Discussion
asthmatic, cough, underdiagnosis, asthma, COPD, shortness of breath
ASTHMATIC, DISEASE, COPD, SECONDARY, ASTHMA
This is the first RCT investigating the effect of a video-based teach-to-goal educational intervention on inhaler technique mastery, in addition to its effect on disease control, disease-related quality of life, and medication adherence among adults with asthma and COPD over a period of three months.The underdiagnosis of COPD among Jordanians might have contributed to the discrepancy in the number of asthma and COPD patients enrolled in the study [Upon assessment of all the inhaler techniques used by the study population, almost half of the techniques were incorrect at baseline. This result cannot be compared to previously published data due to the presence of several checklists and scoring systems used to evaluate the correct use of inhalers [Turbohaler was the inhaler most frequently prescribed among the study participants which goes in line with the GINA recommendations to prescribe formoterol/budesonide combination (Turbohaler-SymbicortThe educational intervention adopted in this study demonstrated superiority over the verbal TTG education and it was able to retain good technique over time. The uniqueness of this intervention is that it blends the initial face-to-face education with a technology-based education. This pinpoints the advantage of interaction with the clinical pharmacists in addition to that offered by a video [Interestingly, when Press et al. (2017) studied the effectiveness of a virtual TTG education without providing direct contact with healthcare providers, patients showed good theoretical knowledge but incorrect inhaler techniques at the time of education [When looking at disease control, the non-significant amelioration between the intervention and control groups at follow-up can result from the initial baseline difference observed in the ACT and CAT levels in favor to the control group. Significant amelioration was however clearly observed after three months within the intervention group in comparison to baseline, which might be a result of inhaler technique improvement among these participants. Mastery of inhaler technique has, in fact, been directly correlated to better control of disease-related symptoms such as shortness of breath and cough, as well as fewer exacerbations. [Improvement in the symptoms and activity domains of the disease-related QoL might also be attributed to the amelioration of inhaler technique and its subsequent benefit on disease control among the intervention group [Medication adherence was also improved significantly over time among participants receiving the video-based TTG education. Better understanding the device technique should have contributed to patients feeling more comfortable in using their inhalers improving adherence [Study limitations include the loss of some patients at follow-up. Due to the COVID-19 pandemic some participants preferred not to visit the study site. Moreover, despite the intention to address both asthma and COPD, the study didn’t achieve a balance in the number of participants with a dominance of asthmatic patients.In conclusion, this study demonstrates that the video-based TTG education could significantly improve the inhaler technique mastery, disease control, disease-related patients’ quality of life and the medication adherence among patients with chronic respiratory conditions. The long-term effect on the study secondary outcomes is suggested to be directly related to the improvement in the inhaler technique mastery and to the reinforcing nature of the videos, easily accessible by the patients at any time.