DI-033 Assessment of the use of inhaled therapy in a hospital setting

Background Respiratory diseases are a worldwide major health problem, specially chronic obstructive pulmonary disease (COPD) and respiratory infections. Treatment usually involves inhaled drugs that are essential in asthma and COPD. Purpose To analyse the indications for which inhaled drugs are prescribed in admitted patients and to determine the most prescribed active ingredients as well as the devices used for their administration. Material and methods A cross sectional study designed to analyse how inhaled drugs are prescribed to admitted patients with respiratory diseases in a tertiary hospital was conducted. The following variables were collected: age, gender, clinical service, inhaled medication, device used for administration and indication. Data were obtained from medical records and treatment sheets. Adult patients with inhaled prescribed therapy on the day of the study were included. Critical care units and psychiatry were excluded. Results From a total of 482 prescriptions analysed, 61 (12.65%) including inhaled therapy were screened. Patient median age was 74 (37–91) years and 39 (64%) were men. 15 (25%) therapies were prescribed by a surgical unit, 11 (18%) by pneumology, 10 (16%) by internal medicine, 8 (13%) by cardiology and 17 (28%) by ‘other units’. 18 (30%) patients had a single inhaled drug prescribed, 33 (54%) had two and 10 (16%) had a combination of three inhaled drugs prescribed. Main indication for which inhaled therapy was prescribed was COPD (15 patients, 25%) followed by asthma (5.8%). In 15 (25%) patients the indication for which the drug was prescribed was not authorised. Most prevalent ‘non-authorised’ indication was ‘dyspnoea without diagnosis’ (5/15, 33%). Prescriptions without an authorised indication were mostly done by ‘non-pneumology’ units (12/15, 80%). The most prevalent active ingredients were ipratropium bromide (43%) and ambroxol (24%). Devices used for inhaled administration were: nebuliser (79%), pressurised cartridge (17%) and dry powder (5%). Conclusion The use of inhaled drugs is common in the hospital setting. Ipratropium bromide is the most prevalent active ingredient prescribed. Inhaled-drugs are normally administered to admitted patients using a nebuliser. Inhaled drug prescriptions for unauthorised indications are common, especially when prescribed by a ‘non-respiratory disease’ clinician. Greater involvement of the hospital pharmacist in the supervision of the pharmacotherapy of respiratory patients is necessary. No conflict of interest