Effectiveness of a pharmacist-led inhalation technique intervention on asthma and COPD patients: The INspira cluster-randomized controlled trial

Background: Asthma and COPD are respiratory disorders highly prevalent worldwide. Disease control remains suboptimal and imposes a significant health and economic burden. Poor inhalation technique is commonly referred as one of the main reasons for the lack of disease control. Objective: To assess the effectiveness of a community pharmacist-led educational intervention on asthma and COPD patients’ inhalation technique. Methods: This was a 6-month cluster randomized controlled trial, conducted in community pharmacies of Portugal, enrolling adults aged 18 years or older, with a self-reported diagnosis of asthma or COPD. Pharmacies were randomly allocated to Intervention or Control group. Intervention focused mainly on inhalation technique education via physical training. Primary outcome was the proportion of patients scoring 100% on the technique. Secondary outcomes were asthma symptom control, dyspnea severity and COPD-specific health status Results: From January to April 2019, 48 pharmacies recruited 201 asthma and COPD patients, of which 132 completed the 6-month follow-up. At the end of follow-up, the odds of intervention group patients score 100% compared to the control group were 5.63 (95% CI 2.21-14.35) accounting for all inhalers in use. Intervention group patients reported having a significantly lower number of scheduled doctors´ appointments compared with the control group (OR=0.17; 95% CI, [0.037;0.79]; p=0.0135). No other significant differences regarding secondary outcomes were found between groups. Conclusion: Educational intervention can be delivered by community pharmacist with a positive impact on patients’ inhalation technique