KNOWLEDGE, ATTITUDES AND PREFERENCES AMONG SPANISH COMMUNITY PHARMACISTS REGARDING INHALED THERAPY (THE OPTIM PHARMACY STUDY) Original Article JORDI GINER 1 , PERE ROURA 2 , BERTA TORRES 3 , FELIP BURGOS 4 , DIEGO CASTILLO 1 , EDUARD TARRAGONA 5 , VICENTE PLAZA 1 1 Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain, 2 Department of Clinical Epidemiology and Research, Hospital General de Vic, Vic, Barcelona, Spain, 3 Pharmacist, Barcelona, Spain, 4 Respiratory Diagnostic Center, Department of Respiratory Medicine (ICR), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Universitat de Barcelona, Barcelona; and Center for Biomedical Metwork Research in Respiratory Diseases (CIBERES), Spain, 5 Received: 29 Mar 2016 Revised and Accepted: 22 Jul 2016 Medical Department, Chiesi España, S. A., L’Hospitalet de Llobregat, Barcelona, Spain Email: jginer@santpau.cat ABSTRACT Objective: To assess knowledge, attitudes, and preferences regarding inhaled therapy among Spanish community pharmacists. Methods: An 11-item questionnaire was developed and distributed to community pharmacists throughout the country. Data collected included demographics, the source of knowledge of inhaler use, known and preferred devices, steps for correct use of metered-dose (pMDI) and dry-powder (DPI) inhalers, important variables when prescribing an inhaler device, patient education, and checking inhaler technique. Results: Of a total of 3000 questionnaires delivered, 1722 (57.4%) were returned. The most common source of knowledge was the package insert (46.9%) followed by personal experience (33.3%). Diskus TM and Turbuhaler TM Conclusion: In spite of the increasing involvement of Spanish community pharmacists in patients’ care, their knowledge of inhaler use and attitudes towards inhaled therapy needs to improve, so that they can provide better patient education. were the best-known devices (96.4% and 93.4%), and DPIs the preferred inhalers. Although more than half of the surveyed pharmacists were aware of the most important step for correct inhalation with pMDI and DPI, only 18% identified the correct answer ‘Patient’s preference’ as the most important variable when prescribing an inhaler device. Most of the respondents had inadequate knowledge of inhaled therapies. Statistically, significant differences were found according to geographical areas. Moreover, the mean score on inhaled therapy with one knowledge source was higher than for those with none (P<0.05). Additionally, patient education was poor. Keywords: Inhaler devices, Inhalation techniques, Community pharmacist, Misuse of inhalers © 2016 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ijpps.2016v8i9.11796 INTRODUCTION Drug delivery by inhalation allows faster onset of action and causes fewer and milder adverse events as compared with systemic delivery routes [1]. Although inhaled therapy can be utilized in a variety of diseases [2], its main use is in obstructive respiratory diseases. Inhaled therapy is the recommended treatment of choice in the clinical guidelines for asthma [3, 4] and chronic obstructive pulmonary disease (COPD) [5, 6]. Many inhalation devices are currently available, thus allowing customized prescriptions. However, this wide range of devices also represents a drawback because healthcare providers should know the different types and the differences between them. Moreover, benefits of inhaled therapy can be limited by inadequate inhalation maneuvering and inhaler handling [7, 8]. The main problem with inhalers is the inhalation technique especially with pressurized metered-dose inhalers (pMDIs) [4]. Even though the newest dry- powder inhalers (DPIs) can be easier to use than older devices [9], patient education is paramount. For that reason, the main guidelines on asthma and COPD, such as GINA (Global Initiative for Asthma) [3], GEMA (Spanish Guide for Asthma Management) [4], and GOLD (Global Initiative for Chronic Obstructive Lung Disease) [6] recommend patient education and training in all stages of the disease. Training and follow-up in the use of inhalation devices are regarded as the most important steps in education programs. Similarly, national societies such as the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) [10] and international societies such as the European Respiratory Society (ERS) and the International Society of Aerosol in Medicine (ISAM) [11] have developed guidelines and consensus reports for the use of inhaled therapy. Community pharmacists have an important role in education and training of patients with obstructive respiratory diseases [3, 12]. As shown in a COPD case finding a program in community pharmacists as a new strategy to reduce COPD underdiagnosis [13], community pharmacists were able to select and assessed patients using a questionnaire and spirometric testing. Also, when pharmacists have been trained, results of their intervention in educational programs were similar to those obtained by physicians and/or nurses [3, 4]. Pharmacists working in community pharmacies should be included in interdisciplinary teams to educate patients and thus obtain the maximum benefit from inhaled therapy [14-18]. The OPTIM Pharmacy Study is a project aimed to assess knowledge, attitudes, and preferences regarding inhaled therapy among health care providers in Spain. In two previous national surveys regarding the level of knowledge and attitudes of both practicing physicians from specialties that frequently prescribe inhaler devices [19] and nurses working with respiratory patients using inhaler devices [20], knowledge of inhalers and inhalation techniques remains poor in Spain. The present study was designed to assess knowledge about inhalation therapy in the third group of professionals involved in respiratory patients’ care: pharmacists, specifically those working in community pharmacies. MATERIALS AND METHODS Design and study population This was a cross-sectional survey study, the objective of which was to assess the level of knowledge, attitudes, and preferences related to inhaled therapy among community pharmacists. Between May and November 2014, a questionnaire specifically designed for the study International Journal of Pharmacy and Pharmaceutical Sciences ISSN- 0975-1491 Vol 8, Issue 9, 2016