Introduction: Optimisation of evidence-based pharmacological & non-pharmacological treatments is essential to improve the outcomes of people with COPD.  Patients admitted to hospital because of an acute exacerbation of their COPD routinely receive specialist input, but what happens when someone is admitted with COPD, not because of it - is this a missed opportunity?

Aim: To assess the appropriateness of inhaled therapy in inpatients admitted for non-COPD reasons

Methods: Between June & August 2021, patients with COPD admitted to a South East London (SEL) hospital for a non-COPD reason were identified & their inhaled therapy reviewed according to local guidelines

Results: 239 patients were identified, of whom 29 (12%) were not prescribed any inhaled therapy. 72 of the 210 patients prescribed inhaler therapy (34%) were prescribed inhalers not approved locally. 9 patients (4%) were prescribed salbutamol monotherapy. 174 patients (83%) were prescribed more than one inhaler, 92 (52%) of whom were prescribed a combination of inhaler types that required different inhalation techniques (e.g. a dry powder inhaler and an aerosol inhaler).

Conclusion: These results suggest that many COPD patients in SEL are not prescribed optimal inhaled treatment, increasing the risk of exacerbations and disease progression. The proportion of mixed inhaler devices is of particular concern, as this can lead to technique errors and worse outcomes. This cohort of patients could benefit from additional inpatient resource to improve care. Ward-based pharmacy teams could be upskilled to make evidence-based treatment interventions, optimise inhaler technique & inhaler choice in an effort to address this missed opportunity.