Quality standard
Quality statement 2: Inhaler technique
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 or changing treatment and then at least annually during treatment. [2011, updated 2023]
Rationale
Long-acting inhaled therapy is usually delivered using a handheld inhaler. 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 reassessed regularly (for example, at their annual review or if their treatment changes) throughout the duration of a person's treatment in primary, community and secondary care services. If necessary, technique should be corrected with training by a healthcare professional competent to do so.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient electronic medical records.
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 who have been prescribed an inhaler.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient electronic medical records.
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 who have been prescribed an inhaler.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient electronic medical records.
Outcomes
a) Exacerbation rates.
Data source: The Royal College of Physicians' National COPD Audit Programme includes data on COPD exacerbation rates.
b) Hospital admissions for a COPD exacerbation.
Data source: COPD secondary care reports of the Royal College of Physicians National Respiratory Audit Programme and NHS Digital Hospital Episode Statistics include data on the number of people admitted to hospital with a primary diagnosis of a COPD exacerbation.
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 or changing treatment and at least annually 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 or changing treatment and at least annually during their treatment.
Commissioners 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 or change treatment, and have their technique reassessed at least annually.
People with COPD who are given an inhaler have a check to make sure that they can use it correctly when they start or change treatment and at least once a year at their annual review.
Source guidance
Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline NG115 (2018, updated 2019), recommendations 1.2.20, 1.2.23, 1.2.24, 1.2.138 and 1.2.140
Equality and diversity considerations
Older 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.