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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Article info
Publication history
Published online: August 23, 2021
Accepted:
August 20,
2021
Received in revised form:
June 25,
2021
Received:
April 7,
2021
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier Ltd. All rights reserved.
