INhaler compliance assessment in the community (INCA GP)

Adherence to medication among chronic obstructive pulmonary disease (COPD) and asthma patients is known to be poor which may negatively impact on patient's clinical outcomes. In Ireland the majority of patients with obstructive airways disease are treated in the community by general practitioners (GPs), and may never be referred to a specialist. GPs tend to be extremely busy, overbooked and lacking facilities such as Respiratory Nurses. This doesn't allow for lengthy discussions with these patients, particularly regarding their inhaler management. This study aims to monitor rates of inhaler adherence and identify technique errors using novel technology (INCA). Six GP practices were given INCA-enabled salmeterol/fluticasone diskus inhalers. GPs enrolled any patient with a history of asthma or COPD on a salmeterol/fluticasone diskus inhaler. Patients were given an INCA-enabled diskus inhaler for a month. Once returned, we downloaded all available data. 42 INCA inhalers provided us with adherence data. Looking at adherence rates in time these ranged from as high as 109% (overdosing) and as low as 8% (under-dosing). Average adherence rate, in time for a month of data, was 70%. There were technique errors noted; most frequent being, poor inspiratory flow rate and exhaling into an inhaler prior to inhalation. Combined adherence (combining errors in time and technique) was low at a rate of 59%. This is an initial observational study on inhaler use in the community through general practitioners using a novel device, the INCA. Our study shows that adherence remains very variable and chaotic in the community. We hope to do a follow up study, educating this group of patients on inhaled medication with the aid of the INCA device.