PURPOSE: Metered-dose inhalers (MDI) with spacer devices has become the preferred delivery route for hospitalized patients requiring acute bronchodilator therapy. We hypothesize that there is a high rate of MDI misuse in the medical inpatient population, likely associated with undiagnosed cognitive dysfunction and/or low education level.
METHODS: Hospitalized patients who have been prescribed MDI short-acting bronchodilator therapy were identified through electronic medical records. Once patients were consented, the Mini-Cog assessment, a validated screening tool for cognitive dysfunction, was performed. Patients were then asked to complete a survey as well as demonstrate their MDI technique. This was evaluated using a 12-point checklist. MDI misuse was defined as less than nine steps completed correctly.
RESULTS: A total of 50 patients were enrolled. Our study population consisted of mainly elderly patients with COPD. Only 40% of participants passed the Mini-Cog assessment and 50% demonstrated proper MDI technique. Failing the Mini-Cog produced an odds ratio of 36.9 (CI:3.67-371.5, p=0.002), while age produced an odds ratio of 1.12 (CI:1.02-1.23, p=0.019). These factors were independent of one another. Other characteristics, like education level and previous MDI technique teaching showed a positive trend, but were not statistically significant.
CONCLUSIONS: In conclusion, there was a high rate of MDI misuse in the medical inpatient population. Only two factors correlated with MDI misuse: failing the Mini-Cog and older age.
CLINICAL IMPLICATIONS: The Mini-Cog as a screening tool for cognitive dysfunction is a powerful predictor of MDI technique in this inpatient population. One potential use may be to screen all medical inpatients who require regular inhaler therapy. Those that pass the Mini-Cog may be targeted for inhaler technique teaching, while those that fail this screening tool may require regular assistance with inhaler use. Further studies on how the Mini-Cog assessment could be incorporated into intervention strategies to improve MDI use in medical inpatients are needed.
DISCLOSURE: The following authors have nothing to disclose: Thanu Nadarajah, Bahareh Ghadaki, Tom Piraino, Greg Pond, Jill Rudkowski
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