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      Effect of a network system for providing proper inhalation technique by community pharmacists on clinical outcomes in COPD patients

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          Nonadherence to inhalation therapy is very common in patients with chronic obstructive pulmonary disease (COPD). Few data are available to support the role of community pharmacists in optimizing inhalation therapy in COPD patients. Since 2007, the Kitano Hospital and the Kita-ku Pharmaceutical Association have provided a network system for delivering correct inhalation techniques through certified community pharmacists. The effects of this network system on clinical outcomes in COPD patients were examined.


          A total of 88 consecutive outpatients with COPD at baseline and 82 of those 4 years later were recruited from the respiratory clinic of Kitano Hospital Medical Research Institute. Measurements included the frequency of COPD exacerbations, patients’ adherence to inhalation therapy using a five-point Likert scale questionnaire, and patients’ health status both prior to this system and 4 years later.


          Usable information was obtained from 55 patients with COPD at baseline, and from 51 patients 4 years later. Compared with baseline values, a significant decrease was observed in the frequency of COPD exacerbations (1.5 ± 1.6 versus 0.8 ± 1.4 times/year, P = 0.017). Adherence to the inhalation regimen increased significantly (4.1 ± 0.7 versus 4.4 ± 0.8, P = 0.024), but health status was unchanged. At 4 years, of 51 COPD patients, 39 (76%) patients who visited the certified pharmacies showed significantly higher medication adherence than those who did not (4.6 ± 0.6 versus 3.9 ± 1.0, P = 0.022).


          The network system may improve COPD control and adherence to inhalation regimens.

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          Most cited references 4

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          The value of demonstration and role of the pharmacist in teaching the correct use of pressurized bronchodilators.

          The use of an improper technique with metered-dose inhalers decreases the efficacy of the bronchodilators being administered. There is evidently a need for patients to watch a demonstration. Twenty-nine adult asthmatic patients from an allergy clinic were divided into three groups, each receiving a different form of instruction: an information sheet, personal instruction or a videotape presentation. Subsequently each patient was tested for correct use of the inhaler. There was no difference in mean scores for inhalation technique between the groups instructed in person and by videotape, but both were significantly better than the mean score of the group given only an information sheet. There was also no significant change in the scores at a follow-up test in the groups who saw the technique demonstrated. These results indicate the need for and value of the demonstration of proper technique with pressurized inhalers. A pharmacy-generated education system using videotape equipment or personal instruction by a pharmacist could readily solve the problem.
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            [Validation of the St George's questionnaire for measuring the quality of life in patients with chronic obstructive pulmonary disease].

            The validity of a French version of a disease specific quality of life instrument, the St George's Respiratory Questionnaire, has been assessed in a sample of 64 patients with chronic respiratory disease undergoing oxygen therapy. The studied properties were internal consistency, test-retest reproducibility and criterion validity. The St George's showed a good internal consistency with Cronbach's alpha coefficients from 0.61 to 0.95 and a good reproducibility with Intraclass Correlation Coefficients (ICC) from 0.67 to 0.95. High correlation with dyspnea (p=0.0004 to 0.01) showed a correct criterion validity. So psychometric properties of the French version of the questionnaire are good. However, its administration caused a few problems, and we advice it to be administered by a trained interviewer in such patients.
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              Impact of a network system for providing proper inhalation technique by community pharmacists.

              The availability of many types of inhalers in the treatment of asthma has resulted in a wide range of prescription choices for clinicians. With so many devices available, however, there is some confusion regarding their proper use among both medical staff and patients. Since 2007, Kitano Hospital and Kita-ku Pharmaceutical Association, Osaka, Japan, have provided a network system for delivering instruction on correct inhalation technique through community pharmacists. We examined the clinical effects of this network system.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                09 May 2013
                : 8
                : 239-244
                [1 ]Respiratory Disease Center, Kitano-Hospital, the Tazuke Kofukai Medical Research Institute, Osaka, Japan
                [2 ]Division of Pharmacy, Kitano-Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
                [3 ]Kita-ku Pharmaceutical Association, Osaka, Japan
                Author notes
                Correspondence: Masaya Takemura, Respiratory Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480, Japan Tel +81 6 6312 1221 Fax +81 6 6361 0588 Email m-takemura@
                © 2013 Takemura et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Original Research

                Respiratory medicine

                adherence, copd, community pharmacist, exacerbation, quality of life


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