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Ward based inhaler technique service reduces exacerbations of asthma and COPD

Published:August 23, 2021DOI:https://doi.org/10.1016/j.rmed.2021.106583

      Highlights

      • Using inhaler devices correctly is critical for chronic lung disease management.
      • Poor inhaler technique continues to be a recurring theme in asthma and COPD.
      • A dedicated service can focus on teaching patients to use inhalers correctly.
      • Improving the use of inhalers prevents future exacerbations and hospital admissions.
      • Patients value the use of a dedicated service to teach correct inhaler use.

      Abstract

      Background

      The management of asthma and COPD is largely dependent on patients being able to use their inhaled medication correctly, but poor inhaler technique continues to be a recurring theme in studies and clinical practice. This is associated with poor disease control, increased risk of exacerbations and hospital admissions, and so there is a need to redesign services for patients to optimise their medicines use.

      Methods

      A novel ward-based dedicated inhaler technique service was developed, and pharmacy support workers trained to provide this, focusing on optimising inhaler technique using a checklist and recommending protocol-guided inhaler device switches. Inpatients on adult respiratory wards with a diagnosis of exacerbation of asthma or COPD consented to receive this service, and the impact on exacerbations and hospital admissions were compared in the 6-months before and after the intervention.

      Results

      266 adults (74 asthma, 188 COPD, and four asthma-COPD overlap) received the inhaler technique service. Six-month exacerbation and hospital admission data were available for 184 subjects. Optimising inhaler technique achieved a significant reduction in the combined asthma and COPD annualised rate of moderate-to-severe exacerbations (Rate Ratio [RR] 0.75, p < 0.05) and annualised rate of hospital admissions (RR 0.57, p < 0.0005). Improvements were also observed in future length of stay (- 1.6 days) and the average cost of admission (-£748).

      Conclusions

      This novel inhaler technique service produced a significant reduction in the rate of moderate-to-severe exacerbations of asthma and COPD, and a reduction in the rate hospital admissions, length of stay and average cost of admission.

      Keywords

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