Role of the pharmacist in improving inhaler technique and asthma management in rural areas in Jordan

Iman A Basheti, Yara B Salhi, Mariam M Basheti, Salim A Hamadi, Walid Al-Qerem, Iman A Basheti, Yara B Salhi, Mariam M Basheti, Salim A Hamadi, Walid Al-Qerem

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 (FEV1%), 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, FEV1%, 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). FEV1% 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 FEV1% scores and high use of reliever medications. Pharmacist-led educational intervention resulted in improved inhaler technique scores, ACT scores, and FEV1% scores and lowered reliever use over time.

Keywords: asthma control; inhaler technique; pharmacist role; reliever use; rural area.

Conflict of interest statement

Placebo inhalers were provided by AstraZeneca plc (London, UK) and GlaxoSmithKline plc (London, UK). The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
CONSORT diagram showing patient recruitment and retention in the study. Abbreviations: MDI, metered dose inhaler; TH, turbuhaler.
Figure 2
Figure 2
Proportion of patients categorized according to asthma severity at baseline (TH, n=44; MDI, n=59) and follow-up (TH, n=27; MDI, n=37). Abbreviations: MDI, metered dose inhaler; TH, turbuhaler.
Figure 3
Figure 3
Proportion of metered dose inhaler users who demonstrated each step in the inhaler technique checklist correctly at baseline and follow-up (n=59).
Figure 4
Figure 4
Proportion of turbuhaler users who demonstrated each step in the inhaler technique checklist correctly at baseline and follow-up (n=44).

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