Intervention to Reduce Misused Inhaler and Insufficient Peak Inspiratory Flow in Hospitalized COPD Patients
- Conditions
- COPD
- Interventions
- Other: Systematic and standardised assessment of inhalers and implementation of a prescribing guide
- Registration Number
- NCT05207631
- Lead Sponsor
- Hôpital Fribourgeois
- Brief Summary
The drug treatment of chronic obstructive pulmonary disease (COPD) is mainly based on inhaled therapy. This route of administration is limited by inhaler handling errors, insufficient inspiratory flow or inappropriate inhalers. According to the scientific literature, these limitations are extremely common in both outpatients and inpatients.
Our hypothesis is that the implementation of a standardised and systematic assessment of inhalers combined with a prescribing guide to help select a suitable inhaler will decrease the proportion of suboptimally used inhalers at discharge in patients hospitalised with a diagnosis of COPD.
To assess the effectiveness of our intervention, the investigators will compare the proportion of inhalers used suboptimally at hospital discharge between a control cohort before the implementation of our intervention and a cohort after the implementation of our intervention. Secondary outcomes include reasons for sub-optimal use of inhalers, i.e. inhaler handling errors, insufficient peak inspiratory flow or inappropriate inhaler. Secondary outcomes will also include length of hospital stay and 30-day readmission rate.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 101
- Admission to the HFR Fribourg internal medicine department
- Age greater than or equal to 18 years
- Diagnosis of COPD
- Use of an inhaler device for the treatment of COPD before admission
- Inability to complete initial assessment due to language problems
- Inability to complete initial assessment due to physical or mental conditions
- Patient who has already received the intervention during a previous hospitalization.
- Length of hospitalization of less than 72 hours
- Patient already included in the control period
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Cohort with intervention Systematic and standardised assessment of inhalers and implementation of a prescribing guide Participants included in the intervention cohort receive a systematic and standardised assessment of their inhaler on admission to our department. Their inhalers are adapted in accordance with a prescribing guide.
- Primary Outcome Measures
Name Time Method Proportion of inhalers used sub-optimally at hospital discharge This outcome is assessed within 48 hours prior to hospital discharge An inhaler used sub-optimally is defined as an inhaler used with at least one critical error and/or with insufficient inspiratory flow.
- Secondary Outcome Measures
Name Time Method Length of hospital stay This outcome is assessed up to three months The length of stay in acute care on the internal medicine department will be documented.
Proportion of inappropriate inhaler at hospital discharge. This outcome is assessed within 48 hours prior to hospital discharge An inhaler is considered unsuitable if the patient is unable to handle it properly after appropriate instruction and/or if the patient does not have sufficient inspiratory flow for optimal use of the inhaler.
Proportion of inhaler used with suboptimal peak inspiratory flow at hospital discharge. This outcome is assessed within 48 hours prior to hospital discharge The peak inspiratory flow values considered sub-optimal for inhaler use are defined in the literature and are specific to each inhaler type.
Proportion of inhalers used sub-optimally at hospital discharge by type of inhaler. This outcome is assessed within 48 hours prior to hospital discharge The proportion of inhalers used sub-optimally at hospital discharge is described by type of inhaler.
Proportion of inhaler used with a critical error at hospital discharge This outcome is assessed within 48 hours prior to hospital discharge In accordance with the literature, the investigators define critical error as an action or an inaction that in itself would have a detrimental impact of the delivery of the drug to the distal airways.
Proportion of inhalers that cannot be handled properly despite appropriate teaching at hospital discharge. This outcome is assessed within 48 hours prior to hospital discharge If critical errors are identified in the handling of the inhaler, the physiotherapist provides targeted instruction to correct these errors. After each instruction, a new assessment of the inhaler technique is performed and the instruction is repeated if a critical error persists. If handling critical errors persist despite appropriate instruction, it's considered that the inhaler cannot be handled by the patient.
Proportion of patients using at least one inhaler sub-optimally This outcome is assessed within 48 hours prior to hospital discharge A participant is considered to have suboptimal device use if making a critical error when using an inhaler or if their peak inspiratory flow rate is insufficient for optimal device use.
Trial Locations
- Locations (1)
HFR Fribourg
🇨🇭Fribourg, Switzerland