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.

Study Overview

• Status: Completed
• Conditions: Inhaled Steroid-Dependent Asthma
• Intervention / Treatment: Procedure: Inhaler technique

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Al Mansurah, Egypt, 35516
    • Mohamed AbdElmoniem

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: nurse-led inhaler education; Known Patients with asthma or COPD, using inhalers and education was Conducted by trained nurses using standardized checklist (Global Initiative for Asthma "GINA"/Global Initiative for Chronic Obstructive Lung Disease "GOLD")	Procedure: Inhaler technique; Patient Education: Conducted by trained nurses using standardized checklist (GINA/GOLD)
No Intervention: Control group on inhaler; Known Patients with asthma or COPD, using inhalers weren't trained

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
impact of nurse-led education on inhaler technique	Participants will be evaluated to assess the impact of nurse-led education on technique Score: 152 This score evaluates the patient's ability to correctly use their inhaler. It covers nine key 153 components: ensuring the prescribed device type is used (MDI, DPI, or nebulizer), shaking 154 the MDI before use, complete exhalation before inhalation, proper lip seal around the 155 mouthpiece or spacer, correct inhalation speed according to device type, holding breath after 156 inhalation, rinsing the mouth after corticosteroid sprays, correct use of spacer devices, and 157 overall error correction. The maximum possible score is 9 points. Scores are interpreted as 158 follows: ≥8 indicates excellent technique, 5-7 represents moderate performance, and ≤4 159 indicates poor technique. The checklist was adapted from guideline-recommended inhaler 160 technique steps according to GINA and GOLD reports	1 month

Collaborators and Investigators

• Sponsor: Mansoura University Hospital
• Investigators: Principal Investigator: Mohamed AbdElmoniem, Lecturer of chest medicine faculty of medicine Mansoura university

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2025
• Primary Completion (Actual): January 1, 2026
• Study Completion (Actual): February 1, 2026

Study Registration Dates

• First Submitted: February 24, 2026
• First Submitted That Met QC Criteria: February 27, 2026
• First Posted (Actual): March 2, 2026

Study Record Updates

• Last Update Posted (Actual): March 2, 2026
• Last Update Submitted That Met QC Criteria: February 27, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Bronchial Asthma; Inhaler technique; nurse-led inhaler education
• Additional Relevant MeSH Terms: Immune System Diseases; Respiratory Tract Diseases; Lung Diseases; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Asthma
• Other Study ID Numbers: R.26.02.3594

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No