Introduction and objectives Ensuring optimal inhaler technique is critical to the successful management of asthma and COPD, but real-life studies continue to highlight that poor inhaler technique is common. It is critical that new services are developed to improve patient care. As the majority of people with asthma and COPD are managed in primary care where community pharmacies provide front line healthcare, a feasibility project was designed to determine the extent to which inhaler technique could be optimised in this setting.
Methods Fifty community pharmacies applied to and were recruited to participate in this project. Pharmacists and pharmacy technicians attended a 2 hour training session, and were provided with a resource box including placebo inhalers, training aids and patient information leaflets. Patients were eligible for the service if they were prescribed inhalers, could speak and understand English, and consented to share information from the consultation with their GP.
Results Thirty-five pharmacies recruited a total of 380 patients (214 female); 190 (50%) used one inhaler, 175 (46.1%) used two, and 15 (3.9%) used three inhalers. Incredibly, 104 (27.4%) patients had never been shown how to use their inhalers before. The most commonly prescribed inhalers were MDI, Ellipta and Turbohaler in 226 (59.5%), 93 (24.5%), and 32 (8.4%) patients. A mixture of aerosol (MDI or soft mist inhaler) and dry powder inhalers (DPI) were prescribed for 108 (56.8%) patients.
At baseline, good inhaler technique (defined as having no critical errors) was significantly more likely with DPIs than with aerosol inhalers (p<0.05). With training, a significant improvement in inhaler technique was achieved for both aerosol (p<0.05) and DPIs (p<0.05); overall improving from 60.2% to 96.2% of inhalers. See table 1.
Conclusions Poor inhaler technique is common, but a dedicated service provided by community pharmacy staff is effective in improving inhaler technique for almost all patients. However uptake at many pharmacies was low and only 11 patients received the service at the weekend, suggesting that capacity for additional key services is limited in the current climate. Further work is required to determine whether good inhaler technique is maintained and the impact on disease control.
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