Introduction

Poor adherence to the prescribed medication regimen is a critical care concern world-wide for healthcare providers. Educating patients about their disease state and medications will improve the patient knowledge regarding medications and can increase thecompliance in therapy.₁ It is well documented that safe and effective drug therapy most frequently occurs when patients are well informed about their medications.₂ Patient counseling is a form of interpersonal communication in which the pharmacist discusses with the patient about the disease, medicines prescribed to treat it, as well as lifestyle modifications,. is Hence, it is critical in achieving the desired outcomes of pharmaceutical care. Several counseling guidelines have been established ₃,₄ to achieve those therapeutic outcomes.

In case of asthma and chronic obstructive pulmonary disease (COPD), inhaler medications are popularly used for their convenience, effectiveness and less side-effects. Improper use of inhalers is one of the major causes of non-compliance among these patients.. The incorrect use of inhalers will lead to suboptimal treatment. This has been demonstrated to occur in upto 75% of patients using metered-dose inhalers.₆

Therefore, the objectives of the study are to evaluate patient knowledge regarding usage of inhalers and to find the impact of patient counseling regarding proper use of inhalers as per the criteria established by the National Asthma, Education and Prevention Program (NAEPP) e developed by the National Institutes of Health, USA.

Study

The study was carried out in the Medication Counseling Center, Out-Patient Department of Manipal Teaching Hospital, Pokhara, Nepal for a period of 60 days.

Patients with respiratory disorders using inhalers who visited the medication-counseling center was included in our study. Patients admitted to the hospitals patients with mental disorders and family members of a patient who came to the Counseling Center to pick up medications were excluded from the study.

Prescription of the patients and questionnaire based interviews based on NAEPP criteria were used as data sources..

At first, the baseline knowledge about the use of inhalers among the participants was assessed with the help of a questionnaire.. Then, the education intervention was done by educating the patients about proper use of inhaler based on NAEPP criteria. Finally, post counseling knowledge was assessed again by using the NAEPP criteria.

Results

A total of 9 patients in the age range 16-70 years were enrolled I nthe study. . Majority of the patients (5 patients) belonged to the age group 61-70 yrs., There were 5 female and 4 male patients. Six patients have COPD s and the rest have asthma. The medications used by the patients were salbutamol, ipratropium and beclomethasone.

Findings from the study is summarized in Table 1

Figure 1

Table 1: Patient knowledge evaluation (NAEPP criteria)

A study by Ansari et al in Kathmandu, Nepalreported that in the case of MDI users, there was a 63.3% improvement in inhalation technique after counseling by a pharmacist.₇ In our study, none of the patients were able to answer seven out of ten steps (NAEPP criteria) prior to counseling. Post-counseling, some improvement was observed in all the criteria except actuation. None of the patients could actuateduring inhalation in both the pre- and post- counseling phase,. Even after counseling it was found to be the most difficult step by the patients.

Hence, this stresses the fact that more of the pharmacist's effort should be utilized to make patient understand this important steps during inhalation.

Our study was small therefore we could not carry out the statistical analysis.

Similar and more extensive studies should be done in large population. It can be conducted for other devices like dry powder inhalers and spacers etc.

It is clear from the study that patient counseling by pharmacists improves the effective use of inhalers. In countries like Nepal, where the role of pharmacists is not well established, medication counseling is a novel approach of improving the status of the pharmacists with the ultimate objective of attaining desired therapeutic outcomes., Furthermore, a recently concluded study from the Western part of the country has concluded that the counseling center can play a definite role in enhancing patients' understanding about medications and disease pattern, leading to improved patient compliance.₈

Correspondence to

Durga Bista B.Pharm Postgraduate student in Pharmacology Department of Pharmacology Manipal Teaching Hospital / Manipal College of Medical Sciences Pokhara, Nepal. E-mail: durgabista40@hotmail.com Phone: 061-526416 (Extn 130/221