PMID- 38444664 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240320 IS - 2312-0541 (Print) IS - 2312-0541 (Electronic) IS - 2312-0541 (Linking) VI - 10 IP - 2 DP - 2024 Mar TI - Development and evaluation of a tool to optimise inhaler selection prior to hospital discharge following an exacerbation of COPD. LID - 00010-2024 [pii] LID - 10.1183/23120541.00010-2024 [doi] AB - INTRODUCTION: Rates of mortality and re-admission after a hospitalised exacerbation of COPD are high and resistant to change. COPD guidelines do not give practical advice about the optimal selection of inhaled drugs and device in this situation. We hypothesised that a failure to optimise inhaled drug and drug delivery prior to discharge from hospital after an exacerbation would be associated with a modifiable increased risk of re-admission and death. We designed a study to 1) develop a practical inhaler selection tool to use at the point of hospital discharge and 2) implement this tool to understand the potential impact on modifying inhaler prescriptions, clinical outcomes, acceptability to clinicians and patients, and the feasibility of delivering a definitive trial to demonstrate potential benefit. METHODS: We iteratively developed an inhaler selection tool for use prior to discharge following a hospitalised exacerbation of COPD using surveys with multiprofessional clinicians and a focus group of people living with COPD. We surveyed clinicians to understand their views on the minimum clinically important difference (MCID) for death and re-admission following a hospitalised exacerbation of COPD. We conducted a mixed-methods implementation feasibility study using the tool at discharge, and collated 30- and 90-day follow-up data including death and re-admissions. Additionally, we observed the tool being used and interviewed clinicians and patients about use of the tool in this setting. RESULTS: We completed the design of an inhaler selection tool through two rounds of consultations with 94 multiprofessional clinicians, and a focus group of four expert patients. Regarding MCIDs, there was majority consensus for the following reductions from baseline being the MCID: 30-day readmissions 5-10%, 90-day readmissions 10-20%, 30-day mortality 5-10% and 90-day mortality 5-10%. 118 patients were assessed for eligibility and 26 had the tool applied. A change in inhaled medication was recommended in nine (35%) out of 26. Re-admission or death at 30 days was seen in 33% of the switch group and 35% of the no-switch group. Re-admission or death at 90 days was seen in 56% of the switch group and 41% of the no-switch group. Satisfaction with inhalers was generally high, and switching was associated with a small increase in the Feeling of Satisfaction with Inhaler questionnaire of 3 out of 50 points. Delivery of a definitive study would be challenging. CONCLUSION: We completed a mixed-methods study to design and implement a tool to aid optimisation of inhaled pharmacotherapy prior to discharge following a hospitalised exacerbation of COPD. This was not associated with fewer re-admissions, but was well received and one-third of people were eligible for a change in inhalers. CI - Copyright (c)The authors 2024. FAU - Price, Evleen AU - Price E AD - THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. FAU - Ahmad, Shanaz AU - Ahmad S AD - Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK. FAU - Althobiani, Malik A AU - Althobiani MA AUID- ORCID: 0000-0002-2230-5708 AD - UCL Respiratory, University College London, London, UK. FAU - Ayoob, Tareq AU - Ayoob T AD - Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK. FAU - Burgoyne, Teresa AU - Burgoyne T AD - Patient and public representative. FAU - De Soyza, Anthony AU - De Soyza A AUID- ORCID: 0000-0002-8566-0344 AD - Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. FAU - Dobson, Melissa AU - Dobson M AD - Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK. FAU - Echevarria, Carlos AU - Echevarria C AD - Respiratory Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK. AD - Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, UK. FAU - Martin, Graham AU - Martin G AD - THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. FAU - Mendes, Renata Goncalves AU - Mendes RG AD - Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil. FAU - Preston, Anne-Marie AU - Preston AM AD - Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK. FAU - Rahman, Najib M AU - Rahman NM AD - Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK. FAU - Sapey, Elizabeth AU - Sapey E AUID- ORCID: 0000-0003-3454-5482 AD - Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham NIHR Biomedical Research Unit, and HDR UK Medicines Driver Programme, Birmingham, UK. FAU - Usmani, Omar S AU - Usmani OS AD - National Heart and Lung Institute, Imperial College London, London, UK. FAU - Hurst, John R AU - Hurst JR AUID- ORCID: 0000-0002-7246-6040 AD - UCL Respiratory, University College London, London, UK. LA - eng GR - G0600475/MRC_/Medical Research Council/United Kingdom GR - G1001128/MRC_/Medical Research Council/United Kingdom GR - MCCC-RP-14-A17178/MCCC_/Marie Curie/United Kingdom PT - Journal Article DEP - 20240304 PL - England TA - ERJ Open Res JT - ERJ open research JID - 101671641 PMC - PMC10910267 COIS- Conflict of interest: A. De Soyza declares research grants in support of investigator and investigator-initiated trials from Sanofi-Aventis, Lilly, Boehringer Ingelheim and AstraZeneca; consulting fees from AstraZeneca, Insmed, Sanofi, Bayer, GSK, Boehringer Ingelheim and Zambon; speakers' fees from AstraZeneca, Insmed, Sanofi, Bayer, GSK, Boehringer Ingelheim and Zambon; and advisory board membership for AstraZeneca, Insmed, Sanofi, Bayer, GSK, Boehringer Ingelheim and Zambon, all in the 36 months prior to manuscript submission. Conflict of interest: M. Dobson declares NIHR Research for Patient Benefit co-applicant funding to their institution in relation to the present work. Conflict of interest: C. Echevarria declares research grants from GlaxoSmithKline and NIHR, in the 36 months prior to manuscript submission. Conflict of interest: G. Martin declares NIHR Research for Patient Benefit co-applicant funding to their institution in relation to the present work. Conflict of interest: R.G. Mendes declares payment for participation in scientific events from Fundacao de Apoio a Pesquisa do Estado de Sao Paulo. Conflict of interest: E. Sapey declares NIHR Research for Patient Benefit co-applicant funding to their institution in relation to the present work. Conflict of interest: J.R. Hurst declares funding for a PhD studentship from AstraZeneca; consulting fees to them and their institution from AstraZeneca and GlaxoSmithKline; payment or honoraria to themselves for lectures, presentations, speakers' bureaus, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, Chiesi, Sanofi and Takeda; support in kind for attending meetings from AstraZeneca; payment to them and their institution for participation on an Advisory Board for AstraZeneca; and donation of oximeters from Nonin, all in the 36 months prior to manuscript submission. Conflict of interest: All other authors declare no competing interests. EDAT- 2024/03/06 06:44 MHDA- 2024/03/06 06:45 PMCR- 2024/03/04 CRDT- 2024/03/06 03:51 PHST- 2024/01/03 00:00 [received] PHST- 2024/01/08 00:00 [accepted] PHST- 2024/03/06 06:45 [medline] PHST- 2024/03/06 06:44 [pubmed] PHST- 2024/03/06 03:51 [entrez] PHST- 2024/03/04 00:00 [pmc-release] AID - 00010-2024 [pii] AID - 10.1183/23120541.00010-2024 [doi] PST - epublish SO - ERJ Open Res. 2024 Mar 4;10(2):00010-2024. doi: 10.1183/23120541.00010-2024. eCollection 2024 Mar.