Impact of an Educational Intervention on Inhalation Technique and Self-Reported Medication Adherence in Adults With Asthma and COPD in a Primary Care Unit

Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are chronic respiratory diseases characterized by airflow restriction and heterogeneous clinical expressions.Inhaled therapy is the cornerstone of management, delivering medication directly to the respiratory tract using inhaler devices, such as pMDIs (pressurized metered dose inhalers), sDPIs (single-dose dry powder inhalers), mDPIs (multiple-dose DPIs), and SMIs (soft mist inhalers).Treatment effectiveness relies on a correct inhalation technique to guarantee optimal drug delivery and adequate treatment adherence to sustain disease control.In this context, prospective primary care data remain scarce regarding how face-to-face educational instruction influences inhaler handling and multidimensional adherence behaviors.Objective: The primary objective was to compare pre-and post-intervention inhalation technique in patients with COPD or asthma attending the primary healthcare unit.The secondary objective was to evaluate treatment adherence through a self-reported questionnaire.Methods: This was a prospective interventional study, approved by the Institutional Ethics Committee and conducted at a Portuguese primary healthcare unit from April to August 2024.Adult patients with COPD or asthma using at least one previously prescribed inhaler were included.The intervention consisted of assessing inhalation technique using device-specific checklists before and two months after face-to-face instruction on the correct technique.Each 30-to 45-minute educational session included 15 minutes dedicated exclusively to demonstrating and correcting the inhalation technique.Self-reported therapy adherence was evaluated through the Medication Adherence Universal Questionnaire (MAUQ) before and after the intervention.Following data insertion into a Microsoft Excel (Microsoft Corp., Redmond, WA, USA) database, statistical analysis was performed.Results: From a total of 76 patients (29 COPD, 47 asthma) initially assessed across 99 inhaler devices, 23 were lost to follow-up (5 COPD, 18 asthma).Ultimately, 53 patients completed the study, corresponding to 69 evaluated inhaler devices.Regarding inhalation technique, SMIs showed the highest proportion of inhalation technique errors (51.11%), followed by mDPIs (37.50%) and pMDIs (33.20%).Following the educational intervention, a significant improvement was noted in common errors, specifically "Failure to exhale forcefully prior to actuation" and "Not holding breath for at least 5 seconds," among asthma patients.The number of errors decreased in 14 (50.00%)COPD and 27 (71.05%)asthma techniques, reaching statistical significance only within the asthma group (p<0.001,Wilcoxon signed-rank test).Error proportion decreased significantly in mDPIs (p<0.001,Wilcoxon signed-rank test).In terms of treatment adherence, although MAUQ total scores revealed no statistical variations within groups before and after the intervention (COPD p=0.125, asthma p=0.195,Wilcoxon signed-rank test), the "Lack of Discipline" dimension improved significantly in both groups (COPD p=0.041, asthma p=0.006,Wilcoxon signed-rank test).Conclusion: Structured teaching and regular review of inhalation techniques in primary care allow healthcare professionals to identify and correct device handling errors that emerge over time.Nevertheless, a more comprehensive, multifaceted intervention is required to effectively promote long-term treatment adherence.