Objective To investigate the influence of pharmacist-led intervention on the mastery of inhalation techniques for patients with asthma/COPD. Methods The inhalation technique assessment form was used to assess the patient mastery of inhalation technique.The patient mastery of inhalation technique after the pharmacist’s face to face intervention was compared to find the effect of pharmacist intervention on inhalation techniques. Results With pharmacist intervention, the frequency of patient making mistakes in using different devices was significantly decreased.The frequency of making mistakes in using Symbicort Turbuhaler and HandiHaler for each patient decreased from 3.22 to 0.65, and from 3.20 to 0.56, respectively. Conclusion The patients with asthma and COPD poorly mastered inhalation technique.Pharmacists intervention has definite effect on the correct use of inhalation device.It is necessary for pharmacists to evaluate the mastery of inhalation technique for patients with asthma/COPD.
CROMPTON GK,BARNES PJ,BROEDERSM,et al.The need to improve inhalation technique in Europe:a report from the Aerosol Drug Management Improvement Team[J].Respir Med,2006,100(9):1479-1494.
Although the principles of management are well established in Europe, the available data indicate that in patients is not well controlled. Many patients derive incomplete benefit from their inhaled medication because they do not use inhaler devices correctly and this may compromise control. The Aerosol Drug Management Improvement Team (ADMIT), incorporating clinicians from the UK, Germany, France, Italy, Spain and The Netherlands, reviewed published evidence to examine ways to improve the treatment of reversible airways disease in Europe. Data indicate that there is a clear need for specific training of patients in correct inhalation technique for the various devices currently available, and this should be repeated frequently to maintain correct inhalation technique. Devices which provide reassurance to patients and their physicians that inhalation is performed correctly should help to improve patient compliance and control. Educational efforts should also focus on primary prescribers of inhaler devices. ADMIT recommends dissemination of information on the correct inhalation technique for each model of device by the use of an accessible dedicated literature base or website which would enable to match the appropriate inhaler to the individual patient. There is also a need for standardisation of prescribing practices throughout Europe. Regular checking of inhalation technique by prescribers is crucial as correct inhalation is one of the keystones of successful management.
BROCKLEBANKD,RAMF,WRIGHTJ,et al.Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease:a systematic review of the literature[J].Health Technol Assesst,2001,5(26):1-149.
Asthma and chronic obstructive pulmonary disease (COPD) are common diseases of the airways and lungs that have a major impact on the health of the population. The mainstay of treatment is by inhalation of medication to the site of the disease process. This can be achieved by a number of different device types, which have wide variations in costs to the health service. A number of different inhalation devices are available. The pressurised metered-dose inhaler (pMDI) is the most commonly used and cheapest de
MOLIMARDM,RAHERISONC,LIGNOTS,et al.Assessment of handling of inhaler devices in real life:an observational study in 3811 patients in primary care[J].J Aerosol Med,2003,16(3):249-254.
The correct use of inhalation devices is an inclusion criterion for all studies comparing inhaled treatments. In real life, however, patients may make many errors with their usual inhalation device, which may negate the benefits observed in clinical trials. Our study was undertaken to compare inhalation device handling in real life. A total of 3811 patients treated for at least 1 month with an inhalation device (Aerolizer, Autohaler, Diskus, pressurized metered dose inhaler (pMDI), or Turbuhaler) were included in this observational study performed in primary care in France between February 1st and July 14th, 2002. General practitioners had to assess patient handling of their usual inhaler device with the help of a checklist established for each inhaler model, from the package leaflet. Seventy-six percent of patients made at least one error with pMDI compared to 49-55% with breath-actuated inhalers. Errors compromising treatment efficacy were made by 11-12% of patients treated with Aerolizer, Autohaler, or Diskus compared to 28% and 32% of patients treated with pMDI and Turbuhaler, respectively. Overestimation of good inhalation by general practitioners was maximal for Turbuhaler (24%), and lowest for Autohaler and pMDI (6%). Ninety percent of general practitioners felt that participation in the study would improve error detection. These results suggest that there are differences in the handling of inhaler devices in real life in primary care that are not taken into account in controlled studies. There is a need for continued education of prescribers and users in the proper use of these devices to improve treatment efficacy.
FINK JB,RUBIN BK.Problems with inhaler use:a call for improved clinician and patient education[J].Respir Care,2005,50(10):1360-1374.
Patient education is a critical factor in the use and misuse of medication inhalers. Inhalers represent advanced technology that is considered so easy to use that many patients and clinicians do not receive adequate training in their use. Between 28% and 68% of patients do not use metered-dose inhalers or powder inhalers well enough to benefit from the prescribed medication, and 39-67% of nurses, doctors, and respiratory therapists are unable to adequately describe or perform critical steps for using inhalers. Of an estimated 25 billion dollars spent for inhalers annually, 5-7 billion dollars is wasted because of inhaler misuse. Reimbursement and teaching strategies to improve patient education could substantially reduce these wasted resources. Problems with inhaler use, the cost of inhalers, and myths associated with inhalers are reviewed, with recommendations for strategies and techniques to better educate patients in inhaler use.
HAMMERLEINA,MULLERU,SCHULZM.Pharmacist-led intervention study to improve inhalation technique in asthma and COPD patients[J].J Eval Clin Pract,2011,17(1):61-70.
Abstract Rational and aims68 Inhaled therapy is the mainstay of treatment in patients with asthma and chronic obstructive pulmonary disease (COPD). For effectiveness of pharmacotherapy, correct use of medication is required. The aims of this study were to survey the quality of inhalation technique in patients and to determine the effect of a single intervention in community pharmacies by means of standardized procedures. Methods68 A total of 757 patients with asthma or COPD were randomly selected by 55 community pharmacies. At baseline, patients were interviewed and their inhalation technique was assessed with a 21-items checklist. Any error was recorded and, if necessary, patients were instructed in the proper use of their device. After 4–6 weeks, demonstration of inhalation technique was repeated in the community pharmacies and a pre–post comparison was performed. Results68 A total of 597 patients (78.9%) made at least one mistake in performing the inhalation technique at baseline. This number dropped to 214 (28.3%) from the first to the second appointment. All patients did benefit from the pharmacists' intervention regardless of their former training experiences. Conclusions68 Inhalation technique of asthma and COPD patients is poor. In daily practice, community pharmacy-based pharmacists are well suited to significantly supplement doctor-based education in inhalation technique.
SRIRAM KB,PERCIVALM.Suboptimal inhaler medication adherence and incorrect technique are common among chronic obstructive pulmonary disease patients[J].Chron Respir Dis,2016,22(5):13-22.
Abstract Patients with chronic obstructive pulmonary disease (COPD) are routinely prescribed one or more inhaled medications. Adherence to inhaler medications and correct inhaler device technique are crucial to successful COPD management. The goals of this study were to estimate adherence and inhaler technique in a cohort of COPD patients. This was an observational study conducted on a sample of 150 COPD patients. Medication adherence was assessed using the Medication Adherence Report Scale (MARS). Inhaler technique was assessed using standardized checklists. Clinical data were collected using a proforma. Of the 150 patients (mean age 70.3 years, 52% male), 58% reported suboptimal adherence (MARS 24). High adherence to therapy (MARS = 25) was associated with older age (p = 0.001), but not any of the other studied variables. Medication non-adherence was not associated with COPD exacerbations. Errors (1) in inhaler technique were common across all of the types of inhaler devices reportedly used by patients, with the highest proportion of errors among Turbuhaler users (83%) and the least proportion of errors among Handihaler users (50%). No clinical variables were associated with errors in inhaler technique. Suboptimal adherence and errors in inhaler technique are common among COPD patients. No clinical variables to assist in the prediction of medication non-adherence and poor inhaler technique were identifiable. Consequently, regular assessment of medication adherence and inhaler technique should be incorporated into routine clinical practice to facilitate improved health outcomes among patients with COPD. The Author(s) 2015.
, 张桂凡, 张晶晶, 葛卫红
