Cognitive Load and Inhaler Technique in COPD

Cognitive Load-Induced Inhaler Errors in COPD: Linking Dual-Task Mobility to Treatment Self-Management

This study evaluates whether cognitive load affects inhaler technique in adults with chronic obstructive pulmonary disease (COPD). During a single study visit, participants will complete assessments of cognitive function, mobility, and respiratory status. Dual-task mobility will be assessed using the Timed Up and Go test performed alone and while completing a cognitive task. Inhaler technique will then be evaluated in two conditions: usual inhaler use without an additional task and inhaler use while maintaining a short sequence of digits in working memory. Inhaler technique will be scored using a standardized five-step device-specific checklist, and inhaler use time will also be recorded. The study will examine whether inhaler technique worsens under cognitive load and whether this deterioration is associated with dual-task mobility performance, cognitive function, respiratory symptoms, and functional capacity. No inhaler training or correction will be provided between the two inhaler conditions. All assessments are performed during a single visit.

Inclusion Criteria:

Age ≥18 years. Established diagnosis of chronic obstructive pulmonary disease (COPD). Clinically stable at the time of assessment. Current use of at least one maintenance handheld inhaler (pMDI, SMI, or DPI). Ability to perform the Timed Up and Go test and the study cognitive tasks. Ability to understand the study procedures and provide written informed consent.

Exclusion Criteria:

Acute COPD exacerbation or incomplete recovery from a recent exacerbation at the time of assessment.

Clinical condition preventing safe completion of the Timed Up and Go test. Inability to complete the cognitive or inhaler assessment procedures required by the protocol.

Inability to provide informed consent.