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Laforest L, Belhassen M, Devouassoux G, Didier A, Letrilliart L, Van Ganse É. [Therapeutic adherence in asthma in France: A general review]. Rev Mal Respir 2017; 34:194-222. [PMID: 28359651 DOI: 10.1016/j.rmr.2016.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/08/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Adherence in asthma is a paramount issue of disease management. A general review of the French publications on this topic has been conducted. METHODS Research equations used for bibliographic databases (MEDLINE, Science Direct, Banque de données en santé publique, Cochrane and Cairn.info) comprised the following keywords: "asthma", "therapeutic adherence" and "France". These publications unrelated to asthma, focused on asthma management without exploring adherence, or those conducted in populations without French patients were excluded. RESULTS A total of 82 articles have been selected (36 surveys, 4 randomized trials and 42 reviews/syntheses). Whatever the methodology used and publication year, the inadequate therapeutic adherence in asthma was steadily reported, notably for controllers and the quality of use of inhaled devices. CONCLUSION The present review highlights the sustainability of adherence-related issues in asthma and the need to improve patients' knowledge on asthma and the finality of therapy. It also highlights the need of an improved communication between patients and physicians is also advocated. Further studies with more recent data are desirable to assess changes in disease management of asthma and the impact of potential future corrective interventions.
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Affiliation(s)
- L Laforest
- PELyon (Pharmacoepidemiology Lyon), faculté d'odontologie, 11, rue Guillaume Paradin, 69008 Lyon, France
| | - M Belhassen
- PELyon (Pharmacoepidemiology Lyon), faculté d'odontologie, 11, rue Guillaume Paradin, 69008 Lyon, France
| | - G Devouassoux
- Service de pneumologie, hôpital de la Croix-Rousse, hospices civils de Lyon, 69000, Lyon, France
| | - A Didier
- Pôle des voies respiratoires, hôpital Larrey, CHU de Toulouse, 31000, Toulouse, France
| | - L Letrilliart
- Département de médecine générale, faculté de médecine, université Claude-Bernard Lyon I, 69000, Lyon, France
| | - É Van Ganse
- PELyon (Pharmacoepidemiology Lyon), faculté d'odontologie, 11, rue Guillaume Paradin, 69008 Lyon, France; Service de pneumologie, hôpital de la Croix-Rousse, hospices civils de Lyon, 69000, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France.
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Shaw N, Le Souëf P, Turkovic L, McCahon L, Kicic A, Sly PD, Devadason S, Schultz A. Pressurised metered dose inhaler-spacer technique in young children improves with video instruction. Eur J Pediatr 2016; 175:1007-12. [PMID: 27251668 DOI: 10.1007/s00431-016-2738-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/16/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED The importance of good device technique to maximise delivery of aerosolised medications is widely recognised. Pressurised metered dose inhaler (pMDI)-spacer technique was investigated in 122 children, aged 2-7 years, with asthma. Eight individual steps of device technique were evaluated before and after viewing an instructional video for correct device technique. Video measurements were repeated every three months for nine months. Device technique improved directly after video instruction at the baseline study visit (p < 0.001) but had no immediate effect at subsequent visits. Additionally, pMDI-spacer technique improved with successive visits over one year for the group overall as evidenced by increases in the proportion of children scoring maximal (p = 0.02) and near-maximal (p = 0.04) scores. CONCLUSION Repeated video instruction over time improves inhaler technique in young children. WHAT IS KNOWN • Correct device technique is considered essential for sufficient delivery of inhaled medication. • Poor inhaler use is common in young asthmatic children using pressurised metered dose inhalers and spacers. What is New: • Video instruction could be used as a strategy to improve device technique in young children.
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Affiliation(s)
- Nicole Shaw
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008
| | - Peter Le Souëf
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia, 6008.,School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia, 6009
| | - Lidija Turkovic
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008
| | - Lucy McCahon
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008
| | - Anthony Kicic
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008.,Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia, 6008.,School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia, 6009.,Centre for Cell Therapy and Regenerative Medicine, The University of Western Australia and Harry Perkins Institute, Nedlands, Western Australia, Australia, 6009
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia, 4029
| | - Sunalene Devadason
- School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia, 6009
| | - André Schultz
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008. .,Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia, 6008. .,School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia, 6009.
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Rodríguez-Martínez CE, Sossa-Briceño MP, Nino G. A systematic review of instruments aimed at evaluating metered-dose inhaler administration technique in children. J Asthma 2016; 54:173-185. [PMID: 27304666 DOI: 10.1080/02770903.2016.1198373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The objective of the present study was to perform a systematic review of instruments aimed at evaluating pressurized metered-dose inhaler (pMDI) administration technique in children and evaluating the measurement properties of these instruments. METHODS A systematic search of the literature was performed in order to identify studies in which an instrument (scale, checklist, or questionnaire) for evaluating pMDI administration technique in children was described. Instruments were evaluated based on their reliability, validity, utility, endorsement frequency, restrictions in range, comprehension, lack of ambiguity, and lack of value-laden or offensive content. RESULTS A total of 24 instruments were identified. The age of the children ranged from 1 month to 18 years, the number of steps or items included in the instruments ranged from 3 to 21, and nearly half of the instruments distinguished between essential and non-essential steps or items. In only 7 of the 24 instruments was there a report of their measurement properties, mainly reliability and utility. Taking into consideration the information contained in the instruments, as well as their measurement properties, we determined four instruments to be the best of the available ones. CONCLUSIONS Among the 24 instruments for the assessment of pMDI administration technique in children that were identified and systematically examined, four were considered to be the best ones available. However, additional evaluation of their measurement properties should be done before using them in clinical practice and for research purposes.
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Affiliation(s)
- Carlos E Rodríguez-Martínez
- a Department of Pediatrics , School of Medicine, Universidad Nacional de Colombia , Bogota , Colombia.,b Department of Pediatric Pulmonology and Pediatric Critical Care Medicine , School of Medicine, Universidad El Bosque , Bogota , Colombia.,c Research Unit, Military Hospital of Colombia , Bogota , Colombia
| | - Monica P Sossa-Briceño
- d Department of Internal Medicine , School of Medicine, Universidad Nacional de Colombia , Bogota , Colombia
| | - Gustavo Nino
- e Division of Pediatric Pulmonary, Sleep Medicine and Integrative Systems Biology, Center for Genetic Research, Children's National Medical Center, George Washington University , Washington, DC , USA
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Crompton GK, Barnes PJ, Broeders M, Corrigan C, Corbetta L, Dekhuijzen R, Dubus JC, Magnan A, Massone F, Sanchis J, Viejo JL, Voshaar T. The need to improve inhalation technique in Europe: a report from the Aerosol Drug Management Improvement Team. Respir Med 2006; 100:1479-94. [PMID: 16495040 DOI: 10.1016/j.rmed.2006.01.008] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 12/21/2005] [Accepted: 01/09/2006] [Indexed: 11/27/2022]
Abstract
Although the principles of asthma management are well established in Europe, the available data indicate that asthma in patients is not well controlled. Many patients derive incomplete benefit from their inhaled medication because they do not use inhaler devices correctly and this may compromise asthma control. The Aerosol Drug Management Improvement Team (ADMIT), incorporating clinicians from the UK, Germany, France, Italy, Spain and The Netherlands, reviewed published evidence to examine ways to improve the treatment of reversible airways disease in Europe. Data indicate that there is a clear need for specific training of patients in correct inhalation technique for the various devices currently available, and this should be repeated frequently to maintain correct inhalation technique. Devices which provide reassurance to patients and their physicians that inhalation is performed correctly should help to improve patient compliance and asthma control. Educational efforts should also focus on primary prescribers of inhaler devices. ADMIT recommends dissemination of information on the correct inhalation technique for each model of device by the use of an accessible dedicated literature base or website which would enable to match the appropriate inhaler to the individual patient. There is also a need for standardisation of prescribing practices throughout Europe. Regular checking of inhalation technique by prescribers is crucial as correct inhalation is one of the keystones of successful asthma management.
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Affiliation(s)
- G K Crompton
- Respiratory Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK.
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Megas F, Benmedjahed K, Lefrançois G, Mueser M, Dusser D. [The "Compli'Asthme" therapeutic observation survey on good use of inhaled drugs for asthma: perception by general practitioners]. REVUE DE PNEUMOLOGIE CLINIQUE 2004; 60:158-165. [PMID: 15292825 DOI: 10.1016/s0761-8417(04)72091-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A cross sectional survey was conducted in 2000 in coordination with the CHIESI medical representatives among 1758 French physicians caring for patients with persistent asthma (80% general practitioners, 20% specialists). This "Compli'Asthme" survey was based on a self-administered questionnaire designed to learn more about the physicians' experience with good use of inhaled drugs and to collect information on therapeutic observance, corticophobia, and use of prescribed inhalers. Poor observance was noted as an important problem by 58-85% of the participants. Most of the problems were related to inability to use the inhaler properly (children, elderly subjects) or to patients forgetting to take their medications (adults, parents). For 58% of the participating physicians, corticophobia is frequent. The patients are worried about the anabolizing effect, secondary effects, and dependence. When there is a potential problem with corticophobia, physicians generally question the patients and provide explanations to achieve good observance. Patient preference is taken into consideration by 86% of the physicians prescribing inhalation devices; 90% demonstrate use of the device at the first prescription and 68% make repeated demonstrations at subsequent consultations. For 56-87% of the physicians, poor therapeutic observance, corticophobia, and poor use of the inhaler can be detected and corrected. Patient education is an important element for 77% of the physicians for improving observance and achieving good use of the inhaler. When poor observance and poor use of the inhaler occur, the physicians responding to this questionnaire applied the currently recommended guidelines.
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