BACKGROUND: Inhalation errors frequently occur in patients receiving inhalation treatment, which can significantly impair treatment success. While this underscores the importance of inhalation training, the role of modern web-based instructional videos has not yet been investigated. METHODS: A randomized controlled trial using standardized checklists (10 items: preparation N = 3, inhalation routine N = 6, and closure of inhalation N = 1) was carried out to determine the relative effects of web-based, device-specific videos versus standard personal instruction on reducing multiple (>= 2) inhalation errors in severe COPD patients requiring hospitalisation. Investigators assessing inhalation errors were blinded to the intervention. RESULTS: Multiple handling errors were recorded at baseline in 152 out of 159 patients (95.6%). Each teaching method led to a similar reduction in errors (videos from 4.2 +/- 1.6 to 1.5 +/- 1.5 errors; personal instruction from 3.8 +/- 1.5 to 1.3 +/- 1.6; p < 0.0001), although non-inferiority of web-based video teaching could not be confirmed statistically due to an unpredictably high number of patients in both groups still making multiple handling errors (44.0% versus 40.3%, mean difference 3.7%; 95%CI -12.0 to 19.4%). CONCLUSION: Multiple inhalation errors regularly occur in severe COPD patients requiring hospitalisation. Web-based video teaching is capable of reducing inhalation errors. However, compared to personal instruction non-inferiority could not be established. This was due to an unexpectedly high number of patients with persisting inhalation errors despite training. TRIAL REGISTRATION: Clinical trial registration German Clinical Trial Register, DRKS00004320.

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