A longitudinal analysis of pharmacist-driven inhaler optimization in the ambulatory care setting.
Blum E, Thavarajah K, and Martirosov A. A longitudinal analysis of pharmacist-driven inhaler optimization in the ambulatory care setting. Am J Respir Crit Care Med 2018; 197.
Am J Respir Crit Care Med
The overall prevalence of correct inhaler technique remains poor, and education alone does not correct poor technique. An important component that is often missing from selection of a pulmonary regimen is an objective assessment of patients' inhaler technique. Pharmacists can play a role in the selection of appropriate pulmonary regimen that matches patients' respiratory abilities using the Vitalograph Aerosol Inhalation Monitor™ (AIM). Methods: This one-group, pretest-posttest quasi-experimental study enrolled patients with asthma and COPD who presented to Henry Ford Hospital Pulmonary Clinic from June 2016 to March 2017. Patients met with a pharmacist who provided a bundle of services including an inhaler technique assessment with the AIM. Based on the patient's performance, the pharmacist developed patientspecific plans. Follow up phone calls were made one, four, and twelve weeks after the initial visit. The primary outcome was change in ACT or CAT at four and twelve weeks compared to baseline. Secondary outcomes included change in patient reported weekly rescue medication use and change in adherence using MMAS-4 scores. An analysis of patients seen by a pulmonologist during the same period, who had at least two documented ACT or CAT scores were randomly selected for comparison. Results: A total 75 patients met inclusion criteria. Based on the AIM assessment, 89% of patients were not on an appropriate device. The most common recommendation made by the pharmacist was to change to a fully nebulized regimen. Patients with asthma had a significant improvement in their ACT scores from baseline to four weeks (12.1 vs 16.3, p<0.01) and baseline to twelve weeks (12.5 vs 17.1, p<0.01). Patients with COPD had a non-significant improvement in their CAT scores from baseline to week four (22.7 vs 20.7, p=0.19), but a significant improvement from baseline to week twelve (22.7 vs 20.1, p=0.02). The historical control group did not have a significant improvements in their ACT and CAT scores. Patient-reported rescue inhaler use improved at week one (20.6 vs 13.3, p<0.01), four (22.1 vs 15.5, p=0.06), and twelve (21.6 vs 12.5, p<0.01). The MMAS-4 scores did not significantly improve at week four or twelve. Conclusion: Incorporating an objective assessment of inhaler technique into a pulmonary clinic visit by a pharmacist may help improve asthma and COPD control though twelve weeks. Future research into objectively assessing inhaler technique in order to optimize patient's pulmonary regimens is warranted.