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1mo
Strengthening COPD onboarding: From first training to lasting adherence

In recent studies, more than 50% of patients with COPD could not correctly demonstrate their inhaler technique just weeks after initiation—even when they left the clinic confident in their skills. This reflects the challenges of managing a lifelong respiratory condition amid complex devices and fluctuating symptoms.

Structured onboarding can shift that trajectory. Using “teach-to-goal” (ie, repeated practice until correct use is demonstrated) and scheduling follow-up checks within weeks have been linked to improved control scores and fewer exacerbations. Brief refreshers at each encounter—during vitals or while updating the EMR—can help reinforce proper technique.

But effective education must go beyond technique. The patient journey includes emotional stages. Some patients are eager to master their device; others may be anxious, in denial, frustrated, or discouraged. Providing tailored education on flare-up management, treatment milestones, and integrating therapy into daily life can improve engagement. Addressing practical barriers such as cost, forgetfulness, or lack of support further supports long-term adherence.

During a busy COPD follow-up, where do you find time for a quick but effective inhaler technique review? How have you adapted your approach for patients who resist repeated inhaler education?

  • 1mo
    So often times I found the double team approach to be effective. I usually have the nurse see if he has his device and demonstrate how to use it, then when I go in, I’ll ask the Patient to demonstrate for me that also kind of helps the patient get motivated to listen to the nurse. Kind of like cheating on an exam.
    As far as the second point All you can do is continue to attempt meet people where they are and wait for the opportunity. Patience is a virtue.
  • 2mo
    I can discuss this at their office visit and demonstrate how to do it or if they have their own inhaler I can have them demonstrate use for me. It can be a large barrier to care if they are not using their medications appropriately. I can tell them that I routinely do this for all patients who use inhalers.
  • 3mo
    When the staff is rooming the patient, they verify which inhalers they are taking before we start the visit. Compliance is a big issue with our older patients due to insurance coverage variability leading to high copays for inhalers among other medications. When starting a patient on an inhaler, teaching is done by the nursing staff and also have the patient demonstrate how they use their rescue inhaler. Patients that do not feel they need it can be frustrating. It can be helpful to have the respiratory therapist attempt to do the teaching when they are there for their PFT.
  • 3mo
    Typically I will try to take a minute or so to make sure that they are using their device correctly after the exam. We try to keep demo devices available such as the Ellipta, Respimat as well as metered-dose inhalers. We have some sample holding chambers to demonstrate as well.

    Within EHR there is a least some of the common inhaler device instructions available also.

    I will usually try to point the patient's to the product website as well typically they will have some Demos videos.

    For those the though don't wish to learn, I will try to keep it as simple as possible with once daily medications or just switching over to nebulized options if there resistant to inhalers.
  • 3mo
    I’ve been thinking a lot about how we can help COPD patients stick with their inhaler techniques over the long haul. We all know that even though patients might leave the clinic feeling confident about their inhaler use, a lot of them struggle to demonstrate it correctly just weeks later. And honestly, that’s not surprising given the complexity of managing COPD, with devices that take time to master and symptoms that fluctuate.
    One thing that’s been helpful for me is incorporating dedicated inhaler teaching where patients practice until they’ve got it down. I have delegated this to my medical assistant. Reevaluation at follow-up appointments, especially when patients get to demonstrate their technique again and get immediate feedback are effective as well. I try to add this during routine things like taking vitals or while updating the EMR, just to squeeze it in without adding time to the visit.
    Some patients are excited to learn, but many have emotional hurdles.  When I work with patients, I focus on disease process education and the importance to being confident with the use of their medications. Helping them with flare-up management, treatment milestones, and making therapy part of their daily life is huge for engagement. And let's be real, cost and non-compliance are often huge issues too. I address these right from the start so it doesn't become a problem later on. I often refer to a medication management program for help with coverage gaps to improve compliance.
  • 3mo
    This is a very challenging area for clinicians to manage. In many COPD visits, we have a lot to discuss: symptoms, smoking cessation, need for oxygen, pulmonary rehab, lung cancer screening, exacerbations, vaccinations, exacerbations, etc. It's not uncommon that there is not enough time in the visit to do inhaler technique review, especially when an insurer may switch from the inhaler that I had prescribed personally. Some ways that i try to deal with this is by utilizing a respiratory therapist in clinic, and ask our patients to bring their inhalers with them to the visit. That way, I can ask the RT to review the patients technique and insure it is correct. This is true for most patients, but can be helpful for the resistant patients especially.

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