MeRIT -- Pharmacist-initiated optimization of inhalers in high-risk, older adults with chronic obstructive pulmonary disease

Introduction: It is estimated that over 12 million Americans have a diagnosis of chronic bronchitis, a component of chronic obstructive pulmonary disease (COPD). Prevalence is highest among persons aged 65 years and older. Several inhalers are available to treat COPD, and studies have evaluated potential barriers to proper technique, including advanced age, cognitive impairment, and inhaler type.

Objectives:  The primary objective is to determine the impact of personalized inhaler selection in a pharmacist-run clinic of high-risk, older adults with COPD, as measured by the COPD Assessment Test (CAT). Secondary objectives include acute care utilization, rescue inhaler use, and SF-12 Health Survey scores.

Study Design:  This retrospective chart review includes community-dwelling participants with a diagnosis related to COPD who self-administer inhalers. Participants are divided into two groups: those seen by a clinical pharmacist twice in a three-month period (Group 1), and those not seen (Group 2).

Methods: Demographics for Groups 1 and 2 will be compared using the chi-square test. Change in CAT score, SF-12 score, acute care utilization, and rescue inhaler use from visit 1 to visit 2 will be compared for Group 1. Acute care utilization and rescue inhaler use will be compared between Groups 1 and 2.

Results:  Participants with low CAT scores (n=5) rated their health as Good, Very Good, or Excellent. Eighty percent of these participants demonstrated correct inhaler technique. Fifty percent of participants with medium, high, or very high CAT scores demonstrated correct inhaler technique. Recommendations were made to change inhalers or add a spacer for three out of 15 participants thus far.

Conclusions: Lower CAT scores in this population may correlate with better quality of life and inhaler technique. Further chart review will reveal the impact of pharmacy visits on improvement in CAT and SF-12 scores.