Pharmacist involvement in the inhaler choice improves lung function in patients with COPD: a prospective single-arm study

Eiji Shiwaku,Masaki Aikawa,Takashi Nishimura,Daiki Hira,Chisato Hei,Shigeaki Iwatsubo,Tomohiro Terada,Michinobu Hashimoto,Shinobu Kaneko,Takahiro Kawai,Satoshi Dote,Yuka Kobayashi,Yuki Sakai,Tomoko Nishimura,Toshiyuki Iwata,Teppei Tsuneishi

doi:10.1186/s40780-021-00211-0

Abstract

BackgroundCurrently, in Japan, shifting tasks from physician to hospital pharmacist is being developed to reduce physician workload and improve the quality of pharmacotherapy. This study aimed to investigate the effects of pharmacist involvement in the choice of inhaler as the task on the clinical outcomes of patients with chronic obstructive pulmonary disease (COPD).MethodsThis prospective, single-center, single-arm study included 36 outpatients with newly diagnosed COPD indicating inhaler therapy. Eligible patients were immediately interviewed by pharmacist. Then, pharmacist assessed patient’s inhalation flow rate, physical function to handle an inhaler, comprehension, and value, and finally recommended a personalized inhaler based on originally developed inhaler choice protocol, and pulmonologist prescribed a pharmacist-selected inhaler. The primary endpoint was the improvement in trough forced expiratory volume in 1 s (FEV1) between baseline and week 26. The secondary endpoints were safety, and improvements at week 26 in scores for the COPD Assessment Test (CAT), modified British Medical Research Council Dyspnea Scale (mMRC), and Adherence Starts with Knowledge-20 (ASK-20).ResultsThe pneumonologists completely agreed with the pharmacist-recommended inhaler. Mean FEV1 significantly increased from baseline to week 26 (1.60, SD 0.54 L vs. 1.98, SD 0.56 L; p < 0.0001). Significant improvements in CAT, mMRC, and ASK-20 scores were also observed. The prevalence of CAT responders as a negative predictor of acute exacerbation, defined as those with a decrease in CAT score of ≥2 points from baseline, was 86%. None of the patients experienced exacerbation during the study period.ConclusionsPharmacist involvement in the choice of inhaler for patients with newly diagnosed COPD was associated with improved lung function, health status, clinical symptoms, and adherence to inhaler therapy. Shifting task of choosing appropriate inhaler from physician to hospital pharmacist may be performed effectively and safely with an inhaler choice protocol.Trial registration numberUMIN000039722, retrospectively registered on March 10, 2020.

Highlights

Pharmacological therapy, whether by inhaler or oral medication, has an important role in the management of chronic obstructive pulmonary disease (COPD), helping to reduce symptoms, prevent exacerbation and improve exercise tolerance and health status
These studies did not examine the impact of patient education and shared decision-making on the improvement of lung function in COPD patients
After receiving a diagnosis of COPD that indicated inhaler therapy, the patient was immediately interviewed by the hospital pharmacist (ES, CH, or SK), who assessed the patient’s ability to use an inhaler [considering factors such as inhalation, grip and hearing] and his or her understanding of what is required, as well as the patient’s expectations and preferences, and practical considerations such as device portability, the need for visual and auditory confirmation of successful inhalation, daily dose frequency and medication cost

Summary

Introduction

Pharmacological therapy, whether by inhaler or oral medication, has an important role in the management of chronic obstructive pulmonary disease (COPD), helping to reduce symptoms, prevent exacerbation and improve exercise tolerance and health status. Reported risk factors for non-adherence to inhaled medication include a low Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage [6)] and patient-related factors such as knowledge, attitudes, beliefs, perceptions and expectations [7)]. Studies have highlighted the importance of patient education, such as proper use of inhalers and purpose of medication [8)], and shared decision-making [9)]. These studies did not examine the impact of patient education and shared decision-making on the improvement of lung function in COPD patients. This study aimed to investigate the effects of pharmacist involvement in the choice of inhaler as the task on the clinical outcomes of patients with chronic obstructive pulmonary disease (COPD)

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