Bridging the Gap Between Prescription and Practice: Impact of Nurse-Led Inhaler Education

Bridging the Gap Between Prescription and Practice: Impact of Nurse-Led Inhaler Education on Patient Technique, Knowledge, Adherence, and Beliefs - A Randomized Clinical Trial

Asthma and chronic obstructive pulmonary disease (COPD) are among the most prevalent chronic respiratory conditions worldwide, affecting hundreds of millions of individuals and contributing substantially to morbidity, mortality, and healthcare burden. Although clinicians routinely advise patients verbally on inhaler use, the lack of structured, hands-on education results in significant variation in technique and consistently poor retention of skills over time.

Asthma and chronic obstructive pulmonary disease (COPD) are among the most prevalent chronic respiratory conditions worldwide, affecting hundreds of millions of individuals and contributing substantially to morbidity, mortality, and healthcare burden. Inhaled therapy remains the cornerstone of management for both diseases, providing targeted delivery of bronchodilators and corticosteroids while minimizing systemic side effects.

Despite correct prescription of inhaler devices, a large proportion of patients demonstrate incorrect technique in inhaler use, leading to suboptimal drug delivery, poor symptom control, increased exacerbations, and frequent emergency department visits. Multiple factors contribute to this gap between prescription and real-world practice, including poor patient understanding of device mechanics, inappropriate inhalation patterns, and misconceptions about the nature and safety of inhaled corticosteroids.

Although clinicians routinely advise patients verbally on inhaler use, the lack of structured, hands-on education results in significant variation in technique and consistently poor retention of skills over time. Nurses, who often maintain the most direct and sustained contact with patients, represent an underutilized resource in addressing this gap. Previous studies indicate that nurse-led inhaler education can significantly enhance practical technique, reinforce adherence, and correct misconceptions about medication use. However, there is limited evidence on the long-term retention of inhaler skills and the impact of structured nurse training on both nurse competency and patient outcomes.

Inclusion Criteria:

• Adults aged ≥18 years diagnosed with Asthma or COPD according to GINA / GOLD guidelines
• Current use of inhaler therapy (MDI, DPI, or Nebulizer) for ≥3 months.
• Able to understand instructions and perform inhaler technique assessments.
• Willing to provide informed consent and participate in all study assessments.

Exclusion Criteria:

• Acute exacerbation requiring hospitalization at the time of enrollment.
• Cognitive impairment or neurological disorders preventing understanding or proper inhaler use.
• Severe comorbidities (e.g., advanced heart failure, end-stage renal disease) that limit participation.