Evaluation of the role of the pharmacists in the rational use of inhaler devices in the treatment of asthma and COPD

Abstract

Background and Aims: Inhaled drug-delivery is the cornerstone for the treatment of asthma and chronic obstructive pulmo- nary disease (COPD). However, these diseases cannot be adequately controlled in most patients due to the misuse of inhaler devices and poor patient compliance. Patient education is a critical component of treatment and requires the cooperative effort of physicians and pharmacists. This study aimed to evaluate a pharmacists’ ability to use inhaler devices and their practical knowledge, and to assess the extent to which pharmacists have consulted on this issue for the rational drug use of asthma or COPD patients.
Methods: A questionnaire containing demographic information, steps for the correct use of inhaler devices, information source for inhaler use, and patient counseling was applied to fifty community pharmacists in Istanbul and the data was evalu- ated.
Results: The number of pharmacists who have adequate knowledge about the use of a Metered-Dose Inhaler was 59%. It was 50% for Turbuhaler®, 54% for Diskus®, and 56% for a Capsule Inhaler. Pharmacists operating in community pharmacies for up to 20 years were more knowledgeable about the correct use of inhaler devices, but there was no statistically significant difference according to the pharmacists years in practice (p<0.05 for each device).
Conclusion: About half of the pharmacists did not have enough knowledge for the correct use of each inhaler device. This suggests that there is a clear need for special and continuing educational programs for pharmacists to increase their knowl- edge of inhaler use and attitudes towards inhaled therapy to provide better patient counseling and training in the manage- ment of asthma and COPD.

Keywords

• Asthma
• Chronic Obstructive Pulmonary Disease
• Inhaler Devices
• Community Pharmacist
• Inhalation Technique

References

1. Al-Jahdali, H., Ahmed, A., Al-Harbi, A., Khan, M., Baharoon, S., Bin Salih, S., Halwani, R., & Al-Muhsen, S. (2013). Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Allergy, Asthma and Clinical Immu- nology, 9, 8-15.
2. Ballantyne, P.J. (2007). The role of pharmacists in primary care. Brit- ish Medical Journal, 334, 1066-1067.
3. Basheti, I.A., Bosnic-Anticevich, S.Z., Armour, C.L., & Reddel, H.K. (2014). Checklists for powder inhaler technique: a review and rec- ommendations. Respiratory Care, 59, 1140-1154.
4. Basheti, I.A., Qunaibi, E., Bosnic-Anticevich, S.Z., Armour, C.L., Khat- er, S., Omar, M., & Reddel, H.K. (2011). User error with Diskus and Turbuhaler by asthma patients and pharmacists in Jordan and Australia. Respiratory Care, 56, 1916-1923.
5. Benavides, S., Rodriguez, J.C., & Maniscalco-Feichtl, M. (2009). Pharmacist involvement in improving asthma outcomes in vari- ous healthcare settings: 1997 to present. Annals of Pharmaco- therapy, 43, 85-97.
6. Broeders, E.A.C.M., Sanchis, J., Levy, M.L., Crompton, G.K., & Dekhuijzen, P.N.R. (2009). The ADMIT Series -- issues in inhala- tion therapy. 2. Improving technique and clinical effectiveness. Primary Care Respiratory Journal, 18, 76-82.
7. Cain, W.T., Cable, G., & Oppenheimer, J.J. (2001). The ability of the com- munity pharmacist to learn the proper actuation techniques of inhaler devices. Journal of Allergy and Clinical Immunology, 108, 918-920.
8. Chrystyn, H., Van Der Palen, J., Sharma, R., Barnes, N., Delafont, B., Mahajan, A., & Thomas, M. (2017). Device errors in asthma and COPD: systematic literature review and meta-analysis. NPJ Primary Care Respiratory Medicine, 27, 22-32.

9. Dizdar-Alyamaç, E., Civelek, E., & Sekerel, B.E. (2007). Community pharmacists’ perception of asthma: a national survey in Turkey. Pharmacy World and Science, 29, 199-204.
10. Gemicioglu, B., Borekci, S., & Can, G. (2014). Investigation of knowledge of asthma and inhaler devices in pharmacy workers. Journal of Asthma, 51, 982-988.
11. GINA, Anon. n.d. (2020, September 13). GINA Main Report - Glob- al Initiative for Asthma - GINA. Retrieved from https://ginasthma. org/gina-reports/.
12. Giner, J., Roura, P., Torres, B., Burgos, F., Castillo, D., Tarragona, E., & Plaza, V. (2016). Knowledge, attitudes and preferences among Spanish community pharmacists regarding inhaled therapy (The Optim Pharmacy Study). International Journal of Pharmacy and Pharmaceutical Sciences, 8(9), 53-60.
13. GOLD, Anon. n.d. (2020). Global Strategy for the Diagnosis, Man- agement, and Prevention of Chronic Obstructive Pulmonary Dis- ease. Retrieved from https://goldcopd.org/2020-gold-reports/.
14. Hämmerlein, A., Müller, U., & Schulz, M. (2011). Pharmacist-led in- tervention study to improve inhalation technique in asthma and COPD patients. Journal of Evaluation in Clinical Practice, 17, 61-70.
15. Hesso, I., Gebara, S.N., & Kayyali, R. (2016). Impact of community pharmacists in COPD management: Inhalation technique and medication adherence. Respiratory Medicine 118, 22-30.
16. Makhinova, T., Walker, B.L., Gukert, M., Kalvi, L., & Guirguis, L.M. (2020). Checking inhaler technique in the community pharmacy: predictors of critical errors. Pharmacy, 8, 6-18.
17. Maricoto, T., Rodrigues, L.V., Teixeira, G., Valente, C., Andrade, L., & Saraiva, A. (2015). Assessment of inhalation technique in clinical and functional control of asthma and Chronic Obstructive Pul- monary Disease. Acta Medica Portuguesa, 28, 702-707.
18. Melani, A.S., Bonavia, M., Cilenti, V., Cinti, C., Lodi, M., Martucci, P., Serra, M., Scichilone, N., Sestini, P., Aliani, M., & Neri, M. (2011). In- haler mishandling remains common in real life and is associated with reduced disease control. Respiratory Medicine, 105, 930-938.
19. Molimard, M., Raherison, C., Lignot, S., Balestra, A., Lamarque, S., Chartier, A., Droz-Perroteau, C., Lassalle, R., Moore, N., & Girodet, P.O. (2017). Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients. European Respiratory Journal, 49, 1601794.
20. Mortensen, N.P., & Hickey, A.J. (2014). Targeting inhaled therapy beyond the lungs. Respiration, 88, 353-364.
21. Ottenbros, S., Teichert, M., De Groot, R., Griens, F., Sodihardjo, F., Wensing, M., & De Gier, J.J. (2014). Pharmacist-led intervention study to improve drug therapy in asthma and COPD patients. In- ternational Journal of Clinical Pharmacy, 36, 336-344.
22. Plaza, V., Giner, J., Rodrigo, G.J., Dolovich, M.B., & Sanchis, J. (2018). Errors in the use of inhalers by health care professionals: A sys- tematic review. Journal of Allergy and Clinical Immunology: In Prac- tice, 6, 987-995.
23. Price D.B., Román-Rodríguez, M., R. McQueen, R.B., Bosnic-Anti- cevich, S., Carter, V., Gruffydd-Jones, K., Haughney, J., Henrichsen, S., Hutton, C., Infantino, A., Lavorini, F., Law, L.M., Lisspers, K., Papi, A., Ryan, D., Ställberg, B., van der Molen, T., & Chrystyn, H. (2017). Inhaler errors in the CRITIKAL study: type, frequency, and associa- tion with asthma outcomes. Journal of Allergy and Clinical Immu- nology: In Practice, 5, 1071-1081.
24. Ruud, K.W., Rønningen, S.W., Faksvåg, P.K., Ariansen, H., & Hov- land, R. (2018). Evaluation of a structured pharmacist-led inhala- tion technique assessment service for patients with asthma and COPD in Norwegian pharmacies. Patient Education and Counsel- ing, 101, 1828-1837.
25. Sanchis, J., Corrigan, C., Levy, M.L., & Viejo, J.L. (2013). Inhaler de- vices - from theory to practice. Respiratory Medicine, 107, 495-502.
26. Sanchis, J., Gich, I., & Pedersen, S. (2016). Systematic review of er- rors in inhaler use: Has patient technique improved over time?” Chest, 150, 394-406.
27. Takemura, M., Mitsui, K., Ido, M., Matsumoto, M., Koyama, M., In- oue, D., Takamatsu, K., Itotani, R., Ishitoko, M., Suzuki, S., Aihara, K., Sakuramoto, M., Kagioka, H., & Motonari Fukui. (2013). Effect of a network system for providing proper inhalation technique by community pharmacists on clinical outcomes in COPD patients. International Journal of COPD, 8, 239-244.
28. Tommelein, E., Mehuys, E., Van Hees, T., Adriaens, E., Van Bortel, L., Christiaens, T., Van Tongelen, I., Remon, J.P., Boussery, K., & Brus- selle, G. (2014). Effectiveness of pharmaceutical care for patients with chronic obstructive pulmonary disease (PHARMACOP): a randomized controlled trial. British Journal of Clinical Pharmacol- ogy, 77, 756-766.
29. Usmani, O.S., Lavorini, F., Marshall, J., Dunlop, W.C.N., Heron, L., Farrington, E., & Dekhuijzen, R. (2018). Critical inhaler errors in asthma and COPD: a systematic review of impact on health out- comes. Respiratory Research, 19, 10-30.
30. Van Manen, J.G., Bindels, P.J.E., IJzermans, C.J., Van Der Zee, J.S., Bottema, B.J.A.M., & Schadé, E. (2001). Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40. Journal of Clinical Epidemiology, 54, 287-293.