Use of an electronic tool contributed to the deprescribing of unnecessary inhalers in patients with interstitial lung disease (ILD), based on data from nearly 200 individuals.
Patients with ILD often have symptoms that overlap with those of obstructive airways diseases, wrote Stephanie Nevison, MD, of the University of Toronto, Toronto, Ontario, Canada, and colleagues in a study presented at the American Thoracic Society International Conference.
These patients may be started on inhalers to improve their symptoms but with no expected physiologic benefit, and inappropriate use of inhalers may lead to not only unnecessary side effects but also increased health care costs and environmental impact, they noted.
"Our aim was twofold: To quantify the extent of inappropriate inhaler use in patients with ILD and to discontinue them where appropriate," the researchers wrote.
"We hypothesized that inappropriate inhaler use in ILD is common and that an electronic initiative would improve deprescribing rates," they said.
The researchers conducted a quality improvement project in an ILD clinic at a single center. They reviewed 5 months of baseline data for 191 patients with ILD to assess baseline frequency of inappropriate inhaler use, defined as one or more of the following criteria: Reported asthma history, smoking history of > 15 pack/years, emphysema on chest CT, patient-reported benefits from therapy, airflow obstruction, or bronchodilator response on spirometry.
A total of 48 patients (25.1%) were on inhalers, and 15 (7.8%) had no indication for them (9% of new referrals and 7% of follow-up patients). The most-prescribed inhalers for patients with no indication were corticosteroids (10 patients), short-acting beta-agonists (eight patients), and long-acting beta-agonists (seven patients).
None of the patients on inhalers received counseling about discontinuing their use. The results of the baseline assessment were shared with clinicians along with education about reducing unnecessary inhaler use in the form of a prompt linked to electronic medical records to discuss deprescription of unnecessary inhalers.
The electronic intervention was applied in 400 of 518 patient encounters, and the researchers reviewed data over another 5-month period. A total of 99 patients were on inhalers, and 3.3% had no indication (5.3% of new referrals and 3.0% of follow-up patients). In the wake of the intervention, "all patients on unnecessary inhalers were counseled on deprescribing, representing a significant increase compared to the preintervention period," the researchers wrote.
Intervention Shows Potential to Curb Unnecessary Inhaler Use
More research is needed as the findings were limited by the relatively small sample size and use of data from a single center, the researchers noted.
However, the results suggest that electronic reminders are effective for prompting a review of inhaler use, and deprescribing inappropriate inhalers for patients with ILD could reduce the potential for adverse events associated with their use, they concluded.
The current study is important because some patients with ILD may not benefit from inhaler use, said David Mannino, MD, of the University of Kentucky, Lexington, Kentucky, in an interview. In the study, "I was a bit surprised that only 3.3% of patients had no indication for them; this seems rather low," said Mannino, who was not involved in the study.
Use of an electronic system that evaluates patients and flags inappropriate therapy is an effective way to decrease overprescribing of medications, Mannino told Medscape Medical News.
As for additional research, application of the tool used in this study to other pulmonary populations could be interesting and potentially useful, he said.
The study received no outside funding. The researchers had no financial conflicts to disclose. Mannino had no financial conflicts to disclose.
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