and observational techniques, along with pre-dose inhaler techniques, such as pursed lip breathing or using a PursedLip Breathing Device may help.