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Wu H, Zhang H, Li X, Zhao Q. Effects of medication adherence on disease activity in chronic obstructive pulmonary disease: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2023; 28:1656-1670. [PMID: 36343098 DOI: 10.1080/13548506.2022.2141277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
The disease activity of Chronic obstructive pulmonary disease (COPD) patients is often measured, which can could be related to medication adherence. Yet, there is no systematic inventory of studies comparing adherents and non-adherent patients in terms of disease activity. The systematic review and meta-analysis aimed to reveal the effect of medication adherence on disease activity in patients with COPD. For the present meta-analysis, studies comparing medication adherence in adherents and non-adherent patients were screened and included. Results were expressed as mean difference (MD) and 95% CI. A total of eleven identified studies matched the inclusion criteria, reporting on a total of 6,346 COPD patients in the analysis. The number of exacerbations in COPD patients over a year was significantly lower in non-adherent patients than in adherent subjects (MD = 0.69, 95% CI [0.36,1.01], P < 0.0001). Similarly, a significant difference was observed between medication-adherent and non-adherent groups in FEV1 (MD = -166.47, 95% CI [-255.03, -77.92], P= 0.0002). Interestingly, the results of the meta-analysis showed no significant difference between medication-adherent and non-adherent patients in SGRQ (MD = -0.85, 95% CI [-4.98, 3.27], P= 0.68), CAT (MD = -0.83, 95% CI [-1.78, 0.13], P= 0.09), and FEV1% (MD = -3.33, 95% CI [-6.83, 0.17], P= 0.06).The studies performed suggested that clinical medical staff should pay attention to the medication behavior of COPD patients and effectively improve the medication adherence of patients.
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Affiliation(s)
- Hongxia Wu
- Department of Respiratory and Critical Care Medicine, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Hui Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xin Li
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qian Zhao
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
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Song CY, Liu X, Wang YQ, Cao HP, Yang Z, Ma RC, Yin YY, Xie J. Effects of home-based telehealth on the physical condition and psychological status of patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Int J Nurs Pract 2022:e13062. [PMID: 35545098 DOI: 10.1111/ijn.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/15/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
AIMS This systematic review and meta-analysis aimed to evaluate the effects of home-based telehealth compared with usual care on six-minute walking distance (6MWD), health-related quality of life, anxiety and depression in patients with chronic obstructive pulmonary disease. METHODS We identified randomized controlled trials through a systematic multidatabase search. Titles and abstracts were assessed for relevance. Two authors independently extracted data and assessed the risk of bias and quality of evidence. Meta-analyses were conducted using Review Manager and Stata. RESULTS We included 32 randomized controlled trials (n = 5232). Devices used for home-based telehealth interventions included telephones, videos, and combined devices. The quality of the evidence was downgraded due to high risk of bias, imprecision, and inconsistency. Home-based telehealth significantly increased 6MWD by 35 m (SD = 30.42) and reduced symptom burden by 3 points (SD = -2.30) on the COPD assessment test compared with usual care. However, no significant differences in anxiety and depression were noted between the home-based telehealth group and the standard care group. In subgroup analysis, home-based telehealth significantly improved 6MWD and health status after 6-12 months and >12 months. CONCLUSION Low quality evidence showed that home-based telehealth interventions reduce symptom burden and increase walking distance to a clinically meaningful extent in patients with COPD. However, no effects on depression and anxiety were observed.
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Affiliation(s)
- Chun-Yu Song
- School of Nursing, Jilin University, Changchun, China
| | - Xin Liu
- School of Nursing, Jilin University, Changchun, China
| | - Ya-Qing Wang
- School of Nursing, Jilin University, Changchun, China
| | - Hui-Ping Cao
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Zhuo Yang
- Department of Emergency, The First Hospital of Jilin University, Changchun, China
| | - Rui-Chen Ma
- School of Nursing, Jilin University, Changchun, China
| | - Ying-Ying Yin
- School of Nursing, Jilin University, Changchun, China
| | - Jiao Xie
- School of Nursing, Jilin University, Changchun, China
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Phanareth K, Dam AL, Hansen MABC, Lindskrog S, Vingtoft S, Kayser L. Revealing the Nature of Chronic Obstructive Pulmonary Disease Using Self-tracking and Analysis of Contact Patterns: Longitudinal Study. J Med Internet Res 2021; 23:e22567. [PMID: 34665151 PMCID: PMC8564654 DOI: 10.2196/22567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/16/2020] [Accepted: 08/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and is characterized by a progressive loss of pulmonary function over time with intermittent episodes of exacerbations. Rapid and proactive interventions may reduce the burden of the condition for the patients. Telehealth solutions involving self-tracking of vital parameters such as pulmonary function, oxygen saturation, heart rate, and temperature with synchronous communication of health data may become a powerful solution as they enable health care professionals to react with a proactive and adequate response. We have taken this idea to the next level in the Epital Care Model and organized a person-centered technology-assisted ecosystem to provide health services to COPD patients. Objective The objective is to reveal the nature of COPD by combining technology with a person-centered design aimed to benefit from interactions based on patient-reported outcome data and to assess the needed kind of contacts to best treat exacerbations. We wanted to know the following: (1) What are the incidences of mild, moderate, and severe exacerbations in a mixed population of COPD patients? (2) What are the courses of mild, moderate, and severe exacerbations? And (3) How is the activity and pattern of contacts with health professionals related to the participant conditions? Methods Participants were recruited by convenience sampling from November 2013 to December 2015. The participants’ sex, age, forced expiratory volume during the first second, pulse rate, and oxygen saturation were registered at entry. During the study, we registered number of days, number of exacerbations, and number of contact notes coded into care and treatment notes. Each participant was classified according to GOLD I-IV and risk factor group A-D. Participants reported their clinical status using a tablet by answering 4 questions and sending 3 semiautomated measurements. Results Of the 87 participants, 11 were in risk factor group A, 24 in B, 13 in C, and 39 in D. The number of observed days was 31,801 days with 12,470 measurements, 1397 care notes, and 1704 treatment notes. A total of 254 exacerbations were treated and only 18 caused hospitalization. Those in risk factor group D had the highest number of hospitalizations (16), exacerbations (151), and contacts (1910). The initial contacts during the first month declined within 3 months to one-third for care contacts and one-half for treatment contacts and reached a plateau after 4 months. Conclusions The majority of COPD patients in risk factor group D can be managed virtually, and only 13% of those with severe exacerbations required hospitalization. Contact to the health care professionals decreases markedly within the first months after enrollment. These results provide a new and detailed insight into the course of COPD. We propose a resilience index for virtual clinical management making it easier to compare results across settings.
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Affiliation(s)
| | - Astrid Laura Dam
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Signe Lindskrog
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Rassouli F, Germann A, Baty F, Kohler M, Stolz D, Thurnheer R, Brack T, Kähler C, Widmer S, Tschirren U, Sievi NA, Tamm M, Brutsche MH. Telehealth mitigates COPD disease progression compared to standard of care: a randomized controlled crossover trial. J Intern Med 2021; 289:404-410. [PMID: 33428219 PMCID: PMC7986739 DOI: 10.1111/joim.13230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND We showed excellent adherence and satisfaction with our telehealth care (TC) approach for COPD. Here, the results of a consecutive randomized controlled trial are presented. METHODS Patients were randomly assigned to TC or standard care (SC). During TC, patients answered six daily questions online, and focused on the early recognition of exacerbations, in addition to SC. RESULTS The mean increase in COPD assessment test (CAT) was 1.8 vs. 3.6 points/year in the TC and SC groups, respectively (P = 0.0015). Satisfaction with care (VAS) at baseline was 8.2; at the end of SC, 8.5 (P = 0.062); and after TC, 8.8 (P < 0.001). We detected significantly more moderate exacerbations during TC. CONCLUSION Whilst receiving TC, the slope of the CAT increase - an indicator of the naturally progressive course of COPD - was reduced by 50%. Satisfaction with care increased with TC. The higher number of detected moderate exacerbations probably indicates a higher diagnostic sensitivity than without TC.
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Affiliation(s)
- F Rassouli
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - A Germann
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - F Baty
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - M Kohler
- Clinic for Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - D Stolz
- Clinic for Pulmonology, University Hospital Basel, Basel, Switzerland
| | - R Thurnheer
- Clinic for Internal Medicine, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - T Brack
- Clinic for Internal Medicine, Cantonal Hospital Glarus, Glarus, Switzerland
| | - C Kähler
- Clinic for Pulmonology, Waldburg-Zeil-Kliniken, Wangen, Germany
| | - S Widmer
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - U Tschirren
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - N A Sievi
- Clinic for Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - M Tamm
- Clinic for Pulmonology, University Hospital Basel, Basel, Switzerland
| | - M H Brutsche
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Hidalgo Requena A, Rojas Feixas L, Aguilar López I, Delgado Fernández L, Mateos Ortega R, López Macías I, Morillo-Velarde Moreno C, Fontans Salguero A, Moreno de Juan C, Martos García R. [Comparing group educational intervention to individual and self-learning in COPD]. Semergen 2020; 47:215-223. [PMID: 33359382 DOI: 10.1016/j.semerg.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/02/2020] [Accepted: 10/25/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is considered a public health issue which affects 10.2% of Spanish population between 40 and 80 years of age. Many patients do not perform well the inhalation technique. Error rates vary between 50-80% depending on the device under study. These values haven been proven to decrease with educational interventions. OBJECTIVE To ascertain whether a group educational intervention is superior to an individual intervention or to a conventional approach in these patients as regards quality of life measured by means of the total score of the COPD Assessment Test (CAT),of adherence to treatment, exacerbations and hospitalizations. MATERIAL AND METHODS A multicenter, multidisciplinary cluster-randomized controlled clinical trial with three branches (conventional intervention, individual intervention and group intervention) in a cohort of COPD-patients. Sociodemographic data and risk factors were collected and several questionnaires were completed (CAT, BODEx, Barthel, Lawton y Brody). A descriptive analysis of qualitative and quantitative variables and a multiple linear regression were conducted. OUTCOMES 149 patients of average age 69.08 (SD 1.26). Significant differences were observed in CAT in the different intervention groups according to the level of severity on BODEx. The rate of patients performing well the inhalation technique was significantly lower at the beginning of the study and the number of exacerbations was lower after the intervention. Last year's exacerbations were linearly related to post-intervention suffering. CONCLUSIONS Better results are obtained using the traditional and individual interventions. There is a decrease in number of exacerbations, hospitalizations, CAT score and post-intervention inhalation technique.
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Affiliation(s)
- A Hidalgo Requena
- Centro de Salud Lucena I, Servicio Andaluz de Salud, Córdoba, España; Grupo de Trabajo de Respiratorio de SEMERGEN, Madrid, España
| | - L Rojas Feixas
- Centro de Salud de Rute, Servicio Andaluz de Salud, Córdoba, España
| | - I Aguilar López
- Centro de Salud Lucena I, Servicio Andaluz de Salud, Córdoba, España
| | | | - R Mateos Ortega
- Centro de Salud de Cabra, Servicio Andaluz de Salud, Córdoba, España
| | - I López Macías
- Centro de Salud Lucena I, Servicio Andaluz de Salud, Córdoba, España.
| | | | | | - C Moreno de Juan
- Centro de Salud Lucena II, Servicio Andaluz de Salud, Córdoba, España
| | - R Martos García
- Centro de Salud de Priego de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Centro Universitario de Enfermería de Cruz Roja adscrito a la Universidad de Sevilla, Sevilla, España
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Beks H, King O, Clapham R, Alston L, Glenister K, McKinstry C, Quilliam C, Wellwood I, Williams C, Wong Shee A. Community health programs delivered through information and communications technology in high-income countries: a scoping review (Preprint). J Med Internet Res 2020; 24:e26515. [PMID: 35262498 PMCID: PMC8943572 DOI: 10.2196/26515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/15/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. Objective The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. Methods The Joanna Briggs Institute’s scoping review methodology guided the review of the literature. Results The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Conclusions Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers.
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong, Australia
| | | | - Renee Clapham
- St Vincents Health Australia, Melbourne, Australia
- Ballarat Health Services, Ballarat, Australia
| | - Laura Alston
- School of Medicine, Deakin University, Geelong, Australia
- Colac Area Health, Colac, Australia
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, Wangaratta, Australia
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Carol McKinstry
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Claire Quilliam
- Department of Rural Health, University of Melbourne, Wangaratta, Australia
| | - Ian Wellwood
- Faculty of Health Sciences, Australian Catholic University, Ballarat, Australia
| | | | - Anna Wong Shee
- School of Medicine, Deakin University, Geelong, Australia
- Ballarat Health Services, Ballarat, Australia
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Swift E, O'Brien MR, Peters S, Kelly C. Healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease: a critical interpretive synthesis. Disabil Rehabil 2020; 44:520-535. [PMID: 32478588 DOI: 10.1080/09638288.2020.1769745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To establish literature regarding healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease.Method: A critical interpretive synthesis was conducted; CINAHL, PsychINFO and MEDLINE were searched between 1988 and August 2019, using MeSH headings and key terms. Reference lists of accepted papers were also searched. Qualitative, quantitative and mixed methods studies, written in English, including healthcare professionals' perceptions of pulmonary rehabilitation were included. The search yielded 133 papers which were assessed for eligibility; 20 met the inclusion criteria.Results: Two themes were identified, the first explored "Barriers to Pulmonary Rehabilitation" from a healthcare professional's perspective. This incorporated a lack of knowledge, a lack of resources, practical barriers, patient barriers, and healthcare professional's being unsure it is their role to refer. The second entitled "General Perceptions of Pulmonary Rehabilitation", highlighted ways in which the programme could be improved, the perceived positives and negatives, facilitators to referral, and perceptions of patients referred.Conclusions: This is the first systematic review to encompass the perceptions of healthcare professionals with ability to refer and those who deliver pulmonary rehabilitation. Referral was low, highlighting potential influencing factors such as a lack of programme knowledge, pulmonary rehabilitation beliefs, and communication skills. Given inclusion of studies from multiple geographical locations, the findings provide implications for any healthcare system that develops and delivers pulmonary rehabilitation. With respect of a lack of referrals to the programme, further research should highlight healthcare professionals' perceptions of the referral process, and the views of those in Secondary Care.Implications for rehabilitationChronic obstructive pulmonary disease:•Pulmonary rehabilitation is a proven cost-effective management strategy for patients with chronic obstructive pulmonary disease, which reduces associated hospital admissions and increases quality of life.•Due to a lack of knowledge and negative perceptions surrounding pulmonary rehabilitation, further training and education is required for healthcare professionals surrounding non-pharmacological management strategies.•Pulmonary rehabilitation programmes should consider ways to increase awareness of the service amongst those with chronic obstructive pulmonary disease.•Those delivering pulmonary rehabilitation should consider ways to support healthcare professionals referring to the programme.
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Affiliation(s)
- Emma Swift
- Faculty of Education, Manchester Metropolitan University, Manchester, UK
| | - Mary R O'Brien
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Carol Kelly
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Revue générale sur l’adhésion aux traitements inhalés de la BPCO. Rev Mal Respir 2019; 36:801-849. [DOI: 10.1016/j.rmr.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 05/23/2019] [Indexed: 01/12/2023]
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Blum E, Thavarajah K, Martirosov AL. Optimization of patient-specific inhaler regimens with the use of the aerosol inhalation monitor. J Am Pharm Assoc (2003) 2018; 59:252-257. [PMID: 30552051 DOI: 10.1016/j.japh.2018.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the addition of a Vitalograph Aerosol Inhalation Monitor (AIM) assessment to a pharmacy bundle to optimize inhaler devices in patients with asthma and chronic obstructive pulmonary disease (COPD). SETTING Hospital-based outpatient pulmonary clinic. PRACTICE DESCRIPTION Ambulatory pharmacy service for underserved pulmonary patients in Detroit, MI. PRACTICE INNOVATION Patients with asthma and COPD received a pharmacy bundle service that included inhaler technique assessment with the use of the AIM. Based on the patient's performance, an optimized pulmonary regimen was developed for the patient in collaboration with the pulmonologists. Follow-up telephone calls were made 1 and 4 weeks after the visit. EVALUATION A 1-group pretest-posttest quasiexperimental study was conducted over a 6-month period. The primary objective of the study was to describe the impact that a pharmacist had on optimizing individuals' inhaled regimens. In addition, clinical outcomes including changes in asthma control test (ACT) and COPD assessment test (CAT) scores, rescue inhaler use, and patient adherence were assessed. RESULTS A total of 44 patients were included in the study, of which 27 (61%) were determined to be on an inappropriate inhaler regimen according to their AIM assessment. The pharmacist subsequently made recommendations to change the device(s) for those patients, with the most common recommendation being a change to a nebulized regimen. There was a significant improvement in ACT/CAT scores, patient-reported inhaler use, and patient adherence at week 4 compared with baseline. CONCLUSION Assessing inhaler technique with the use of the AIM allows pharmacists to identify an optimized inhaled regimen for patients with asthma and COPD and may be a potential solution to the problem of poor inhaler technique.
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