Many individuals with Asthma lack the skills to properly manage their disease. They are not very knowledgeable about Asthma medication and often don’t know how to use metered dose inhalers (MDIs) correctly. However, these patients have no difficulty learning and retaining instructions about their Asthma regimen and MDI technique.

These are the findings of Dr. Michael K. Paasche-Orlow, of Boston University School of Medicine, and colleagues, who examined the association between inadequate “health literacy” and difficulties learning and retaining instructions about medications and appropriate MDI technique in 73 adults hospitalized for severe Asthma at two inner-city hospitals.

At discharge, the subjects received one-on-one, 30-minute, guideline-based written and oral instruction about their Asthma discharge regimen. They also received information about appropriate MDI technique.

A total of 16 patients (22 percent) were deemed by investigators to have poor health literacy. These patients were at higher risk for readmission to the hospital during the following year.

Inadequate health literacy was also associated with lower Asthma medication knowledge and worse MDI technique before instruction. However, these patients did not have difficulty learning or retaining instructions about the discharge regimen and about appropriate MDI technique, the study team reports the American Journal of Respiratory and Critical Care Medicine.

Before the educational sessions, “the level of comprehension for crucial self-management skills was very low - and even lower for those with inadequate health literacy,” said Paasche-Orlow said. “This should be a wake-up call about patient education needs in general, not just for those with inadequate health literacy,” he said.

“Teach-to-goal may be a strategy that can work,” he noted. “The central idea of teach-to-goal education is to confirm comprehension with a teach-back (i.e. show me how you will use your inhaler) and to continue focused teaching with further rounds of teach-back until the learner exhibits mastery.”

SOURCE: American Journal of Respiratory and Critical Care Medicine, October 2005.