If you have COPD (chronic obstructive pulmonary disease, 慢阻肺), have your doctor or pharmacist watch you use your inhaler once at each follow-up visit; if you have been hospitalized for an acute flare-up, go to pulmonary rehabilitation after you leave the hospital

Cost

Having your inhaler technique checked costs nothing extra: bring the medicine to your follow-up visit and use it in front of them, which takes a few minutes. Pulmonary rehabilitation is exercise training done under guidance, plus explanations of medicines and self-management; you attend a program several times, and costs vary by place. The hard part is that you feel weak after leaving the hospital and still have to keep going to train.

What you get

A national sampling survey in China: 50991 adults aged 20 and older all had a lung function test. The share with COPD was 8.6% (95% CI 7.5–9.9, confidence range), about 99,900,000 (9990万) people. Among those aged 40 and older it was 13.7%. Among COPD patients, only 12.0% had ever had a lung function test before. One analysis pooled 144 studies in which 54354 patients were watched by trained people as they used inhalers. Completely correct technique was 31%, barely acceptable 41%, and poor 31%. There was no improvement when the first 20 years were compared with the last 20. Among those using pressurized sprays, 45% could not coordinate pressing and breathing in. Not inhaling fast or deep enough was 44%, and not holding the breath after inhaling was 46%. A survey in France, with records only and no assigned groups, had doctors watch 2935 COPD patients use their inhalers. More than half had mistakes in their technique. Critical errors that keep the medicine from getting in ranged from 15.4% to 46.9% across the types of inhaler. Hospitalization or an emergency visit for a flare-up in the past 3 months was 3.3% among patients with no errors and 6.9% among those with a critical error (OR 1.86, 1.14–3.04). The summary of the GOLD 2023 report states that doctors and patients should be taught to use inhalers correctly, and that technique should be checked regularly at follow-up visits. It also recommends that COPD patients get flu, pneumococcal and other vaccines according to local rules. A 2016 Cochrane review pooled 20 randomized trials with 1477 people. It compared pulmonary rehabilitation after a COPD flare-up with usual care without rehabilitation. 8 studies with 810 people looked at rehospitalization. Rehospitalization was possibly about 56% lower with rehabilitation (OR 0.44, 95% CI 0.21–0.91), with moderate-quality evidence. But the results differed greatly between studies. 6 studies with 670 people looked at death, OR 0.68 (0.28–1.67); the difference may be chance, and the evidence quality is low. The improvement in quality of life exceeded the amount patients can feel, with high-quality evidence. The distance walked in 6 minutes was 62 meters longer on average (38–86 meters), with high-quality evidence

Notes

Disputed: when to start pulmonary rehabilitation is not agreed. A randomized trial in the UK started training within 48 hours of admission, and a year later rehospitalizations were not fewer (HR 1.1). Deaths were actually higher (OR 1.74, 95% CI 1.05–2.88). The summary of the GOLD 2023 report says that the effect of starting within the first 4 weeks after discharge is still unclear. So what to do is wait until your condition has settled after discharge and go as your doctor arranges, and don't add training on your own during the acute stage in the hospital. The Cochrane review also states that newly included studies had smaller effects than the early ones. The two inhaler studies are both record-only surveys, and no trial directly shows that "checking once at a follow-up visit" means fewer hospital stays. The specific technique differs for each device; follow the package insert and your doctor's demonstration. For the flu vaccine see §1.20 (flu vaccine), and for the pneumococcal vaccine see §1.22 (pneumococcal vaccine). If you still smoke, quit first; see §2.3 (quitting smoking: don't just tough it out, get medication first). The beneficiary is mainly you.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Wang C, Xu J, Yang L, et al.; China Pulmonary Health Study Group (2018). Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet, 391(10131), 1706-1717. https://doi.org/10.1016/S0140-6736(18)30841-9
2. Sanchis J, Gich I, Pedersen S; ADMIT (2016). Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time? Chest, 150(2), 394-406. https://doi.org/10.1016/j.chest.2016.03.041
3. Molimard M, Raherison C, Lignot S, et al. (2017). Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients. European Respiratory Journal, 49(2), 1601794. https://doi.org/10.1183/13993003.01794-2016
4. Agustí A, Celli BR, Criner GJ, et al. (2023). Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. European Respiratory Journal, 61(4), 2300239. https://doi.org/10.1183/13993003.00239-2023
5. Puhan MA, Gimeno-Santos E, Cates CJ, Troosters T (2016). Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 12, CD005305. https://doi.org/10.1002/14651858.CD005305.pub4
6. Greening NJ, Williams JE, Hussain SF, et al. (2014). An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. BMJ, 349, g4315. https://doi.org/10.1136/bmj.g4315（反方）

Translated from the Chinese original. Original book, section 16, tip 12. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer