Service de Pneumologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, France.
Respir Med. 2011 Dec;105(12):1815-22. doi: 10.1016/j.rmed.2011.07.004. Epub 2011 Jul 28.
Poor inhaler technique is frequent in asthma, but its long-term consequences have been seldom assessed. Pharmacists are ideally positioned to teach inhaler technique. This prospective observational study evaluated the feasibility of inhaler training by pharmacists in patients receiving inhaled corticosteroids by pressurised metered-dose inhaler (pMDI) or breath-actuated MDI. In parallel, the relationships between inhaler technique, adherence, and asthma control, and their modulation one month after training were assessed. Of 727 patients receiving training at pharmacies (n=123), 61% were prescribed a pMDI; 35%, an Autohaler(®); and 5%, an Easi-Breathe(®) inhaler. Poor asthma control (Asthma Control Questionnaire score ≥ 1.5) at baseline was significantly (p<0.05) and independently associated with poor inhaler technique and poor self-reported adherence (Morisky score ≥ 3). The percentage of patients with optimal inhaler technique rose from 24% before to 79% after training (p<0.001). Median training session length was 6 min. At 1 month, mean (SD) ACQ score had improved from a baseline score of 1.8 (1.2) to 1.4 (1.1), (p<0.001). Importantly, greater change was observed in patients with improved inhaler technique versus those without. Similar results were observed for Morisky score. Inhaler technique is associated with adherence and influences asthma control. Inhaler training by pharmacists is feasible and seams to improve inhaler technique, asthma control and adherence.
在哮喘患者中，吸入器使用技术不佳的情况较为常见，但长期影响却很少被评估。药剂师在教授吸入器使用技术方面处于理想位置。本前瞻性观察研究评估了药剂师对接受压力定量吸入器（pMDI）或气动定量吸入器（pMDI）吸入皮质激素的患者进行吸入器训练的可行性。同时，评估了吸入器技术、依从性和哮喘控制之间的关系，以及这些因素在训练一个月后的变化。在接受药店培训的 727 名患者中（n=123），61%使用 pMDI，35%使用 Autohaler（®），5%使用 Easi-Breathe（®）吸入器。基线时哮喘控制不佳（哮喘控制问卷评分≥1.5）与吸入器技术不佳和自我报告的依从性差（Morisky 评分≥3）显著相关（p<0.05）。吸入器技术达标患者的比例从培训前的 24%上升至培训后的 79%（p<0.001）。平均培训时间为 6 分钟。在 1 个月时，ACQ 评分的均值（标准差）从基线的 1.8（1.2）改善至 1.4（1.1）（p<0.001）。重要的是，在吸入器技术改善的患者中，观察到的变化大于无改善的患者。Morisky 评分也观察到类似的结果。吸入器技术与依从性相关，并影响哮喘控制。药剂师进行的吸入器培训是可行的，似乎可以改善吸入器技术、哮喘控制和依从性。
