Inhaler technique education and asthma control among patients hospitalized for asthma in Jordan

Iman A Basheti, Nathir M Obeidat, Helen K Reddel, Iman A Basheti, Nathir M Obeidat, Helen K Reddel

Abstract

Objectives: To investigate the effect of inhaler technique education delivered by a clinical pharmacist to patients hospitalised for asthma, on inhaler technique scores and asthma control at three months post-discharge.

Methods: This pre-post interventional study in Jordan enrolled patients who had been admitted for asthma and were using controller medication by Accuhaler [Diskus] (ACC), Turbuhaler (TH) or Pressurized metered dose inhalers (pMDI). Inhaler technique was assessed using published checklists (score 0-9). Asthma symptom control was assessed by Asthma Control Test (ACT, range 5-25). Patients were assessed on admission (baseline), pre-discharge, and 3 months later. All patients received a 'Show-and-Tell' inhaler technique counseling service prior to discharge.

Results: Baseline data were available for 140 patients, 71% females, mean age 52.7 (SD 16.64) years, mean ACT score 10.0 (SD 4.8). Mean inhaler score was 7.5 (SD 1.52) with no significant difference between the inhaler groups (p = 0.174). After pre-discharge training, all patients had correct technique (score 9/9). After 3 months, mean inhaler scores were significantly higher than at baseline (8.14 (SD 0.87, p < 0.001), with mean change significantly higher for TH 1.21 (SD 2.25) and ACC 0.85 (SD 0.97) than pMDI (0.16; SD 0.72), p = 0.001. Symptom control improved significantly for all patients, with a mean increase in ACT score of 7.54 (SD 8.18), with no significant difference between the inhaler device groups (p = 0.326).

Conclusions: Patients hospitalized for asthma achieved correct inhaler technique after training by a pharmacist, and maintained better technique at 3 months than on admission. Significant improvements in ACT scores were documented for all inhaler groups.

Keywords: Asthma control; Asthma knowledge; Hospitalized asthma patients; Inhaler technique; Jordan; Pharmaceutical care.

Figures

Fig. 1
Fig. 1
Flow chart of study participation.
Fig. 2A
Fig. 2A
Mean score of inhaler technique for Accuhaler (ACC, n = 41), Turbuhaler (TH, n = 23) and Metered Dose Inhaler (pMDI, n = 76) users at initial assessment, prior education assessment (before hospital discharge) and after 3 months. All patients were trained to correct technique (score 9/9) prior to discharge.
Fig. 2B
Fig. 2B
Asthma symptom control, assessed by Asthma Control Test (ACT) for patients using the Accuhaler (ACC, n = 41), Turbuhaler (TH, n = 23) and Metered Dose Inhaler (pMDI, n = 76).
Fig. 3
Fig. 3
Complementary herbal treatments used by the study patients (n = 140).

References

    1. Abu-Ekteish F., Otoom S., Shehabi I. Prevalence of asthma in Jordan: comparison between Bedouins and urban schoolchildren using the International Study of Asthma and Allergies in Childhood phase III protocol. Allergy Asthma Proc. 2009;30:181–185.
    1. Basheti I.A., Armour C.L., Bosnic-Anticevich S.Z., Reddel H.K. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Educ. Couns. 2008;72:26–33.
    1. Basheti I.A., Armour C.L., Reddel H.K., Bosnic-Anticevich S.Z. Long-term maintenance of pharmacists' inhaler technique demonstration skills. Am. J. Pharm. Educ. 2009;73:32.
    1. Basheti I.A., Bosnic-Anticevich S.Z., Armour C.L., Reddel H.K. Checklists for powder inhaler technique: A review and recommendations. Respir. Care. 2014;59:1140–1154.
    1. Basheti I.A., Obeidat N.M., Ammari W.G., Reddel H.K. Associations between inhaler technique and asthma control among asthma patients using pressurised MDIs and DPIs. Int. J. Tuberc. Lung Dis. 2016;20:689–695.
    1. Basheti I.A., Obeidat N.M., Reddel H.K. Effect of novel inhaler technique reminder labels on the retention of inhaler technique skills in asthma: a single-blind randomized controlled trial. NPJ Prim. Care Respir. Med. 2017;27:9.
    1. Basheti I.A., Qunaibi E., Bosnic-Anticevich S.Z., Armour C.L., Khater S., Omar M., Reddel H.K. User error with Diskus and Turbuhaler by asthma patients and pharmacists in Jordan and Australia. Respir. Care. 2011;56:1916–1923.
    1. Basheti I.A., Qunaibi E.A., Hamadi S.A., Reddel H.K. Inhaler technique training and health-care professionals: effective long-term solution for a current problem. Respir. Care. 2014;59:1716–1725.
    1. Basheti I.A., Reddel H.K., Armour C.L., Bosnic-Anticevich S.Z. Counseling about turbuhaler technique: needs assessment and effective strategies for community pharmacists. Respir. Care. 2005;50:617–623.
    1. Basheti I.A., Reddel H.K., Armour C.L., Bosnic-Anticevich S.Z. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J. Allergy Clin. Immunol. 2007;119:1537–1538.
    1. Bosnic-Anticevich S.Z., Sinha H., So S., Reddel H.K. Metered-dose inhaler technique: the effect of two educational interventions delivered in community pharmacy over time. J Asthma. 2010;47:251–256.
    1. Burney P., Jarvis D., Perez-Padilla R. The global burden of chronic respiratory disease in adults. Int. J. Tuberc. Lung Dis. 2015;19:10–20.
    1. Clarenbach C.F., Nicod L.P., Kohler M. Real-world asthma management with inhaler devices in Switzerland-results of the asthma survey. J. Thorac. Dis. 2016;8:3096–3104.
    1. Dal Negro R.W., Distante C., Bonadiman L., Turco P., Iannazzo S. Cost of persistent asthma in Italy. Multidiscip. Respir. Med. 2016;11:44.
    1. Ejebe I.H., Jacobs E.A., Wisk L.E. Persistent differences in asthma self-efficacy by race, ethnicity, and income in adults with asthma. J. Asthma. 2015;52:105–113.
    1. Giraud V., Allaert F.A., Roche N. Inhaler technique and asthma: feasibility and acceptability of training by pharmacists. Respir. Med. 2011;105:1815–1822.
    1. Giraud V., Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur. Respir. J. 2002;19:246–251.
    1. Global Initiative for Asthma (GINA) - Global strategy for asthma management and prevention report 2017. Available online at: (Accessed September 2017).
    1. Guilbert T.W., Garris C., Jhingran P., Bonafede M., Tomaszewski K.J., Bonus T., Hahn R.M., Schatz M. Asthma that is not well-controlled is associated with increased healthcare utilization and decreased quality of life. J. Asthma. 2011;48:126–132.
    1. Hasegawa K., Bittner J.C., Nonas S.A., Stoll S.J., Watase T., Gabriel S., Herrera V., Camargo C.A., Jr. Children and adults with frequent hospitalizations for asthma exacerbation, 2012-2013: A multicenter observational study. J. Allergy Clin. Immunol. Pract. 2015;3:751–758 e751.
    1. Issa R.A., Basheti I.A. Herbal Products Use Among Chronic Patients and its Impact on Treatments Safety and Efficacy: A Clinical Survey in the Jordanian Field. Trends Med. Res. 2016;12:32–44.
    1. Kritikos V., Krass I., Chan H.S., Bosnic-Anticevich S.Z. The validity and reliability of two asthma knowledge questionnaires. J Asthma. 2005;42:795–801.
    1. Lababidi H., Hijaoui A., Zarzour M. Validation of the Arabic version of the asthma control test. Ann. Thorac. Med. 2008;3:44–47.
    1. Melani A.S., Bonavia M., Cilenti V., Cinti C., Lodi M., Martucci P., Serra M., Scichilone N., Sestini P., Aliani M., Neri M. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir. Med. 2011;105:930–938.
    1. Ozturk A.B., Ozyigit Pur L., Kostek O., Keskin H. Association between asthma self-management knowledge and asthma control in the elderly. Ann. Allergy Asthma Immunol. 2015;114:480–484.
    1. Papi A., Haughney J., Virchow J.C., Roche N., Palkonen S., Price D. Inhaler devices for asthma: a call for action in a neglected field. Eur. Respir. J. 2011;37:982–985.
    1. Philp J.C., Maselli J., Pachter L.M., Cabana M.D. Complementary and alternative medicine use and adherence with pediatric asthma treatment. Pediatrics. 2012;129:e1148–e1154.
    1. Press V.G., Arora V.M., Shah L.M., Lewis S.L., Ivy K., Charbeneau J., Badlani S., Nareckas E., Mazurek A., Krishnan J.A. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD. J. Gen. Intern. Med. 2011;26:635–642.
    1. Price D., Bosnic-Anticevich S., Briggs A., Chrystyn H., Rand C., Scheuch G., Bousquet J. Inhaler competence in asthma: common errors, barriers to use and recommended solutions. Respir. Med. 2013;107:37–46.
    1. Schatz M., Kosinski M., Yarlas A.S., Hanlon J., Watson M.E., Jhingran P. The minimally important difference of the Asthma Control Test. J. Allergy Clin. Immunol. 2009;124(719–723)
    1. Schatz M., Sorkness C.A., Li J.T., Marcus P., Murray J.J., Nathan R.A., Kosinski M., Pendergraft T.B., Jhingran P. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J. Allergy Clin. Immunol. 2006;117:549–556.
    1. Skoner J.D., Schaffner T.J., Schad C.A., Kwon A.Y., Skoner D.P. Addressing steroid phobia: improving the risk-benefit ratio with new agents. Allergy Asthma Proc. 2008;29:358–364.
    1. The British Guideline on the Management of Asthma. (Available online at: . Accessed September 2017).
    1. van der Palen J., Klein J.J., Schildkamp A.M. Comparison of a new multidose powder inhaler (Diskus/Accuhaler) and the Turbuhaler regarding preference and ease of use. J. Asthma. 1998;35:147–152.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다