Basheti Iman A, Salhi Yara B, Basheti Mariam M, Hamadi Salim A, Al-Qerem Walid
Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
Clin Pharmacol. 2019 Jul 23;11:103-116. doi: 10.2147/CPAA.S213271. eCollection 2019.
Pharmacists can have a valuable role in educating patients on correct inhaler technique leading to improved asthma management. Rural areas can benefit from the role of the pharmacist considering the barriers found in attending primary health-care facilities.
This study aimed to assess the impact of inhaler technique education delivered by pharmacists on patients' inhaler technique, Asthma Control Test (ACT) score, forced expiratory volume in the first 1 second (FEV%), and reliever use (puffs/day).
A pre-post interventional study was conducted over 6 months from February 2017 to July 2017 in rural areas in Jordan. Asthma patients visiting respiratory clinics and using metered dose inhaler (MDI) or turbuhaler (TH) controlled medication were randomly recruited. Inhaler technique was assessed via published checklists. The ACT, FEV%, and reliever use (puffs/day) were assessed. Patients were educated on inhaler technique via demonstration with return demonstration education. All assessments were repeated 3 months post education.
A total of 103 (TH, n=44; MDI, n=59) patients were recruited (mean age=46.5±13.5), 74% females. Patients reported an overuse of their reliever (5.1±4.2 puffs/day). Only 2 patients (1.9%) had well-controlled asthma, while the rest had either moderately (19.4%) or poorly (78.6%) controlled asthma. Patients using the MDI achieved 3.03±4.30 ACT score improvement (<0.001), which is a clinically significant improvement in control. Patients using the TH achieved a statistically significant improvement of 2.07±4.72 (=0.031). FEV% improved significantly for MDI users (=0.005) but not for TH users (=0.097). Reliever use decreased significantly for MDI and TH users.
Asthmatic patients living in rural areas in Jordan reported poor inhaler technique, ACT scores, and FEV% scores and high use of reliever medications. Pharmacist-led educational intervention resulted in improved inhaler technique scores, ACT scores, and FEV% scores and lowered reliever use over time.
药剂师在指导患者正确使用吸入器技术以改善哮喘管理方面可发挥重要作用。鉴于农村地区居民在前往初级卫生保健机构时存在诸多障碍，药剂师的作用能使农村地区受益。
本研究旨在评估药剂师提供的吸入器技术教育对患者吸入器使用技术、哮喘控制测试（ACT）得分、第1秒用力呼气量（FEV%）以及缓解药物使用量（每日吸数）的影响。
2017年2月至2017年7月在约旦农村地区开展了一项为期6个月的前后对照干预研究。随机招募前往呼吸科诊所就诊且正在使用定量吸入器（MDI）或都保（TH）控制药物的哮喘患者。通过已发表的清单评估吸入器使用技术。评估ACT得分、FEV%以及缓解药物使用量（每日吸数）。通过示范及患者重复操作的方式对患者进行吸入器技术教育。在教育3个月后重复所有评估。
共招募了103名患者（使用TH的44名，使用MDI的59名）（平均年龄 = 46.5±13.5岁），其中74%为女性。患者报告其缓解药物使用过度（5.1±4.2吸/天）。只有2名患者（1.9%）哮喘得到良好控制，其余患者哮喘控制情况为中度（19.4%）或差（78.6%）。使用MDI的患者ACT得分提高了3.03±4.30（<0.001），这在控制方面具有临床显著改善。使用TH的患者ACT得分有统计学意义的提高，为2.07±4.72（=0.031）。MDI使用者的FEV%显著提高（=0.005），但TH使用者未显著提高（=0.097）。MDI和TH使用者的缓解药物使用量均显著减少。
约旦农村地区的哮喘患者吸入器使用技术、ACT得分和FEV%得分较低，缓解药物使用量较高。由药剂师主导的教育干预随着时间推移使吸入器使用技术得分、ACT得分和FEV%得分得到改善，缓解药物使用量降低。
