A dedicated inhaler technique optimization service for hospitalized patients with COPD and asthma exacerbations reduced the rate of moderate to severe disease exacerbations, according to results of an analysis published in Respiratory Medicine.

In the study, pharmacy support workers were trained to provide a novel, ward-based inhaler technique service to adults admitted to the respiratory wards at The Leeds Teaching Hospitals NHS Trust in Leeds, United Kingdom.

The investigators sought to evaluate the association of proper inhaler technique with improved disease control, decreased risk for exacerbations, and reduced hospitalization in patients with asthma and COPD. The inhaler service workers optimized patients’ inhaler technique and recommended protocol-guided switches in inhaler device. Inpatients from adult respiratory wards who had been diagnosed with an exacerbation of COPD or asthma provided their consent to receive this service.


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The inhaler technique service was provided to 266 participants. The mean patient age was 60.5 years; 53% of the participants were female. Hospital admission and 6-month exacerbation data were available for 164 of the 266 participants and were included in the outcomes analyses. Of these individuals, 99 had a diagnosis of COPD, 61 had a diagnosis of asthma, and 4 had a diagnosis of asthma-COPD overlap. Overall, 79.9% (131 of 164) of the participants were followed up at 48 hours.

Each of the participants was prescribed a mean of 2.3 inhalers (range, 1 to 3 inhalers). A total of 616 inhaler technique evaluations were performed (303 with a dry powder inhaler and 313 with an aerosol inhaler). Inhaler technique was considered optimal in 176 patients, satisfactory for 304, and unsatisfactory for 136 patients using inhalers at baseline. Further, inhaler technique did not differ significantly for aerosol devices compared with dry powder inhalers. After training and recommended changes in treatment, inhaler technique was considered optimal for 494 patients, satisfactory for 46, and unsatisfactory for 0 of those using inhalers (P <.00001 for both aerosol and dry powder inhalers).

Improvements in inhaler technique were attained through training (43.3% of evaluations), switching inhaler device (21.8% of assessments), or optimizing treatment with or without changing inhaler device (34.9% of evaluations). Optimizing inhaler technique was associated with a significant reduction in the combined asthma and COPD annualized rate of moderate to severe exacerbations (rate ratio [RR], 0.75;

P <.05) and annualized rate of hospitalizations (RR, 0.57; P <.0005). The length of hospitalization was also reduced by 1.6 days (2.8 days for participants with asthma and 0.9 days for those with COPD). The average cost of hospital admission was reduced by £748 (£1286 for asthma and £466 for COPD).

The researchers concluded that prevention of exacerbations and hospitalization, a key requirement for improving quality of life and health in patients with asthma and COPD, can be attained with the use of a dedicated inhaler service. This service should focus on the optimization of inhaler technique, along with education for patients on when, why, and how to use inhaled medications. Although the current study utilized the skills of pharmacy support workers, these findings should be transferable in the event other healthcare professionals administer the program.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Capstick TG, Azeez NF, Deakin G, Goddard A, Goddard D, Clifton IJ. Ward based inhaler technique service reduces exacerbations of asthma and COPD. Respir Med. Published online August 24, 2021. doi: 10.1016/j.rmed.2021.106583