Following a healthcare provider’s advice is crucial for patients with respiratory problems such as asthma and chronic obstructive pulmonary disorder (COPD). “Adhering to the treatment regimen can improve their lung function and prevent exacerbation and trips to the hospital,” says Jenna Schulner, physician assistant at the Mount Sinai Respiratory Institute in New York. “This will in turn improve their quality of life.”
But numerous road blocks can get in the way of adherence. Trouble understanding and taking medication properly is one of them, says Maria Villanueva, a family nurse practitioner with expertise in pulmonology at Santa Clara Valley Medical Center in California. “Very often patients are given various inhalers for relief and control, and each one can be different in when it’s taken, how it’s taken, and the right dose to take,” she says.
Inconvenience can be another stumbling block. “Some nebulizers are big, and if patients go on vacation they don’t want to bring it—which means they’re not on their regimen while they’re gone,” Schulner says.
Another challenge is environmental control. “Patients may have triggers for their pulmonary disease at home—such as dust, mold, or pet dander—that they don’t realize are causing symptoms,” Villanueva says.
Failing to adhere to the protocol can result in a worsening quality of life—which is why it’s so vital for healthcare providers to do all they can to help patients stay on track. These six recommendations from providers who work with respiratory patients can help.
1. Provide a written plan. Be sure to include the names of medication, how much to take, and how often to take it.
2. Demonstrate equipment use. “Education comes from us as healthcare providers,” Schulner says. “We need to show patients how to use the equipment, not just tell them.” Both she and Villanueva teach patients how to use an inhaler and then ask the patients to teach back. “Very often I will find out that they don’t know how to use it,” Villanueva says. Schulner’s office also uses the PadInMotion app, which provides patients with how-to videos they can consult anytime.
3. Repeat. There’s no such thing as too much repetition! “Repeat the message over and over,” Villanueva says. “Make sure to emphasize that daily controllers need to be taken every day even when patients feel good.”
4. Include emergency information. Patients need to know what to do in case their disease gets into what the American Lung Association calls the “red zone”—which signifies an emergency. Phone numbers for doctors, emergency departments, medical transport, and family/friends who can provide support should be listed, along with instructions for quick-relief (or rescue) medications.
5. Encourage loved ones to attend appointments. “Some patients put on a good face when things are difficult,” Schulner says. A patient may be prescribed an inhaler that requires fine-motor coordination to use, for example. The patient may not tell the provider that would be difficult, but a son or daughter who is in the room may say, “Dad can’t do that.” If loved ones attend appointments, they can also hear for themselves what’s recommended and reinforce adherence when a patient is out of the office.
6. Have a conversation. Direct, honest, and compassionate communication can be beneficial when a patient is having trouble with adherence. “Sometimes it’s helpful to sit down with a patient and ask, ‘What’s getting in your way? What’s keeping you from following the plan?,’” says Schulner. It may be as simple as switching from a once-daily dosage to twice-daily. “If patients take other medications twice a day, it may be easier to take everything at once,” she says. “Working with a patient on an individual basis can make a big difference.”
Last updated on 9/30/19.