Real-world data on inhalation technique lead by community pharmacies of Spain

Background

Inhaled therapy is the cornerstone of chronic obstructive pulmonary disease (COPD) and asthma treatment, but incorrect inhaler handling (up to 90%) has not improved over the past 40 years. We aimed to assess real-life inhaler device handling in COPD and asthma and its association with the pathology control after pharmacist-led intervention.

Methods

A multicentre, longitudinal, observational study was conducted involving children and adults with asthma, COPD and asthma-COPD overlap (ACO). Inhalation errors were assessed across several consecutive visits to the pharmacy using a standardised protocol. Disease control was evaluated through the COPD Assessment Test (CAT), the Asthma Control Test for adults (ACT) and children aged 4–11 (C-ACT). Descriptive, inferential and multiple linear regression analysis were applied.

Results

2,472 patients were included (1056 COPD, 865 Asthma adults, 83 Asthma kids and 117 ACO) across 104 community pharmacies in 89 cities throughout Spain. Mean handling errors decreased significantly (p < 0.001) from the first visit onwards: in COPD [2.64 to 1.11]; asthma adults [2.32 to 0.67]; asthma kids [2.34 to 0.60]; and ACO [2.91 to 1.86]. Parallel improvements in disease control were observed: COPD CAT (16.04 to 11.67) (p < 0.001), asthma adults progressed from uncontrolled to controlled status (ACT 17.28 to 21.92). Children achieved well-controlled asthma (C-ACT from 18.50 to 23.33). Linear regression analysis found associated the visit number, inhaler device and age to be significant predictors of the inhaler handling errors and pathology control.

Conclusions

Inhaler errors clearly decreased after pharmacist-led intervention, with parallel improvements in disease control of all respiratory conditions studied.

Key messages

• For the first time, real-world evidence clearly shows that pharmacist-led education reduces inhaler technique errors in patients with COPD and asthma, in both adults and children.

• These findings suggest that integrating pharmacist-led educational programs into national health strategies can significantly mitigate the clinical and economic burden of chronic respiratory diseases.