Background: COPD is associated with high morbidity and mortality. It is the third-ranked cause of death in the United States, killing more than 120,000 individuals each year. As a consequence of its high prevalence and chronic nature, COPD causes high resource utilization with frequent clinician office visits, hospitalizations due to acute exacerbations, and need for chronic therapy. Studies have reported that up to 60% of patients with COPD do not adhere to prescribed therapy and that up to 54% of patients use their inhaler ineffectively. The hospital implemented an auto-substitution where prescribed inhalers (i.e., metered-dose inhalers, dry-powder inhalers) were subbed to corresponding nebulization therapy. Pharmacists educated each patient on appropriate inhaler technique.

Methods: The purpose of the study was to assess the effect of auto substitution of inhaler to nebulizers in the inpatient setting. We were interested in looking to see whether autosubstitution led to a change in same major diagnostic category (MDC) 30-day readmission, length of stay, and patient satisfaction. Cost analysis was completed to see if there was a cost savings with autosubstition.

Results: There was a significant reduction in same major diagnostic category (MDC) 30-day readmission from 21.4% in 2015 to 11% in 2016, as well as a reduction in any 30-day readmission from 26.5% in 2015 to 22% in 2016. Length of stay was also found to decrease from 4.6 days in 2015 to 3.9 days in 2016. Patient satisfaction scores improved after the intervention. Furthermore, there was a significant cost savings of over $126,000 as well as an environmental impact by decreasing waste created by inhalers.

Conclusions: The pharmacist driven COPD Program can function as a tool to improve patient care as well as to provide significant pharmaco economic benefit. This study improved patient outcomes by decreasing length of stay, educating patient on proper inhaler technique, decreasing COPD 30 day readmissions, improving patient satisfaction while providing cost savings to the healthcare system. Moreover, an environmental impact was made by decreasing inhaler waste. The success of the study led to its launch in other hospitals within the hospital network.