Rachel Carter speaks to Ravi Solanki, a pharmacist at Davina Pharmacy in Tyldesley, Manchester, about how their inhaler technique service is improving local patients’ lives

Adequate inhaler technique is essential to the management of long-term lung conditions such as asthma and chronic obstructive pulmonary disease (COPD). Ravi Solanki, a pharmacist at Davina Pharmacy in Manchester, has seen first-hand the benefits of delivering an inhaler technique service to local patients.

Mr Solanki recalls one particular example - a patient who was struggling to use a pressurised metered dose inhaler. At the initial consultation, he trained the patient in terms of the right technique to use, but when she came for her follow-up, she still hadn’t been able to get the hang of it, he says.

‘We recommended that actually this was not the type of device she should be using and we were able to refer her within the day to get a new inhaler,’ he adds.

‘She doesn’t need to press the new inhaler, just breathe from it, which has been ideal for her and from that, control of her COPD has gradually improved.’

‘Well-funded service’

Davina Pharmacy’s inhaler technique service launched in 2016. Patients come in for an initial consultation and then a follow-up appointment six to eight weeks later – a structure Mr Solanki says is really important because it gives patients time to understand their inhaler technique and see if it has improved their condition.

The service is free to patients and it is commissioned by the Greater Manchester Health and Social Care Partnership. The pharmacy receives £17 per patient for running the service – £10 for the initial consultation and a further £7 for the follow-up appointment, so ‘it is well-funded from a business point of view’, Mr Solanki says.

The pharmacists use the ‘InCheck’ device, which helps patients understand how quickly they are breathing in. For example, the guidance for a pressurised metered dose inhaler is to not have an inspiratory flow of anything over 60 litres per minute, but actually ‘a lot of patients far exceed that every single time,’ Mr Solanki says.

‘It is often patients’ understanding that if they breath in sharp and fast then the dose is going to get to the bottom of their lungs, but that is false,’ he adds.

‘This is part of the training we did, which enabled us to start to fully understand the range of inhalers available and the best type of technique for each inhaler.’

‘Use of language’ 

Mr Solanki’s training was provided by the local local pharmaceutical network (LPC) and he says any pharmacist wanting to deliver this service should consider face-to-face training to ‘get their hands on placebo inhaler devices and actually understand how to use them’.

‘One of the things I found before and after the training was also just the difference in the language I could use to describe inhaler technique to patients,’ he says.

‘Being able to describe how to use an inhaler is really important – for example,  “take a slow, gentle breath” is something patients can easily understand.’

The training also exposed Mr Solanki to some research findings, including that an estimated 90% of patients do not use their inhalers correctly. This then went onto inform the pharmacy’s marketing campaign for promoting the service.

‘A key advertising tool for us was bag leaflets, putting a leaflet in with any inhaler we dispensed, which featured some of that information from the training,’ he says.

‘That worked really well for our patients here, they brought those slips back and said, "I would really like to speak to somebody about my inhaler technique."’

‘Value to patients’

Pharmacists should also consider the time it takes to deliver the service, Mr Solanki says. He has found it takes ‘a good 15 minutes’ to really get to the bottom of someone’s device and how they’re using it, and if necessary retrain the patient.

Taking this time out of the pharmacist’s day can obviously impact where they are needed ‘elsewhere in the business’, Mr Solanki adds, but one way around this is tying the inhaler technique check in with a medicine use review (MUR).

‘In certain circumstances we are using MURs to engage with patients and then encompassing the inhaler check with that as well, which from a business point of view is quite a good revenue stream, because of the payments for both,’ he says.

As part of the MURs and inhaler technique checks, Davina Pharmacy also use asthma and COPD control tests, a set of questions designed to identify whether the patient’s condition is well, or poorly, controlled. This has enabled them to work with local GPs and asthma nurses to identify and refer patients where appropriate.

‘So it may be that a patient needs stepping down, if their asthma is well-controlled for example, or if we find that the patient’s control is poor then we can refer on.’

The service has also helped with identifying asthma referrals for the Quality Payments Scheme (QPS) criterion on the overuse of bronchodilators, Mr Solanki says.

‘It has made it easier to claim that quality payment because we are already engaged with our asthma patients and actually at the last review point, we found that there were hardly any patients left to refer because of that,’ he adds.

‘Startling examples’

Mr Solanki estimates that the service has supported 60 patients since 2016. Although not at a huge number, the value it adds to those patients is ‘massive’, he says.

‘Some examples we’ve had are startling – patients using their inhalers incorrectly for years and when we slightly adjusted their technique, their outcomes improved.

‘Even for those patients using their inhalers correctly, it provides that reassurance to say you know what, your technique is fine and it’s working okay for you.’