The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

ASSESSMENT OF MEDICATION ADMINISTRATION, KNOWLEDGE, EFFECT ON LUNG FUNCTION AND QUALITY OF LIFE WITH PATIENTS RECEIVING THE COMBINATION SALMETEROL/FLUTICASONE BY DRY POWDER INHALER

Bill Pruitt1, Ericka Griggs1, Tiffany Faircloth1



Background: The combination of salmeterol xinofoate and fluticasone propionate (S/F) is available in three strengths based on the amount of corticosteroid and is delivered by dry-powdered inhaler called a Diskus. It is often prescribed for asthma and COPD patients to improve lung function. Effective S/F self-administration relies on accomplishing certain steps and avoiding wrong steps. Patients should also have some knowledge of their prescribed medication and should receive benefit in terms of improved lung function or quality of life (LFQOL). The purpose of this study was to assess self-administration, knowledge about S/F, and patient perception of its effect.

Methods: With IRB approval, we randomly selected in-patients from a local acute care hospital who were receiving S/F. Twenty-five patients met our criteria and agreed to participate. Participants were interviewed using a survey form and then asked to demonstrate self-administration using a placebo Diskus. Performance was evaluated by a list of nine required steps on the survey. We graded each performance using A, B, C, D, or F based on percentage of correct steps (A = 90% to 100%, B = 70% to 89%, etc.) Results: The average age was 53.7 years (± 17.4). Sixteen of the 25 were females. Twenty-one patients had been taking S/F > 1 year. Eleven reported using S/F for COPD and eleven for asthma; one said "both" and two said "other." Seven of the patients were graded with an F on the performance evaluation. All 7 missed four of nine steps in common ("hold level," "exhale first," "breath hold after drug administration," "rinse mouth") and five of seven missed one step "inhale quickly and deeply" (the two correctly performing this step had asthma versus the rest having COPD). 28% said incorrectly nothing would happen if you tilt the cocked Diskus to a vertical position, and 28% said incorrectly to wash it to keep it clean. 88% knew the strength of their prescribed S/F. 76% knew about the dose counter.12% rated the S/F effect on LFQOL as "very little," 36% rated the effect as "somewhat" and the remaining 52% rated the effect as "a fair amount"or "a great deal."

Conclusion: Patients are performing poorly in self-administration of S/F. They also lack knowledge of the care and use of the Diskus and of the details of their prescribed medication. Many perceive little improvement in lung function or quality of life related to S/F despite taking this expensive medication for > 1 year.