Asthma affects 4.3 million of UK adults. Long-term inhaled therapies are the mainstay of management (1). Latest evidence suggests that control is rarely optimized in practice with poor inhaler technique as a prominent contributor (2-4). Currently there are no routine practices to optimize inhaler technique in asthmatic adults presenting with non-asthma related illness to our hospital. We developed a quality improvement project to optimize inhaler techniques in our patients during their acute admission. METHODS:Admitted adults with diagnosis of asthma, at least on one inhaler, were identified via electronic records by the lead pharmacist over an eight week period. To standardize our assessment process, a proforma was developed containing the seven basic steps pertinent to all inhalers as per UK Inhaler Group's competency document. (5)Patients' techniques were checked as per the proforma by a doctor or senior medical student. Corrections were made as necessary to meet the agreed gold-standard criteria. Re-assessment for recall of education in these patients was then carried out at a maximum of 48 hours.RESULTS: Forty patients were originally assessed over an eight week period with thirty-one being re-assessed within a maximum of 48 hours. Nine patients were lost to follow up due to unexpected out of hour discharge.On average each patient was on two different inhalers with Ventolin (Salbutamol) and Fostair (Beclomethasone) most frequently prescribed. On our initial assessment, two patients completed all steps with no errors which was in contrast to only two patients self-identifying their techniques as "suboptimal" prior to our review. Five patients used adjunct devices (aero-chamber or Volumatic) and nine patients had a comorbidity which adversely affected their techniques, such as mild to severe dementia, disabling stroke or poorly-controlled arthritis. Prior to our intervention, there was an average of 2.3 steps missed by each patient. The most commonly missed were steps one (not preparing the device), six (not holding breath for up to 10 seconds after delivering the dose) and seven (not waiting for a few seconds before attempting the second dose). On re-assessment, there was a reduction to an average of 1.1 points missed per patient. Post intervention, seven patients achieved all steps thoroughly with three not having any recollection of consultations.CONCLUSIONS: Incorrect inhaler use in asthmatic adults is unacceptably high in our cohort with inversely low self-awareness of this fact by our patients. A variety of reasons could account for this high incorrect use of medications, including receiving little or no advice at the time of initiation of therapy in the community, being instructed in a busy clinic by a non-asthma specialist clinician (with less attention and plan for follow up) and a lack of recent and up to date assessment of the technique.Careful instruction, observation of taught techniques and frequent assessment of inhaler techniques could show an overall improvement in use of these medications in ...
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