title: Inhaler Use in Hospitalized Patients with Chronic Obstructive Pulmonary Disease or Asthma: Assessment of Wasted Doses.
abstract: BACKGROUND
  Hospitalized patients with chronic obstructive pulmonary disease (COPD) or asthma routinely have inhaled medications ordered for acute and maintenance therapy. Treatment may be administered via metered-dose inhaler (MDI) or dry-powder inhaler (DPI). These products must be appropriately labeled to be released home with the patient or discarded before discharge.
  
  
  OBJECTIVE
  To assess the amount and estimated cost of wasted doses of medications via MDI or DPI for hospitalized patients with COPD/asthma.
  
  
  METHODS
  A retrospective study was conducted at a university-affiliated hospital. Patients admitted between January 2011 and June 2012 with a primary diagnosis of COPD or COPD with asthma and who were ≥40 years of age were included. Information collected included use of albuterol, ipratropium, inhaled corticosteroids, long-acting beta agonist, or tiotropium and whether treatments were given by nebulizer, MDI, MDI plus valved holding chamber (VHC), or DPI. The number of doses dispensed, as well as doses not used, via MDI, MDI + VHC, or DPI were collected from electronic medical records. Costs associated with wasted medications were evaluated.
  
  
  RESULTS
  Of 555 patient admissions screened, 478 (mean age, 66 years; 58% women; 74% African American) met study criteria. Of the total MDI or DPI doses dispensed, 87% were wasted, and associated hospital cost was approximately $86,973.
  
  
  CONCLUSIONS
  Substantial waste of inhaled medications was found in our study. Practical strategies are needed to reduce wasted inhalers. Further assessment of this problem is needed in other US hospitals.
authors.affiliation: Clinical Pharmacist, Methodist University Hospital , Memphis, Tennessee.
authors.forename: Sami
authors.initials: S
authors.lastname: Sakaan
authors.affiliation: University of Tennessee Health Science Center , Memphis.
authors.forename: Dagny
authors.initials: D
authors.lastname: Ulrich
authors.affiliation: University of Tennessee Health Science Center , Memphis.
authors.forename: Jenny
authors.initials: J
authors.lastname: Luo
authors.affiliation: Assistant Director, Clinical Pharmacy Services, Methodist University Hospital , Memphis, Tennessee ; Associate Professor of Clinical Pharmacy, University of Tennessee Health Science Center , Memphis.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Finch
authors.affiliation: Professor of Clinical Pharmacy, University of Tennessee Health Science Center , Memphis ; Program Director, PGY2 Internal Medicine Pharmacy Residency, Methodist University Hospital , Memphis, Tennessee.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Self
keywords: hospitalized COPD patients; inhalers; waste