Poster presentation
Introduction
Good inhaler technique is essential for the effective treatment of inhaled medications. The Enchanced Asthma Care Service (EACS), an independent nurse service sponsored by Teva UK Limited, aimed to assess patients with uncontrolled asthma by their ability to learn and to use a pMDI. It was demonstrated that the majority of patients can not use their pMDI correctly. The abstract below summarises the findings of the study, which is sponsored by Teva UK Limited.
Abstract
TECHNIQUE TRAINING DOES NOT IMPROVE THE ABILITY OF MOST PATIENTS TO USE PRESSURISED METERED DOSE INHALERS (pMDI)
1AIJ Hardwell, 2T Hargadon, 2V Barber, 3ML Levy. 1National Services for Health Improvement (NSHI), Dartford, UK; 2Magister Consulting, Bristol, UK; 3Clinical Research Fellow, Allergy and Respiratory Research Group Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
Introduction: The pressurised metered dose inhaler (pMDI) technique should be tested in poorly controlled asthmatic patients.1 This service evaluation aimed to assess uncontrolled patient ability to learn to use a pMDI using the aerosol inhalation monitor (AIM; Vitalograph), which tests inspiratory flow, synchronisation and breathholding.
Method: The enhanced asthma care service (EACS;* since February 2006) provides detailed clinical review by trained asthma nurses, according to agreed practice protocols. Practices determine a proxy measure of control—the total number (4–6) of short-acting beta-2-bronchodilators prescribed in 12 months. This, together with 77 predetermined clinical parameters (including prescribing and healthcare utilisation data) formed the basis of detailed discussion with the practices before and after selected patients complete postal symptom questionnaires (RCP three questions);1 symptomatic patients were then invited for a practice pre-agreed clinical review, which included inhaler technique. All patients using pMDI had at least two assessments using AIM since January 2007. In most cases, technique education was provided after testing if appropriate. We present data for patients previously prescribed pMDI seen from 1 April 2008 to 30 June 2008.
Results: 2123/8843 (24%) symptomatic asthma patients were invited from 100 practices caring for approximately half a million patients, including 30 779 diagnosed with asthma (prevalence 6.9%). 1291/2112 (61%) of those reviewed were using pMDI (mean age 52 years; SD 21.37). 685 (55.4%) and 368/1236 (29.8%) were in BTS steps 2 and 3, respectively. 1092/1275 (85.6%) using pMDI failed the first AIM test. There was a statistically significant increase in the numbers of patients able to use their pMDI correctly following instruction, after the second (129 to 260 of 1197 patients, p,0.01) and third (61 to 181 of 528 patients, p,0.01) tests. However, 909/1197 (76%) and 323/527 (61.3%) of those tested twice and three times, respectively, failed on these subsequent attempts, despite instruction. Over 54% and 60% failed the inspiratory flow criterion on the second and third tests, respectively. A logistic regression failed to show any effect of age and BTS step on these outcomes.
Conclusion: Despite training, a significant majority of symptomatic asthma patients are unable to use pMDI correctly.
*The EACS service is an independent nurse service sponsored by Teva UK Limited.
- Douglas G, et al. Thorax 2008;63(Suppl 4):iv1–121.