Effect of pharmacist counseling on ambulatory patients' use of aerosolized bronchodilators

Patients' use of a newly prescribed inhaler was evaluated on the basis of pulmonary function test (PFT) results and the number of steps of an 11-step inhaler sequence that were completed correctly. Adult male outpatients with mild to moderate chronic obstructive pulmonary disease were assigned to a counseled (n = 10) or noncounseled (n = 9) group. Patient characteristics were similar in both groups. The counseled group was instructed by a pharmacist on the correct use of the inhaler; the noncounseled group was not. Counseled patients had a significantly higher mean percentage change in forced expiratory volume in one second (FEV1) after inhaler use than did the noncounseled group. The mean number of steps missed was significantly greater for the noncounseled group, and there was a significant negative correlation between the number of steps missed and the percentage change in FEV1. Evaluation of the 11-step inhaler sequence identified three steps ("shake the inhaler," "use one puff at a time," and "shake between puffs") that correlated with PFT results and appeared to contribute to improved bronchodilation. Of the five patients who achieved adequate response, only four (all in the counseled group) performed these steps correctly. Instruction with demonstration and practice resulted in better patient understanding and performance of the correct steps for inhaler use, with improved bronchodilation as measured by PFTs.