Effect of a network system for providing proper inhalation technique by community pharmacists on clinical outcomes in COPD patients

Abstract

IntroductionNonadherence to inhalation therapy is very common in patients with chronic obstructive pulmonary disease (COPD). Few data are available to support the role of community pharmacists in optimizing inhalation therapy in COPD patients. Since 2007, the Kitano Hospital and the Kita-ku Pharmaceutical Association have provided a network system for delivering correct inhalation techniques through certified community pharmacists. The effects of this network system on clinical outcomes in COPD patients were examined.MethodsA total of 88 consecutive outpatients with COPD at baseline and 82 of those 4 years later were recruited from the respiratory clinic of Kitano Hospital Medical Research Institute. Measurements included the frequency of COPD exacerbations, patients’ adherence to inhalation therapy using a five-point Likert scale questionnaire, and patients’ health status both prior to this system and 4 years later.ResultsUsable information was obtained from 55 patients with COPD at baseline, and from 51 patients 4 years later. Compared with baseline values, a significant decrease was observed in the frequency of COPD exacerbations (1.5 ± 1.6 versus 0.8 ± 1.4 times/year, P = 0.017). Adherence to the inhalation regimen increased significantly (4.1 ± 0.7 versus 4.4 ± 0.8, P = 0.024), but health status was unchanged. At 4 years, of 51 COPD patients, 39 (76%) patients who visited the certified pharmacies showed significantly higher medication adherence than those who did not (4.6 ± 0.6 versus 3.9 ± 1.0, P = 0.022).ConclusionThe network system may improve COPD control and adherence to inhalation regimens.

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence

“…With respect to IT, the offered interventions were found to significantly reduce IT errors or even improve the choice of the inhaler [5, 23-25, 28, 29]. For MA, the review showed that CPs interventions resulted in improving adherence to inhaled medications which was statistically significant in the addressed studies [8,23,25]. This is consistent with other studies which show that pharmacist-delivered interventions can lead to significant improvement in medications adherence in other diseases [30,31].…”

“…There was a clear emphasis from the reviewed studies on the need to provide patients with repeated instructions on correct IT by CPs and not to consider it as a one-time service in order to ensure sustainability [5,8,29]. The German study [5] in this review highlighted that patients benefited from IT education intervention irrespective of their previous education.…”

“…IT is the process through which the patient correctly performs a number of steps in certain order to obtain the adequate dose out of the inhaler device [3]. The importance of IT stems from the fact that inhalation therapy represents the main pillar in COPD treatment [4][5][6][7][8]. It is the best treatment strategy to ensure delivery of adequate concentrations of the administered drug directly to the lungs [3][4][5][9][10][11].…”

Effect of Implementing an Educational Module About Inhaler Use on Severity of Dyspnea and Adherence to Inhalation Therapy Among Patients with Chronic Obstructive Pulmonary Disease

“…Adhering to inhaled medications is one of the most important factors for managing COPD in both clinical and ambulatory settings. In a recent study, it was shown that there was a significant decrease in the frequency of dyspnea, cough, sputum purulence or wheeze [18].…”

“…This may lead to decrease disease control, increase the absenteeism from work or school, unnecessary increase in medication dosage, increase risk of side effects, non adherence to inhaled medication and exacerbations manifestations especially deterioration of dyspnea that requires oral corticosteroid treatment [17]. Many COPD patients are non adherent to the inhaled drugs so mortality rate is susceptible to increase more than twice among those patients compared to patients who adhere to the inhaled medications [18,19].…”