Inhalant Research Articles

Budesonide/Formoterol or Budesonide/Albuterol as Anti-Inflammatory Reliever Therapy for Asthma

Over use of reliever as short acting beta-agonist (SABA) and associated underuse of controller as inhaled corticosteroid (ICS) administered via separate inhalers results in worse asthma outcomes . Such discordance can be obviated by combining both controller and reliever in the same inhaler. So called anti-inflammatory reliever (AIR) therapy comprises the use of a single inhaler containing an ICS such as budesonide (BUD) in conjunction with a reliever as either albuterol (ALB) or formoterol (FORM) ,to be used on demand with variable dosing driven by asthma symptoms in a flexible patient centred regimen. Global guidelines now support the use of BUD-ALB as AIR therapy to reduce exacerbations , either on its own in mild asthma or in conjunction with fixed dose maintenance ICS-long acting beta-agonist (LABA) in moderate to severe asthma . Using BUD-FORM on its own allows patients to seamlessly move in an intuitive flexible fashion between AIR or maintenance and reliever therapy (MART) , by stepping up and down the dosing escalator across a spectrum of asthma severities . Head to head clinical studies are indicated to compare BUD-FORM versus BUD-ALB as AIR in mild asthma ,and also BUD-FORM as MART versus BUD-ALB as AIR plus maintenance ICS-LABA in moderate to severe asthma. Patients should be encouraged to make an informed decision in conjunction with their health care professional regarding the best therapeutic option tailored to their individual needs , which in turn is likely to result in long term compliance and associated optimal asthma control.

Participant Perspectives on the Implementation of a School-Linked Text-Message Intervention to Improve Pediatric Asthma Medication Adherence.

Background: Poor adherence to inhaled corticosteroids (ICS) is a significant challenge in pediatric asthma, contributing to health inequities. Text-message reminders for ICS therapy are an evidence-based approach that improves pediatric asthma medication adherence, yet has not been widely adopted into practice, partly due to lack of (1) participant input on design and implementation and (2) use of sustainable community linkages. Remote Asthma Link™ (RAL) seeks to fill this gap as a school-linked text-message intervention wherein parents of children with poorly controlled asthma received daily, 2-way text-message reminders for preventive inhaler use. Responses were shared with school nurses who conducted remote check-ins with families. Enrolled children, largely from underserved backgrounds, experienced improvements in medication adherence and asthma health outcomes. While initial results were promising, we have yet to elicit participant input to refine the protocol for more widespread implementation. Objective: Examine participant perspectives on barriers and facilitators of RAL implementation. Methods: Semistructured interviews were conducted May-June 2022 with intervention participants: 10 parents, 7 school nurses, and 4 pediatric providers (n = 21) until thematic saturation was reached. Interview transcripts were coded using thematic analysis. Results: Several facilitators for RAL implementation were identified, including ease of use and accessibility, personal connection to the school nurse, and receipt of a visual notification for habit formation. Barriers included challenges with school nurses reaching parents, poor understanding of program expectations, and lack of reimbursement structure. Participant-proposed solutions to barriers included utilizing alternate communication methods (eg, social media), educational sessions, and meeting with payors to consider reimbursement models. Conclusion: RAL is a school-linked text-message intervention demonstrating promise in improving outcomes and equity in asthma care. Key implementation facilitators, barriers, and proposed solutions will inform protocol adaptations to promote successful implementation of this and other text-message interventions into clinical practice.

Descriptive Study to Assess the Level of Knowledge Regarding Adverse Effects of Inhalant Substance Abuse among Adolescence

The study conducted to assess the level of knowledge regarding the adverse effects of inhalant substance abuse among adolescents in selected schools of Perinthalmanna with a view to develop an awareness video. The objectives are to assess the knowledge of adolescents regarding adverse effects of inhalant substance abuse, to determine the association between the level of knowledge regarding adverse effects of inhalant substance abuse and selected demographic variables, to develop an awareness video regarding the adverse effects of inhalant substance abuse. The study design was non-experimental descriptive survey design. The population in the study were adolescence between age group of 10-15 years studying in Tharakan Higher Secondary School in Perinthalmanna, Malappuram. Convenient sampling technique is used for selecting, samples (N=500). A semi structured questionnaire regarding inhalant substance abuse. The data obtained were analyzed based on the objectives and hypothesis using descriptive and inferential statistics. The study findings reveals that there is an association between the knowledge of adolescence regarding adverse inhalant substance abuse and the selected demographic variables such as age, religion and education of father and mother.

Effect of Pharmacist-Led Training on Adherence and Practice of Inhaler Use: A Pre-Post Interventional Study in Outpatients With Asthma at Hue University Hospital.

Objective This study aimed to evaluate the impact of a pharmacist-led intervention on improving adherence and practice of inhaler use in outpatients with asthma at a hospital in Vietnam. Methods A pre-post interventional study was conducted at Hue University Hospital. An adapted checklist for both metered-dose inhalers and/or dry powder inhalers was used to evaluate the inhaler technique. Adherence was assessed by using the Test of Adherence to Inhalers questionnaire. The means of interventions comprised "Face-to-face training," "Creating the leaflet for patients," and "Watching guidance video." Results The number of participants with complete data was 79. Before the intervention, 54.4% of patients had misused inhalers, especially inappropriate posture when using devices (70.2%) and not exhaling before inhalation (46.8%). Non-adherence accounted for 55.7% of patients, and the erratic pattern was the highest, with 83.5%. The intervention had remarkably raised the number of good practice and good adherence patients after three months (P < 0.001). Conclusion Pharmacist-led intervention has a positive impact on improving the adherence to inhalers and inhalation techniques of patients with asthma. Practice Implications The pharmacist-led education model could be considered as an effective and feasible solution for asthma management in outpatients and better medication use. Key Points (1) The most frequently observed mistakes in this study were inappropriate posture and inhalation skill when using devices. (2) Pharmacist-led training remarkably improved patients' practice of inhaler use as well as medication adherence.

CFD Analysis for Valve-Holding Camber Permanent Inhaler Spacer (AerospaAcer) with Different Valves

During the COVID-19 pandemic, data statistics showed that patients with respiratory problems become infected. One of the therapy techniques for the respiratory condition was the use of a metered-dose inhaler and spacer. The objective of this paper is to determine the flow parameters of three types of valves which is duckbill valve, cross slit valve and umbrella valve in inhaler spacer to compare fluid flow between valve Previous researchers chose the duckbill valve to control fluid flow in inhaler spacer. The flow characteristics are unaffected by the materials used in the new disposable inhaler spacers, such as paper and polylactic acid (PLA). Several design valves reduced the skewness below 0.94 by suppressing the fillet and chamfer. ANSYS Workbench Fluent 19.2 is used to calculate flow parameters such as turbulence kinetic energy (TKE), turbulence eddy dissipation (TED), velocity, particle velocity magnitude, streamline, and vector velocity. The setup input data is based on the previous researcher's specified parameters such as viscosity model, drug characteristics (salbutamol and propellant), discrete phase model (DPM) equal to 80, boundary condition model, and SIMPLE technique. For the three types of valves, the nozzle injection used a 0.50-millimetre dimension. The simulation work is cross-checked against the results of prior simulations. Within each iteration, the transient flow employed a time step size of 0.01 for 200 steps. The results show that computational analysis can distinguish between models of varying complexity. The TED, TKE, and velocity graphs showed the approximate value between the model geometries. Overall, the study was successful in achieving the desired velocity magnitude in terms of visual and graph representations of the various valve.

Impact of the implementation of a telemedicine program on patients diagnosed with asthma

BackgroundAsthma is one of the most common respiratory ailments worldwide. Despite broad understanding of the illness and of the available therapeutic options for it, patients with serious asthma suffer poor monitoring of their illness in 50% of cases.AimTo assess the impact of the implementation of a mobile application (ESTOI) to control asthma in patients diagnosed with the illness, their adherence to treatment, and their perceived quality of life.MethodologyRandomized clinical trial with 52 weeks’ follow-up of patients with asthma seen in a specialized hospital for their treatment in Spain. Some 108 included patients will be divided into two groups. The intervention group will undergo more exhaustive follow-up than normal, including access to the ESTOI application, which will have various categories of attention: control of symptoms, health recommendations, current treatment and personalized action plan, PEF record, nutritional plan, and chat access with a medical team. The asthma control questionnaire ACT is the main assessment variable. Other variables to be studied include an adherence test for the use of inhalers (TAI), the number of exacerbations, maximum exhalation flow, exhaled nitric oxide test, hospital anxiety and depression scale, asthma quality-of-life questionnaire, forced spirometry parameters (FVC, FEV1, and PBD), and analytic parameters (eosinophilia and IGE). The data will be collected during outpatient visits.Trial registrationThis trial has registered at ClinicalTrials.gov (Identifier: NCT06116292).

Coughing during or after use of Viatris inhaler

Coughing during or after use of Viatris inhaler

Analytical methods for detecting butane, propane, and their metabolites in biological samples: Implications for inhalant abuse detection

Worldwide, various inhalants are widely abused for recreational purposes, with butane and propane emerging as among the most commonly misused volatile substances, posing a significant risk of sudden death. The rapid elimination and oxidation of these highly volatile compounds upon inhalation necessitate the identification of butane and propane along with their metabolites in biological samples. Hence, the primary objective of this study is twofold: firstly, to establish a method for analyzing butane, propane, and metabolites, and secondly, to demonstrate the detection window and exposure indicators associated with the inhalation of butane and propane. In pursuit of this objective, we developed analytical methods for the determination of isobutane, n-butane, propane, and their nine metabolites in both blood and urine. Headspace-gas chromatography–mass spectrometry (GC–MS) and solid-phase microextraction-GC–MS were employed for the analyses, demonstrating acceptable precision and accuracy. An animal study revealed that isobutane and n-butane were only detectable below the limit of quantification (LOQ) in rat blood 5 min after exposure. Meanwhile, the three major metabolites—2-methyl-2-propanol, 2-butanol, and 2-butanone—were observed 5 min after exposure but persisted in rat urine even 5 h post-exposure. Additionally, human urine samples identified other metabolites, including acetone, acetoin, and 2,3-butanediol isomers. The presence of specific metabolites corresponding to each inhalant confirmed the abuse of butane and propane. This comprehensive approach provides valuable insights into the detection and assessment of inhalation to these volatile substances.

Hypertonic saline inhalation therapy among patients with moderate asthma and functional dyspepsia commorbidity

Aim: Dry powder hypertonic saline inhalation use possibilities evaluation in moderate asthma and functional dyspepsia patients. Materials and Methods: 68 moderate asthma and functional dyspepsia patients were examined and treated according to the standard protocols, serum and erythrocytes membrane fatty acid levels were evaluated. The groups of patients with (n=35) and without (n=33) additional dry powder hypertonic saline inhalation use were compared after 1 month. Results: After additional use of dry powder hypertonic saline inhalations vs only standard treatment the rate of well controlled asthma was 3 fold higher with significantly higher FEV1. We also observed positive dynamics of serum arachidonic and docosahexaenoic acids levels indicating resolution of inflammatory reaction with erythrocytes membranes linoleic acid level normalization (source of antiinflammatory cytokines synthesis) among patients with dry powder hypertonic saline inhalation use vs without it. Among patients who used only standard therapy compared to the control group, the erythrocytes membrane linoleic acid level remained decreased with high serum arachidonic and docosahexaenoic acids levels. Follow-up results (after 1 year) showed a significant decrease in exacerbations frequency among patients who underwent dry powder hypertonic saline inhalation vs only the standard treatment. Conclusions: Among moderate asthma patients with functional dyspepsia use of dry powder hypertonic saline inhalation therapy additionally to the standard treatment allows to improve not only clinical and functional parameters but serum and erythrocytes membranes fatty acids spectrum as well leading to the systemic inflammatory reaction reduction and exacerbations prevention in remote period.

Outcome of educating asthmatic children caregivers about proper use of inhaler device

Objective: To identify the attitude and practice of mothers of asthmatic children concerning their use of inhalers. Methodology: This Quasi experimental study collected data from August 2019 to February 2020 and included 248 mothers of asthmatic children. An interview questionnaire was used. The data were analyzed through the SPSS 23 program. Results: The total number of caregivers and their children were 248 with male to female ratio of 1.5: 1. Out of 248 caregivers, 200 (80.6%) had never used a spacer for their children before; whereas 48 (19.4%) had used it and had received training about its use. Ninety (36.3%) out of 248 children had been hospitalized three times per year. Proper use of salbutamol by spacers after the intervention training program led to significant improvement of asthma management in children with moderate asthma attacks, with reduction in hospital admissions and frequency of emergency room visits. Conclusion: There is need for educational program for mother with asthmatic children and the education needs to include demonstration about use of spacer inhaler device.

Adherence to application technique of inhaled corticosteroid in patients with asthma and COVID-19 improves outcomes

BackgroundInhaled corticosteroids have been widely reported as a preventive measure against the development of severe forms of COVID-19 not only in patients with asthma.MethodsIn 654 Czech and Slovak patients with...

Prevalence of Critical Errors and Insufficient Peak Inspiratory Flow in Patients Hospitalized with COPD in a Department of General Internal Medicine: A Cross-Sectional Study.

The suboptimal use of inhalers in the treatment of patients with chronic obstructive pulmonary disease (COPD) is probably a major but poorly documented problem in hospitalized patients. We aimed to describe the prevalence of misused inhalers among patients hospitalized with COPD in a department of general internal medicine. We conducted a monocentric cross-sectional study in consecutive patients with a diagnosis of COPD and hospitalized between August 2022 and April 2023 in the internal medicine division of Fribourg Hospital, Switzerland. Patients underwent an assessment of their inhaler technique and peak inspiratory flow (PIF) using the In-Check Dial G16®. The primary outcome was the prevalence of misused inhalers, defined as an inhaler used with a critical error and/or insufficient PIF. Secondary outcomes included the prevalence of inhalers unsuitable to patients' characteristics and of patients using at least one misused inhaler. The study included 96 patients and 160 inhalers were assessed at admission. Among these inhalers, 111 (69.4%; 95% confidence interval [CI] 61.6-76.4) were misused; 105 (65.6%; 95% CI 57.7-72.9) due to the presence of a critical error in the inhalation technique and 22 (13.8%; 95% CI 8.8-20.1) due to insufficient PIF. Concerning the secondary outcome, 27 inhalers (16.9%) were unsuitable, and 79 patients (82.3%) used at least one misused inhaler. Among patients hospitalized with a diagnosis of COPD, two-thirds of inhalers were misused. Suboptimal use was mainly due to the presence of critical errors, but also to the presence of an insufficient PIF and unsuitable inhalers.

Understanding Knowledge, Practices, and Barriers in Metered Dose Inhaler Use Among Sri Lankan Patients with Bronchial Asthma and Chronic Obstructive Pulmonary Disease

Background and Aims: Despite declining mortality rates, asthma and chronic obstructive pulmonary disease (COPD) continue to pose significant public health challenges with persistently high morbidity rates. One prominent con¬tributing factor is the inadequate use of prescription metered dose inhalers (MDIs) by patients, leading to insufficient dosing and suboptimal disease control. Thus, it is crucial to assess patients’ knowledge, practices, and barriers concerning MDI usage. Methods: This descriptive convenience sampling, conducted at Polonnaruwa District General Hospital in Sri Lanka, enrolled 250 participants to investigate MDI-related behaviors. Questionnaire was used as data collection tool and sampling technique is conveniet sampling. Microsoft Excel spreadsheet and SPSS version 20 (IBM Corporation, New York, USA) software were used for statistical analysis. Results: The majority of participants were aged over 40, with a higher proportion of females (59%) than males (39%). Over half of them had been managing bronchial asthma and COPD for more than five years. Notably, all participants were MDI users, but 59% reported disease exacerbations occurring more than four weeks ago, with dust being the primary trigger (45%). Healthcare professionals, especially nurses and doctors, were common sources of MDI education. However, none of the participants demonstrated correct inhalation technique both before and after receiving education, raising significant concerns. Conclusions: This study highlights the inadequacies in MDI utilization among participants, emphasizing the urgent need for improved patient education by healthcare professionals. Addressing these knowledge and skills gaps related to MDI usage is essential for enhancing asthma and COPD management, ultimately leading to improved patient outcomes and a reduced disease burden.

Quality improvement project to improve inhaler delivery in the intensive care unit

Background Late 2022, an ICU nurse discovered that Seretide™ (salmeterol/Fluticasone) Evohaler, a commonly used inhaler, did not change its dose counter when used with the inhaler connector 22M-22F. This was identified as a medication safety issue. Knowledge gaps of inhaler use in mechanically ventilated patients were identified as well. Aims To effectively administer metered dose inhalers to ventilated patients and increase its accuracy and safety. Methods We instituted education programs for healthcare professional in the ICU and introduced a new inhaler connector RTC 24-V. This was compared with the existing 22M-22F connector in a comparative study. Results The dose counter of Seretide™ recorded prior to initiation and extubation showed an obvious drop in doses ranging from 15 to 63 in patients randomized to use RTC 24-V, compared to 0 to 2 drop in doses for patients using 22M-22F. A total of 51 pre study and 33 post study questionnaires were completed. Confidence that the accurate dose of medications was administered rose from 58.8% to 84.8% after using the RTC 24-V. Responses that there was no issue compromising patient safety rose from 0% to 51.5% and fewer staff expressed concern about disconnections causing infections, dropping from 51% to 9.1%. 93.9% of respondents chose the new RTC 24-V as the preferred inhaler connector. Conclusion The new inhaler connector RTC 24-V was assessed to have less medication errors. ICU healthcare professionals expressed greater confidence in its safety and accuracy. We will implement the use of this connector with continued medical education.

Prediction of underage alcohol, marijuana, and inhalant use as predictors

Prediction of underage alcohol, marijuana, and inhalant use as predictors

Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly.

Patients with chronic obstructive pulmonary disease (COPD) rely primarily on inhaled medications to control and treat symptoms. Although the medications delivered by inhaler devices are often quite efficacious when delivered to the lung, the real-world effectiveness of these inhaler devices often falls short. Barriers to effective inhaler use include inhaler misuse and cost-related nonadherence. Inhaler misuse can be reduced with appropriate education which leads to improved outcomes. Education can be provided in multiple settings by a wide array of clinicians and clinical team members including pharmacists, respiratory therapists, nurses, physicians, advanced practice nurses, physician assistants, and community health workers, among others. However, despite decades of research and existing effective strategies across settings and types of educators, overall not much progress has been made with respect to effective inhaler technique among populations of patients with COPD in nearly half a century. Similarly, cost-related nonadherence is a long-standing and critical barrier to effective control of COPD, with limited improvements, especially until very recently. This perspective reviews the current promising directions for inhaler-based therapies, ongoing challenges, and critical issues requiring urgent attention.

Применение тройного комбинированного препарата будесонид/гликопиррония бромид/формотерол у больных хронической обструктивной болезнью легких в реальной клинической практике (первый отечественный опыт)

Background: the Global Initiative for Chronic Obstructive Lung Disease (COPD) recommends triple therapy as an initial treatment for patients of "group E" (eosinophil count ≥ cells/μL) or as maintenance therapy for patients with frequent exacerbations. Triple therapy combines three types of inhaled medications that help improve lung function, manage symptoms and prevent exacerbations. The use of a single inhaler helps to increase patients' adherence to therapy. Aim: to evaluate the efficacy of the triple combination drug — budesonide/glycopyrronium bromide/formoterol (BUD/GLI/FOR) – and the patients' adherence to the ongoing inhalation therapy of COPD in real clinical practice. Materials and Methods: 30 patients with severe COPD (mean age 65.55±5.98 years) receiving basic therapy in accordance with clinical recommendations during remission were examined. After the initial examination, patients were recommended therapy with a combination of BUD/GLI/FOR 160/7.2/5 μg 2 inhalations twice a day. Patients received the prescribed therapy for 3 months, after which the assessments of therapy adherence and satisfaction with it, the changes concerning the severity of dyspnea (mMRC scale), COPD symptoms (CAT-test), spirometry exams were conducted. Results: after 3 months of therapy with BUD/GLI/FOR, none of the patients had an exacerbation of COPD. During treatment, there was a tendency to decrease the disease severity. No significant changes in spirometry have been established. In 83,3% of cases, patients performed inhalation without errors while reproducing the correct technique. All patients were satisfied with the therapy and were ready to continue treatment. Conclusion: the results obtained serve as the basis for further treatment of patients with COPD with the drug used in real clinical practice and are encouraging in achieving the clinical and functional efficacy announced in randomized clinical trials. KEYWORDS: COPD, triple combination, phospholipids, aerosphere, adherence, inhaled glucocorticosteroid, dual bronchodilator therapy. FOR CITATION: Titova O.N., Kuzubova O.A., Sklyarova D.B. Triple combination drug — budesonide/glycopyrronium bromide/formoterol in patients with chronic obstructive pulmonary disease in real clinical practice (the first domestic experience). Russian Medical Inquiry. 2024;8(8):459–463 (in Russ.). DOI: 10.32364/2587-6821-2024-8-8-3.

Клініко-фармакоекономічні аспекти лікування хворих на COVID-19 нетяжкого перебігу та наявністю факторів ризику прогресування захворювання

Abstract. COVID-19 treatment issues are still a difficult problem worldwide because of huge economic losses of society as a result of the widespread disease, the peculiarity of its course and the development of complications. The aim of the work is to study the clinical efficiency, safety and economic feasibility of the use of aminocaproic acid (AСA) in the treatment of patients with mild COVID-19 and the presence of modifying risk factors compared to nirmatrelvir/ritonavir and symptomatic therapy. Materials and research methods. 96 patients with mild COVID-19 and the presence of factors of increased risk of progression of the disease to a severe form (old age; overweight; pregnancy; chronic kidney disease; diabetes; primary or secondary immunodeficiency; cardiovascular diseases; chronic lung diseases, etc.). Depending on the treatment regimen, all patients were divided into three groups. Patients of group 1 (n = 33) received ACA inhalation through a compressor inhaler (nebulizer), patients of the 2nd (n = 31) — antiviral therapy with combined drug nirmatrelvir /ritonavir, and patients of the 3rd (n = 32) — symptomatic inhalation Ektobris. The study analyzed the clinical condition, manifestations of certain symptoms of the disease, undesirable phenomena and quality of life of patients, as well as indicators of the cost of drug treatment. The effectiveness of treatment was evaluated by the clinical condition of the patient on the 1st, 3rd, 8th and 14th day of observation. The safety of therapy was evaluated by the frequency of unwanted phenomena, their severity and the emergence of clinically significant changes in laboratory testing. Results. Based on the analysis of the dynamics of individual symptoms, it was found that on the 8th day of treatment in the 1st and 2nd groups of patients was observed faster and reliably (p &lt; 0.05) reduction of the main clinical manifestations of the disease in comparison with patients of 3rd group. But at the end of treatment, the effectiveness of treatment in all groups was almost the same (p &gt; 0.05) recovery was reached in the 1st, 2nd and 3rd groups in 84.6 %, 83.8 % and 75.0 %. In the rest of the patients, a positive dynamic of symptoms was observed. When assessing the safety of the proposed treatment regimens in patients of the 1st and 3rd study groups no treatment side effects were observed in all cases. At the same time, 19.4 % of patients of group 2 for the 2nd day of treatment were registered with undesirable mild side effects from the gastrointestinal tract, but their intensity and duration did not require termination or correction of further therapy. Given the same clinical efficiency and safety of the proposed treatment schemes of patients with Covid-19, the method of "minimizing value" was applied to carry out pharmacoeconomic research. According to the results of this analysis, it was found that the most optimal in these indicators was the treatment of the 1st group of patients, which was significantly the smallest of all comparison groups (p &lt; 0.05). Conclusions. The results of the study of clinical efficacy, safety and pharmacoeconomic aspects of the treatment of patients with a mild course of Covid-19 and the presence of risk factors for the progression of the disease indicate the unconditional advantages of the use of ACA inhalation in the treatment of this category of patients in comparison with the use of nirmatrelvir. The use of this therapeutic tactics allows you to achieve significantly faster clinical improvement, prevent the development of unwanted phenomena and the progression of the disease, as well as reduce the cost of treatment of this category of patients.

Smoking cessation encouragement by community pharmacists.

Background: Pharmaceutical care interventions have shown to improve health outcomes in specific patient populations. However, which smokers could be reached by community pharmacists in Belgium is unknown. Moreover, the impact of behavioural interventions for smoking cessation (such as brief motivational interviewing) on short term health outcomes remains unclear. Therefore, we aimed to describe the population reached and potential impact on health outcomes among persons who received a brief motivational interview by their community pharmacist.&#x0D; Methods: Demographics of approached smokers in Flemish community pharmacies during the months May-June 2021, and objectifiable outcomes of a brief motivational interview were retrieved from the pharmacy database. Smoking cessation aids use as well as the impact on cough, inhaler or exacerbation medication use was evaluated 90 and 180 days after the encouragement. Data were analysed using the Mann-Whitney U test, ꭕ² test and binary logistic regression analysis.&#x0D; Results: Community pharmacists provided a brief motivational interview to a broad population of smokers of both sexes, including young persons and persons without chronic medication use. Two out of three smokers were motivated to quit (67.7%) and a third of the included population (33.0%) purchased a smoking cessation aid on the index date (36.7% after 90 and 39.3% after 180 days). Smokers motivated to quit who purchased a smoking cessation aid on the index date had a significantly lower use of cough (OR = 0.37; p = 0.032) and inhaler medication (OR = 0.37; p = 0.009) after 90 days than those not motivated to quit. Effects were less pronounced after 180 days but still statistically significant for lower inhaler use (OR = 0.46; p = 0.031).&#x0D; Conclusions: By implementing a brief pharmaceutical counselling in Belgian community pharmacies, a broad range of smokers can be reached and triggered to start smoking cessation aids with suggestive short-term health benefits.&#x0D; Acknowledgements&#x0D; The authors want to thank the Flemish Pharmacists Network (VAN) for training the pharmacists and Farmaflux and the Association of Pharmacists Belgium (APB) for providing the data with special acknowledgements to Karel Verlinde, An Vanthienen, Corine De Winter and Marc Buckens.

Development and Implementation of an Integrated Pharmaceutical Care Program for patients with COPD in a Rehabilitation Hospital.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with airflow limitation and prolonged respiratory problems. The treatment requires an interdisciplinary approach with a holistic view of the patient. A cornerstone of the treatment consists of inhalation therapy. Inhalation errors are abundant and medication adherence towards inhalation therapy is low. We aimed (1) to develop a standardized pharmaceutical care protocol for hospitalized patients with COPD and (2) to evaluate the effect and feasibility of protocol implementation.&#x0D; Methods: This study took place at the rehabilitation hospital Koningin Elisabeth Instituut (RH-KEI) in Oostduinkerke, Belgium from January 2021 to April 2022. The protocol was based on the PHARMACOP protocol, tailored to the specific setting using in-depth interviews with all HCPs involved in the pharmaceutical care of patients with COPD (physicians, pharmacists, pharmacy technicians, nurses, physiotherapists and an occupational therapist). The finalized protocol consisted of six additional patient contacts (3 evaluation moments, 2 educational moments and 1 evaluation moment two weeks after discharge), mainly between the hospital pharmacist and the patients. Consequently, from January 2022 to April 2022, adult patients with COPD were included to follow the complete protocol. Patient outcomes were evaluated using standardized questionnaires (i.e. mMRC, BMQ, CAT, EQ-D and EQ-VAS). The feasibility was assessed during a focus group discussion with all involved HCPs and a patient survey after discharge.&#x0D; Results: Before the start of the study, the hospital pharmacist in RH-KEI had no patient contact and there were no (recurrent) training sessions about inhaler use. The in-depth interviews elucidated that most involved health care providers (HCPs) had insufficient knowledge of the correct use of inhalers. This is however needed as 37% of included patients made at least one critical inhalation error at hospitalization. The adapted PHARMACOP protocol was tested in 13 patients, after which a significant improvement was noted in mMRC (p = 0.047), BMQ concerns (p = 0.011) and CAT score (p = 0.002). A trend towards improvement was noted in the EQ-5D and EQ-VAS score (resp. p = 0.065, p = 0.590). Finally, mean inhalation technique scores had significantly improved (p = 0.003). Transferring information to primary care HCPs seemed difficult as only a third of patients had handed over their discharge letter to their community pharmacist. The in-hospital HCPs concluded that the protocol was feasible for implementation with some adjustments, such as a more prominent role of the (hospital) pharmacist, the possibility to tailor the program to the patient and a set timing for interdisciplinary (patient) discussions. &#x0D; Conclusion: An interdisciplinary pharmaceutical care program can improve outcomes in patients with COPD. Additional attention should be given to the inclusion of primary care HCPs to guarantee continuity of care concerning inhalation therapy for COPD management.