Assessment of the inhalation technique and adherence to therapy and their effect on disease control in outpatients with asthma

Objectives The objective of this study was to assess correct use of inhaler devices, adherence to inhaler corticosteroid treatment and their effects on asthma control. Methods This study was a prospective, single-centre, observational study conducted between July and February 2016 at Al-Makased Hospital, respiratory outpatient clinic. Inhaler technique of asthma patients using pressurized metered-dose inhalers or dry powder inhalers (Turbuhaler (TH) and Accuhaler DiskusTM (ACC)) were assessed against published inhaler technique checklists. Asthma control variables measured using Asthma Control Test (maximum 25, higher score corresponding to better asthma control) were assessed, and adherence to asthma medications was assessed by Morisky adherence scale. Key findings Two hundred and twenty patients were recruited in the study. The mean age was 42.3 15.2 years and 59.1% were male. One hundred and seventeen (53.2%) were using TH, 60 (27.3%) were using ACC and 43(19.5%) were using MDIs. Only 22 (10%) were smoker and only 48 (21.8%) patients were their asthma controlled (ACT score >20). The devices were used correctly by 79.1% of patients using MDI, 69% of ACC and 55.6% of TH users (P > 0.001). The most common improper step was ‘forceful inhalation’ (65.4%) made by the MDI users, ‘Not exhaling to residual volume’ (58.7%) made by ACC users and ‘Not inhaling deeply enough’ (52.2%) made by TH users. Multivariate analysis showed that the likelihood of having controlled asthma was significantly higher in those with correct inhaler techniques (OR 2.3; 95% CI: 1.08–4.77; P = 0.028), high adherence to medications (OR 2.37; 95% CI: 1.05–4.92; P = 0.03) and having a higher level of education (OR 2.58; 95% CI: 1.19–3.63; P = 0.018). Conclusions It was found that asthma control was better among correct users. Repetitive training about using devices may contribute improving inhaler technique.This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors

Pharmaceutical care for adult asthma patients: A controlled intervention one‐year follow‐up study

Asthma is a clinical problem with social, psychological and economic burdens. To improve patient disease management, different education programmes have been developed. Challenges in asthma management may be partially attributed to nonadherence or improper use of inhalers. This study aimed to implement and assess hospital‐based pharmaceutical care services for asthmatic patients. A 12‐month, single‐ centre, randomized, controlled study was initiated in asthmatic adult patients who had been divided into either a control or intervention group. Patients in the control group received the usual care, and patients in the intervention group received patient counselling per study protocol that covered asthma knowledge, control, adherence to treatment and inhalation techniques. The main variables compared measurements at baseline with those at 6 and 12 months. A total of 192 patients completed the study protocol: 90 in the control group and 102 in the intervention group. The control group included 90 patients, and the intervention group included 102 patients. Over the course of the 12‐month follow‐up period, a significant difference was observed between intervention and control groups with respect to asthma control (38.2% vs 10.0%; P < .001), mean correct inhalation technique (confidence interval [CI]: 8.1, 7.8‐8.5 vs CI: 6.1; 5.6‐6.6; P = .01) and good medication adherence (60.7% vs 50.0%, P = .02). There were 34% and 25% decreases in emergency room visits and hospital admissions, respectively, in the intervention group compared to the control group. This study emphasizes the importance of patient counselling in asthma management and the significant contribution that the pharmacist's intervention can have on asthma control

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely