Previously submitted to: Interactive Journal of Medical Research (no longer under consideration since Jun 18, 2018)
Date Submitted: Oct 27, 2017
Open Peer Review Period: Oct 27, 2017 - Jun 18, 2018
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Prescription and use of inhaled medication in patients with asthma and COPD: Baseline-data of an adherence-Intervention-study
Background:
In Swiss adults, prevalence of asthma and COPD is around 7%. To date, asthma and COPD are not curable but treatable respiratory diseases. The burden of each disease among patients is high and people affected are frequently hospitalised due to exacerbations. This is associated with accelerated lung function decline, increased mortality and reduced health-related quality of life (HRQoL). However, there are numerous reasons for the lack of disease control in asthma and COPD patients. It is repeatedly associated with non-adherence to guidelines regarding treatment recommendation on the part of the health care provider and with poor inhalation technique and/or non-adherence to the prescribed treatment plan by the patient.
Objective:
This study aims at presenting data on compliance in accordance with current treatment guidelines. Moreover, we provide baseline data on inhaler application and its impact on quality of life and symptom control in a typical population with chronic lung disease from the Adherence-Trial.
Methods:
For this cross-sectional analysis, 169 in- and out-patients with asthma and COPD were recruited. Correct application of inhaler devices was tested using pre-defined checklists. Quality of life and symptom control were investigated using COPD Assessment Test (CAT) and Asthma Control Test (ACT). Spirometry was used to measure forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).
Results:
Overall, correct inhalation technique ranged from 55% to 100% depending on the type of inhaler. 112 participants (68%) participants were treated according to global guidelines. COPD patients with incorrect device application had a higher CAT sum score compared to those with a correct device application (P=.02). Moreover, COPD patients with incorrect device application had more often cough (P=.03) and were more breathless while walking up hills or one flight of stairs (P=.02). While there was no significance found in asthma patients, COPD patients who used their devices correctly had a significantly better mean FEV1% predicted at baseline compared to those who applied their devices incorrectly (P=.04).
Conclusions:
Regular and comprehensive training of correct an inhalation technique is recommended in patients with chronic lung disease, in particular COPD. Correct inhalation of prescribed medication is associated with improved health status and lung function. These findings should encourage physicians and pharmacists to provide instructions on correct inhalation technique and to re-evaluate the patients’ inhalation technique on a regular basis.
ClinicalTrial:
Trial registration: ClinicalTrials.gov: NCT02386722
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