Respiratory Medicine ( IF 4.3 ) Pub Date : 2021-08-24 , DOI: 10.1016/j.rmed.2021.106583 Toby Gd Capstick 1 , Nooria F Azeez 1 , Gary Deakin 1 , Ashleigh Goddard 1 , Dawn Goddard 1 , Ian J Clifton 2
Background
The management of asthma and COPD is largely dependent on patients being able to use their inhaled medication correctly, but poor inhaler technique continues to be a recurring theme in studies and clinical practice. This is associated with poor disease control, increased risk of exacerbations and hospital admissions, and so there is a need to redesign services for patients to optimise their medicines use.
Methods
A novel ward-based dedicated inhaler technique service was developed, and pharmacy support workers trained to provide this, focusing on optimising inhaler technique using a checklist and recommending protocol-guided inhaler device switches. Inpatients on adult respiratory wards with a diagnosis of exacerbation of asthma or COPD consented to receive this service, and the impact on exacerbations and hospital admissions were compared in the 6-months before and after the intervention.
Results
266 adults (74 asthma, 188 COPD, and four asthma-COPD overlap) received the inhaler technique service. Six-month exacerbation and hospital admission data were available for 184 subjects. Optimising inhaler technique achieved a significant reduction in the combined asthma and COPD annualised rate of moderate-to-severe exacerbations (Rate Ratio [RR] 0.75, p < 0.05) and annualised rate of hospital admissions (RR 0.57, p < 0.0005). Improvements were also observed in future length of stay (- 1.6 days) and the average cost of admission (-£748).
Conclusions
This novel inhaler technique service produced a significant reduction in the rate of moderate-to-severe exacerbations of asthma and COPD, and a reduction in the rate hospital admissions, length of stay and average cost of admission.
中文翻译:
基于病房的吸入器技术服务可减少哮喘和 COPD 的恶化
背景
哮喘和 COPD 的管理在很大程度上取决于患者能否正确使用吸入的药物,但吸入器技术不佳仍然是研究和临床实践中反复出现的主题。这与疾病控制不佳、加重和住院风险增加有关,因此需要重新设计为患者提供的服务,以优化他们的药物使用。
方法
开发了一种新的基于病房的专用吸入器技术服务,并培训了药房支持人员以提供此服务,重点是使用清单优化吸入器技术并推荐协议引导的吸入器设备开关。诊断为哮喘加重或慢性阻塞性肺病的成人呼吸病房住院患者同意接受此项服务,并比较干预前后6个月对哮喘加重和住院的影响。
结果
266 名成人(74 名哮喘、188 名 COPD 和 4 名哮喘-COPD 重叠)接受了吸入器技术服务。184 名受试者获得了 6 个月的恶化和住院数据。优化吸入器技术显着降低了哮喘和 COPD 的中度至重度加重年率(比率 [RR] 0.75,p < 0.05)和住院年率(RR 0.57,p < 0.0005)。未来住院时间(- 1.6 天)和平均入院费用(- 748 英镑)也有所改善。
结论
这种新颖的吸入器技术服务显着降低了哮喘和 COPD 的中度至重度恶化率,并降低了住院率、住院时间和平均住院费用。