Inhaler technique education and asthma control among patients hospitalized for asthma in Jordan

Public involvement in chronic respiratory diseases research: A qualitative study of patients', carers' and citizens' perspectives

INTRODUCTION

Patient and public involvement (PPI) initiatives involving patients with chronic respiratory disease (CRD) are rare. Therefore, this study aimed to explore the perspectives of patients with CRD, carers and interested citizens regarding the relevance and need for a PPI network and suggestions for its implementation.

METHODS

A qualitative study based on focus groups was conducted. Recruitment occurred through invitations on social media platforms and to patients who have participated in previous asthma studies of the team. Three focus groups were conducted, via video conference, using a semi-structured guide. Thematic analysis was performed by two independent researchers and discussed with the extended team.

RESULTS

Fifteen patients with CRD, one carer and one interested citizen (13 females, median 36 (range: 18-72) years) participated. All participants acknowledged the importance of implementing a collaborative network and demonstrated interest in being integrated. Participants acknowledged the importance of their involvement in several phases of the research cycle. The main aim identified for this network was to facilitate communication between patients and researchers. Participants regarded the integration of patients, carers, researchers and healthcare professionals from different scientific areas as relevant. The use of digital platforms to attract members and support the work, together with group dynamics and regular meetings, were some of the most relevant practical considerations for implementing the network. The identified facilitators for their engagement were sharing experiences, researchers' and healthcare professionals' support and feedback and schedule flexibility. The identified barriers included the amount of time dedicated, low health/digital literacy and the potential detachment of nondiagnosed patients or those with low symptom impact in daily life.

CONCLUSION

Patients, carers and citizens acknowledged the relevance of implementing a collaborative network and demonstrated interest in active participation in every stage of the health research cycle. A deeper knowledge of the barriers and facilitators identified in this study could support implementing these initiatives in Portugal.

PATIENT OR PUBLIC CONTRIBUTION

This study was designed by a research team that included one patient with asthma and one carer. They were specifically involved in building the study protocol and the interview guide. They also gave feedback regarding the electronic consent form and the short sociodemographic questionnaire created, namely by removing noncontributing words or phrases and rewording expressions. The lay summary was written by another patient with asthma. All participants of this study were invited to implement and integrate the ConectAR network-a collaborative network of research in respiratory health.

PUBLIC SUMMARY

In Portugal, chronic respiratory patients do not have an active role as 'coinvestigators'. This study aimed to acknowledge if patients and citizens considered a patient and public involvement network useful, whose main purpose would be to facilitate communication between patients and researchers. A study based on online group interviews was carried out with patients with chronic respiratory diseases and interested citizens, both recruited on social media platforms. Participants considered that bringing together patients, carers, researchers and healthcare professionals is valuable because sharing different experiences and perspectives may help patients to improve their daily lives and increase research quality. In conclusion, patients agree that implementing a collaborative network with researchers and healthcare professionals and participating in the health research cycle is quite preponderant. Acknowledging what can help and deter this network may be beneficial to implementing this type of initiative in Portugal.

Pharmacist intervention for pediatric asthma: A systematic literature review and logic model

BACKGROUND

Asthma is highly prevalent in children. Evidence about pharmacist-led interventions in the management of pediatric asthma is emerging.

OBJECTIVE

To summarize empirical evidence of pharmacist-led interventions for pediatric asthma patients, and to identify the components of a logic model, which can inform evidence-based pharmacy practice.

METHODS

PubMed, Web of Science, Embase Scopus, ScienceDirect, Medline and CNKI were searched. Studies concerning pharmacist-led interventions for pediatric asthma patients with an interventional design published between January 2013 and February 2023 were selected for analysis. Literature was searched and retrieved according to PRISMA guidelines. Components of pharmacist-led interventions were compiled into a logic model comprising input, activity, output, outcome and contextual factors.

RESULTS

The initial search retrieved 2291 records and 35 were included in the analysis. The main interventional activities included optimising medicines use and prevention and control of asthma. Commonly reported outputs were medication adherence, knowledge and inhaler technique. The main economic outcomes included cost of medication and hospitalization; clinical outcomes included Childhood Asthma Control Test/Asthma Control Test scores and lung function in FEV1% and PEF%; humanistic outcomes included patients' quality of life and satisfaction. Social, economic, political, and technological factors were identified as contextual factors.

CONCLUSION

The logic model summarized components of interventions evaluated in literature. It provides a blueprint for pharmacist-led management of pediatric asthma. Further research can focus on the pharmacists' role in a multidisciplinary healthcare professional team and transition of care in patient-centered management of pediatric asthma.

A systematic review on the impact of pharmacist-provided services on patients' health outcomes in Arab countries

WHAT IS KNOWN AND OBJECTIVE

The pharmacist's role has evolved dramatically over the last few decades and shows considerable impact globally. The aim of this systematic review was to describe the nature and extent of studies evaluating the impact of pharmacist-provided services on clinical, humanistic and economic outcomes in different healthcare settings across the Arab world.

METHODS

A systematic literature search was conducted using the following databases from their inception until June 2020: Cochrane, Embase, MEDLINE, PubMed, ScienceDirect and Scopus. Reporting was done according to PRISMA guidelines, and the quality assessment utilized the Mixed Methods Appraisal Tool.

RESULTS AND DISCUSSION

Thirty-five eligible studies were included in this review, the majority of which were randomized controlled trials (RCT) (n = 26) conducted in hospital settings (n = 26). Most of the studies involved patients with specific medical conditions (n = 29) and pharmacist's interventions involved mainly medication therapy management (n = 32), counselling and education (n = 29), and medication therapy recommendations (n = 12). Several studies showed a positive impact (i.e., a statistically and/or clinically significant difference in favour of pharmacist-provided care or intervention) of pharmacist-provided services on clinical (n = 28), humanistic (n = 6) and economic (n = 5) outcomes. Conversely, five studies showed neutral or mixed effect of pharmacist interventions on clinical and humanistic outcomes.

WHAT IS NEW AND CONCLUSION

The findings of this systematic review demonstrate a positive impact of pharmacist-provided services on clinical, humanistic and economic outcomes across diverse settings in the Arab world. Most of the included studies evaluated clinical outcomes and were from hospital setting. Directed approaches are needed to advance pharmacy practice across various healthcare settings in the Arab world.

The impact of using a mobile application to improve asthma patients' adherence to medication in Jordan

The main aim of this study is to assess the effectiveness of using a developed asthma mobile application to enhance medication adherence in Jordan. Asthma patients visiting outpatient respiratory clinics and using inhalers were recruited. Patients were assigned into two groups: intervention and control. The intervention group was instructed to download and use the application. Asthma control was assessed using Asthma Control Test (ACT) at baseline and at follow-up of 3 months for both groups. A total of 171 patients (control, n = 83, and intervention, n = 88) participated in the study. After 3 months of usage, patients in the intervention group achieved a significant improvement in ACT score compared to control (p-value <0.05), and reported a significant satisfaction of the application use. Therefore, the asthma mobile application is found as an effective tool to enhance medication adherence in asthma patients.

Clinical and economic impact of telemedicine in the management of pediatric asthma in Jordan: a pharmacist-led intervention

OBJECTIVE

Pediatric asthma is a major public health concern, considering its chronic nature and negative effects on quality of life of affected children. Telemedicine is efficacious in providing pharmaceutical care for patients with several chronic diseases, including asthma. This approach allows habitants of sparsely populated rural Jordanian areas to remotely access high-quality healthcare services. Pharmacist-provided asthma counseling has proven benefits in improving patient adherence rates and their understanding. This study evaluated clinical and economic impacts of pharmacist-led, interactive synchronous telemedicine counseling of pediatric asthma patients in Jordan.

METHODS

A randomized, controlled, 12-week pre-post interventional study was conducted. Ninety patients with uncontrolled asthma aged 5-11 years were recruited and randomly assigned to two groups: intervention or control. Inhaler use was checked for both groups at baseline, along with assessment of clinical and economic measures. Counseling on proper inhaler use was provided by pharmacists. Telemedicine sessions for the intervention group were scheduled every 4 weeks, whereas the control group received standard care. Pertinent measures reflecting the level of disease control and relapse were tracked monthly.

RESULTS

The intervention group showed more significant improvement in clinical and economic outcomes than the control group (the Childhood Asthma Control Test mean scores [P = 0.0134], decreased parental loss of wages [P = 0.0015], and decreased economic burden [P < 0.001]). Additionally, overall improvement in quality of life and satisfaction with the telemedicine sessions were reported.

CONCLUSION

Pharmacist-led telemedicine counseling could be a promising approach to deliver distant pharmaceutical care for patients with childhood asthma.

The Effect of a Theory of Planned Behavior Education Program on Asthma Control and Medication Adherence: A Randomized Controlled Trial

BACKGROUND

Disease management in individuals with asthma is affected by factors such as avoiding triggers that cause attacks and properly using inhaler devices.

OBJECTIVE

To determine the effect of a theory of planned behavior (TPB) education program on asthma control and medication adherence.

METHODS

A randomized controlled trial enrolled 30 participants in the intervention group and 30 in the control group. The educational approach was employed in participants in the intervention group for five home visits over 3 months according to the TPB program.

RESULTS

Before the education program, all participants in the intervention group and 90% of those in the control group had poorly controlled asthma (P > .05). After the program, all individuals in the intervention group and 20% of the control group had well-controlled asthma (P < .001). There was no statistically significant difference between Morisky Medication Adherence Scale-8 pretest scores in the intervention and control groups in terms of medication adherence (2.37 ± 1.75 and 3.13 ± 1.71, respectively; P > .05). Mean Morisky Medication Adherence Scale-8 scores in the intervention group at posttest (7.50 ± 0.78) were significantly higher than those of the control group (3.93 ± 2.03; P < .001.

CONCLUSIONS

This study revealed that asthma control and medication adherence increased in the intervention group after the TPB education program. The program was effective in asthma control and medication adherence for individuals with asthma.

Inhaler Use Technique in Chronic Obstructive Pulmonary Disease Patients: Errors, Practices and Barriers

Background

Inhaled medications are the main therapeutic treatment of chronic obstructive pulmonary disease (COPD) and inhaler technique remained important that can increase medication efficacy, reducing dose and side effects. Poor inhaler technique is multi-factorial and the quality of inhaler technique has not previously assessed in Pakistan. We conducted a study to examine a range of competing factors that impact COPD patient willingness, practices, and preference in using their inhalers.

Methods

A cross-sectional of 765 patients with COPD were interviewed and assessed by qualitative questionnaires. Objective inhalation technique and steps assessment was performed; satisfaction, preferences, perception, and practice of different types of inhaler devices were evaluated at a single cross-sectional visit at the study enrolment.

Results

The study included 765 participants of mean age 58.7 years (SD ±7.8); 32% males and 68% females. Almost all of the females were exposed to biomass fuel smoke exposure (99%) and pipe (Huka) smokers 53%, while most male participants were cigarette smokers (92%). Only 6.3% of participants were able to perform correct steps of inhaler use, and few educated patients completed 7-steps. 66% of patients were using dry powder inhalers (DPI) inhaler devices and mostly performed the steps 1, 2, and 4 (98%) correctly, while 44% who were using metered-dose inhalers (MDI) completed only steps 2 and 4 correctly (88%). The majority of participants reported the particular inhaler devices was prescribed by the visiting consultants (54%). Interestingly, they were using two inhalers together (47%) relieving symptoms of dyspnea (83%) and cough (73%). The inhaler use technique was demonstrated to most of the patients by the pharmacy salesman (38.4%), while 15.8% reported that their doctors taught them the inhaler technique. 54.2% reported reason for poor adherence to inhaler use as they understand it might not work lately and 75.2% were not aware of any side effects associated with the regular use of an inhaler.

Conclusions

Poor inhaler technique is highly prevalent and the associated errors did not appear to be dependent on device type. Most of the participants had not receive proper training about the correct use and were not involved in decision making about the choice of inhaler device.

Assessment of medication knowledge among patients with asthma

Objectives

Asthmatic patient's knowledge about their treatment can affect asthma control and adherence level. This study investigated the level of medication knowledge, the level of adherence and factors affecting both knowledge and adherence in adult patients with asthma.

Methods

A cross-sectional study was carried out in Jordan between 2017 and 2018. A face-to-face interview was conducted by a clinical pharmacist with asthma patients attending hospital pharmacies for refilling their prescriptions.

Key findings

A total of 218 adults with asthma were included into the study and 60.6% were knowledgeable about their medications. University degree education (OR = 3.67; P value &lt; 0.001), positive family history of asthma (OR = 1.89; P value = 0.04) and longer asthma duration (OR = 1.03; P value = 0.049) were significantly associated with a high medication knowledge. On the other hand, married participants were less knowledgeable than single ones (OR = 0.30; P value = 0.041). High medication knowledge score (OR = 4.76, P value = 0.008), older age (OR = 1.06, P value = 0.004) and male gender (OR = 3.82, P value = 0.01) were significant predictors of high medication adherence.

Conclusions

These findings highlight the importance of educational programmes that should be conducted in primary healthcare settings, such as community pharmacies, where pharmacists should educate patients about their medication and the importance of adherence.

Asthma Control and Its Predictive Factors in Adult Asthma Patients

BACKGROUND

Asthma is a highly prevalent condition that remains difficult to control, as its associated factors remain poorly understood. Thus, the primary aim of the present investigation was to determine the prevalence of uncontrolled asthma in hospital units in south Jordan and to evaluate the risk factors that may contribute to uncontrolled asthma.

METHODS

This was a cross-sectional study involving 93 patients aged 40.5 ± 13.6 years that met the criteria of the Global Initiative for Asthma (GINA). Relevant patient data were collected via a questionnaire and through a review of medical records. The questionnaire comprised of sections pertaining to sociodemographic and clinical characteristics, as well as pharmacological asthma treatment, asthma severity and asthma control. Asthma severity was determined in line with the GINA guidelines, whereby the patients were classified into four groups (intermittent, mild persistent, moderate persistent or severe persistent). Moreover, based on the findings yielded by the asthma control questionnaire (ACQ), patients were divided into three levels, whereby those diagnosed with partly controlled and uncontrolled asthma were combined into one group, denoted as "poorly controlled asthma", with "uncontrolled asthma" and "controlled asthma" as the remaining two groups. Atopy was defined as one or more positive reactions (A/H ratio > 1) on a skin prick test.

RESULTS

Asthma control was achieved in 45.2% of the sample. Moreover, older age, severe asthma according to the GINA guidelines, longer duration of asthma, atopy, being on treatment for asthma and history of allergic rhinitis were identified as the main risk factors contributing to poorly controlled asthma. Multivariate analyses, however, revealed that only atopy to two or more allergens and having severe asthmatic attacks were statistically significantly associated with poorly controlled asthma, for which the odds ratio Mantel-Haenszel (ORMH) of 17.2 and 2.2 was obtained, respectively.

CONCLUSION

Our findings indicate that severe asthma and atopy to two or more allergens are the main risk factors for uncontrolled asthma. However, further studies with larger sample sizes are needed to confirm these results.

Pharmacist Led Intervention on Inhalation Technique among Asthmatic Patients for Improving Quality of Life in a Private Hospital of Nepal

Purpose

Asthma is a chronic disease which cannot be cured but can be controlled. Although drug therapy is used to relieve and prevent symptoms of asthma and treat exacerbations, still a good asthma control and a better quality of life in many patients is suboptimal due to improper use of inhalation technique. Thus, this interventional study was conducted to evaluate the effect of a pharmacist intervention on asthma control, quality of life and inhaler technique in adult asthmatic patients.

Patients and Methods

A total of 72 patients who met the inclusion criteria and agreed to give written consent were enrolled in the study. These patients were randomly divided into two groups i.e., test group (36) and control group (36) by simple block randomization technique. Test group were the interventional groups. Mini Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire (ACQ) and structured questionnaires were used to sort the information like quality of life, asthma control and demographic details. They were counselled by the pharmacist about the asthma management and proper use of inhalers. Out of 72 patients, only forty six patients came for follow up after one month. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) software version 20.

Results

A significant change was observed in the mean score of quality of life (p = 0.001) in test group as well as control group, however change in the mean score of asthma control in the test group (p = 0.001) was more significant as compared to the control group (p = 0.099). Inhalation technique was found to be improved significantly after intervention among patients using the metered dose inhaler and dry powder inhaler. Majority of the patients were prescribed with Methylxanthines (24.5%) followed by combined Beta 2 agonists and Inhaled Corticosteroids (21.7%).

Conclusion

Pharmacist provided intervention improves the quality of life, asthma control and inhalation technique among asthmatic patients.

Role of the pharmacist in improving inhaler technique and asthma management in rural areas in Jordan

Introduction

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.

Objectives

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 (FEV₁%), and reliever use (puffs/day).

Methods

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, FEV₁%, 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.

Results

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 (p<0.001), which is a clinically significant improvement in control. Patients using the TH achieved a statistically significant improvement of 2.07±4.72 (p=0.031). FEV₁% improved significantly for MDI users (p=0.005) but not for TH users (p=0.097). Reliever use decreased significantly for MDI and TH users.

Conclusion

Asthmatic patients living in rural areas in Jordan reported poor inhaler technique, ACT scores, and FEV₁% scores and high use of reliever medications. Pharmacist-led educational intervention resulted in improved inhaler technique scores, ACT scores, and FEV₁% scores and lowered reliever use over time.