Quality statement 2: Inhaler technique

Quality statement

People with chronic obstructive pulmonary disease (COPD) who are prescribed an inhaler have their inhaler technique assessed when starting treatment and then regularly during treatment. [2011, updated 2016]

Rationale

Bronchodilator therapy is usually delivered using a hand‑held inhaler device. People with COPD need to use their inhaler correctly to receive the optimal treatment dose. Assessing inhaler technique should happen at the first prescription once a person has been taught the correct technique, and then be reassessed regularly (for example, at their annual review, if their treatment changes or after an acute exacerbation) throughout the duration of a person's treatment in primary, community and secondary care services.

Quality measures

Structure

a) Evidence of local arrangements and written clinical protocols to ensure that people with COPD who are prescribed an inhaler have their technique assessed at the start of treatment and then regularly during their treatment.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

b) Evidence of local arrangements and written clinical protocols to ensure that healthcare professionals in primary, community and secondary care services are trained and competent in teaching inhaler technique.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

Process

a) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed at the start of treatment.

Numerator – the number in the denominator who have their inhaler technique assessed at the start of treatment.

Denominator – the number of people with COPD prescribed an inhaler.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

b) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed at their annual review.

Numerator – the number in the denominator whose last inhaler annual review was no longer than 12 months since the previous one or since inhaler initiation.

Denominator – the number of people with COPD prescribed an inhaler for more than 12 months.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

c) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed after a change in treatment.

Numerator – the number in the denominator who had their inhaler technique assessed after a change in treatment.

Denominator – the number of people with COPD prescribed an inhaler who have had their inhaler changed.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

d) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed after an acute exacerbation.

Numerator – the number in the denominator who had their inhaler technique assessed after an acute exacerbation.

Denominator – the number of people with COPD prescribed an inhaler who have had an acute exacerbation.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

Outcomes

a) Exacerbation rates.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

b) Hospital admissions.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

What the quality statement means for different audiences

Service providers (primary care services, community services and secondary care services) ensure that systems are in place and healthcare professionals are trained and competent to teach people with COPD who are prescribed an inhaler the correct inhaler technique and to assess their inhaler technique when starting treatment and regularly during their treatment.

Healthcare professionals (nurses, GPs, secondary care doctors, physiotherapists, occupational therapists and pharmacists) ensure that they provide training in the correct inhaler technique to people with COPD when they have been prescribed an inhaler. Healthcare professionals ensure that they assess the person's inhaler technique when starting treatment and regularly during their treatment.

Commissioners (clinical commissioning groups) ensure that they commission services in which people with COPD who are prescribed an inhaler are trained and assessed in the correct inhaler technique when they start treatment, and have their technique reassessed regularly during their treatment.

People with COPD who are given an inhaler have a check to make sure that they can use it correctly when they start treatment and at least once a year at their annual review. They should also have a check if their treatment changes or after a sudden flare up of their symptoms (called an acute exacerbation).

Source guidance

Chronic obstructive pulmonary disease in over 16s: diagnosis and management (2018, updated 2019) NICE guideline NG115, recommendations 1.2.24, 1.2.25 and 1.3.45

Equality and diversity considerations

Elderly people, or people with learning disabilities, physical disabilities or cognitive impairment may experience difficulties learning and retaining the adequate inhaler technique to ensure that they get the optimal treatment dose. An individual patient assessment should be carried out before choosing the most appropriate device for delivery of inhaled therapy.