<p>Role of the pharmacist in improving inhaler technique and asthma management in rural areas in Jordan</p>

Abstract

Introduction Pharmacists can have a valuable role in educating patients on correct inhaler technique leading to improved asthma management. Rural areas can benefit from the role of the pharmacist considering the barriers found in attending primary health-care facilities. Objectives This study aimed to assess the impact of inhaler technique education delivered by pharmacists on patients’ inhaler technique, Asthma Control Test (ACT) score, forced expiratory volume in the first 1 second (FEV 1 %), and reliever use (puffs/day). Methods A pre–post interventional study was conducted over 6 months from February 2017 to July 2017 in rural areas in Jordan. Asthma patients visiting respiratory clinics and using metered dose inhaler (MDI) or turbuhaler (TH) controlled medication were randomly recruited. Inhaler technique was assessed via published checklists. The ACT, FEV 1 %, and reliever use (puffs/day) were assessed. Patients were educated on inhaler technique via demonstration with return demonstration education. All assessments were repeated 3 months post education. Results A total of 103 (TH, n=44; MDI, n=59) patients were recruited (mean age=46.5±13.5), 74% females. Patients reported an overuse of their reliever (5.1±4.2 puffs/day). Only 2 patients (1.9%) had well-controlled asthma, while the rest had either moderately (19.4%) or poorly (78.6%) controlled asthma. Patients using the MDI achieved 3.03±4.30 ACT score improvement ( p <0.001), which is a clinically significant improvement in control. Patients using the TH achieved a statistically significant improvement of 2.07±4.72 ( p =0.031). FEV 1 % improved significantly for MDI users ( p =0.005) but not for TH users ( p =0.097). Reliever use decreased significantly for MDI and TH users. Conclusion Asthmatic patients living in rural areas in Jordan reported poor inhaler technique, ACT scores, and FEV 1 % scores and high use of reliever medications. Pharmacist-led educational intervention resulted in improved inhaler technique scores, ACT scores, and FEV 1 % scores and lowered reliever use over time.

Asthma Control and Its Predictive Factors in Adult Asthma Patients

“…Moreover, only 30% of the adult patients that took part in a recent Jordanian study were reported to have achieved asthma control [20]. A study from northern of Jordan showed that smoking is the main cause of poor asthma control in adolescent[4] and two studies from Jordan attributed poor control to non-adherence or improper use of inhalers [21, 22]; moreover one study showed a significant association between the level of asthma control and genetic in Arab population [23]. However, this issue is rarely investigated in the south of Jordan and the burden of uncontrolled asthma on patients is largely unknown.…”

Inhaler Use Technique in Chronic Obstructive Pulmonary Disease Patients: Errors, Practices and Barriers

“…Unfortunately, 50% to 81% of patients do not use their inhalational devices accurately, in particular, older patients preparing the dose in the wrong orientation which are the common errors [ 20 - 21 ]; in our study, most of the participants were older patients who could not perform the crucial step 3, 5 and 6 correctly. Few observational studies are more concerned about many health professionals do not use inhalers accurately [ 22 - 23 ] and their role being evaluated by a few countries [ 24 ]. Therefore, health care providers are not in a position to assess and coach patients' inhaler technique effectively as noted in Table 2 ; pharmacy salesman is the main trainer (38%) who educates patients on inhaler technique but with major errors, while 16% reported that their prescribing doctors taught them the technique with less errors while performing their inhaler technique with optimal seven steps.…”

The impact of using a mobile application to improve asthma patients’ adherence to medication in Jordan

“…The ACT is a validated patient-based tool that is usually used to evaluate asthma control in clinical practice. 22,28,29 It is recommended by the American Thoracic Society/ European Respiratory Society Task Force as an assessment tool of asthma control. 30 It is a questionnaire consisting of five questions; four of them are related to symptoms and use of relievers and one question is about patient self-assessed level of control.…”

“…28,29,31 ACT reflects asthma patients' status during the last 4 weeks using a total score ranging from 5 to 25, with higher scores indicating a better asthma control. 22,29 Asthma patients who had scores between 20 and 25 were classified as well controlled; 16-19 as partially controlled; and 5-15 as poorly controlled. 31 In this study, a validated Arabic version of the ACT test was used.…”

“…Studies have shown that asthma control is poor among the Jordanian population, 10,22 and this was attributed to multiple factors, including the poor inhalation techniques and the incorrect use of devices. 22,23 Interestingly, no previous studies have investigated the use of mHealth technology to promote adherence to the correct use of inhaler devices and asthma self-management among Jordanians. The current study aimed to explore and assess Jordanian asthmatic patients' knowledge and attitude and design preferences toward using the mHealth app to enhance adherence to the correct use of inhaler devices and asthma self-management.…”