The impact of pharmacist-guided inhaler technique education on chronic obstructive pulmonary disease and asthma patients

Objective: The core treatment for asthma and chronic obstructive pulmonary disease (COPD) is inhalers. Today, there are many types of pressurized metered-dose inhalers (pMDIs) and dry powdered inhalers (DPIs). Each inhaler requires special sequential manoeuvres and coordination. It is well-known from previous studies that most patients perform at least one mistake using their inhaler which may lead to ineffective drug delivery and poor disease control. The aim of this study is to measure the proportion of patients who used the inhalers in a fully effective way before and after the pharmacist's guidance. Methods: Patients prescribed inhalers for asthma and COPD, were offered by the local pharmacist to personally assess and correct their inhaler use technique over two visits. At each visit, before any pharmacist correction of technique, a general score for inhaler technique was given and 16 types of mistakes were assessed. Comparisons of inhaler technique were made between the two visits. Key findings: Sixty patients aged 21-91 (median 69; IQR 48-78) participated in the initial session of which 35 (58%) were females using 81 inhalers (DPI-60, pMDI-21). A fully effective inhaler technique was found in nine patients (15%) using 13 inhalers (16%) while 22 inhalers (27%) were used fully ineffectively (there were no statistically significant differences between DPIs and pMDIs). Twenty-three patients using 24 inhalers returned for a second visit in which 12 patients (52%, P = 0.0014 between the visits) used 12 inhalers (50%) fully effectively and only three inhalers (12.5%) were used fully ineffectively (P = 0.0045 between the visits). The odds for using the inhaler fully effectively were 5.2 (95% CI, 1.9 to 14.2; P = 0.0011) times higher on the second visit. Conclusions: Personal pharmacist guidance can improve inhaler technique in a low socio-economic neighbourhood. However, larger multicentre studies that will also examine clinical outcomes are needed.