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Fullwood I, Evans T, Davies B, Ninan T, Onyon C, Clarke J, Srikanthiah R, Frost S, Iqbal N, Atkinson M, Rao S, Nagakumar P. Do you know when the inhaler is empty? Arch Dis Child 2022; 107:902-905. [PMID: 35551051 DOI: 10.1136/archdischild-2022-324027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Medication review is recommended at asthma appointments. The presence of propellant in the metered dose inhalers (MDIs) makes it challenging to identify when the inhaler is empty. The COVID-19 pandemic has resulted in move towards more virtual monitoring of care. We aimed to evaluate if patients identify when the inhaler is empty and the method of inhaler disposal. METHODS Prospective, multicentre quality improvement project. Data collected from children with asthma and other respiratory conditions. OUTCOME MEASURES Children/carers attending hospital were asked how they identify an empty salbutamol inhaler; dose counters in the preventer inhalers and disposal practices were reviewed. RESULTS 157 patients recruited. 125 (73.5%) patients deemed an empty inhaler as either full/partially full. 12 of 66 (18.2%) preventer inhalers with a dose counter were empty. 83% disposed their inhalers in a dustbin. CONCLUSIONS Patients cannot reliably identify when their MDI is empty. There is an urgent need for improving inhaler technology and providing appropriate guidance on how to identify when an MDI is empty.
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Affiliation(s)
- I Fullwood
- Department of Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - T Evans
- Department of Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Benjamin Davies
- Department of Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - T Ninan
- Department of Paediatrics, University Hospitals of Birmingham NHS Trust, Birmingham, United Kingdom, Birmingham, UK
| | - C Onyon
- Department of Paediatrics, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - J Clarke
- Department of Paediatrics, Wye Valley NHS Trust, Hereford, UK
| | - Rajesh Srikanthiah
- Department of Paediatrics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Susan Frost
- Department of Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - N Iqbal
- Department of Paediatrics, Walsall Hospitals NHS Trust, Walsall, UK
| | - M Atkinson
- Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Satish Rao
- Department of Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Prasad Nagakumar
- Department of Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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2
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Morton RW, Elphick HE, Craven V, Shields MD, Kennedy L. Aerosol Therapy in Asthma-Why We Are Failing Our Patients and How We Can Do Better. Front Pediatr 2020; 8:305. [PMID: 32656165 PMCID: PMC7325940 DOI: 10.3389/fped.2020.00305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022] Open
Abstract
In order for inhaled corticosteroids to be delivered adequately to the airways they require patients to take them regularly using an effective technique. Patients often have a poor inhaler technique, and this has been shown to result in sub-optimal asthma control. It is important for all clinicians prescribing inhaled medication to be experienced in the correct technique, and take time to train children so that they have mastered corrected inhaler technique. Using Teach to Goal or teach back methodology is a simple and effective way to provide this in the clinic setting. More than one training session is typically needed before children can master correct inhaler technique. Adherence to inhaled therapy has been shown to be sub-optimal in pediatric populations, with studies showing an average rate of around 50%. Subjective methods of measuring adherence have been shown to be inaccurate and overestimate rates. The advent of new technology has allowed adherence rates to be measured electronically, and it has been shown that regular feedback of these data can be effective at improving asthma control. New mobile apps and smart technology aim to engage patients and families with their asthma care. Effective use of these apps in collaboration with health care professionals has a vast potential to improve adherence rates and inhaler technique, resulting in improved asthma control.
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Affiliation(s)
| | | | - Vanessa Craven
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Michael D Shields
- Queen's University Belfast, Belfast, United Kingdom.,Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
| | - Lesley Kennedy
- Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
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3
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Errors in Aerosol Inhaler Use and Their Effects on Maternal and Fetal Outcomes among Pregnant Asthmatic Women (Subanalysis from QAKCOP Study). Can Respir J 2018; 2018:7649629. [PMID: 30662579 PMCID: PMC6312601 DOI: 10.1155/2018/7649629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/17/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022] Open
Abstract
Data on inhaler technique and its effects on maternal and fetal outcomes during pregnancy are seldom reported. The primary objective of this study was to evaluate inhaler technique and identify errors in inhaler use among pregnant women with asthma. Secondary objectives were to identify factors associated with poor inhaler technique and study the association between inhaler technique and maternal and fetal outcomes. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. Seventy-three and 41 asthmatic pregnant women reported using pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs), respectively. Overall, wrong inhaler technique was observed in 47 (64.4%) subjects. Among pMDI users, correct inhaler use was observed in only 26/73 (35.6%) of the patients, with lack of coordination between inhalation and generation of the aerosol and failure to breathe out gently before using the inhaler, being the most common errors. Among DPI users, 21 (51.2%) demonstrated correct inhaler use, with failure to perform a breath-hold for 10 seconds after inhaling the powder and to exhale gently before using the inhaler being the most common errors. Significant associations between inhaler technique and patient's understanding of asthma medications and the kind of follow-up clinic (respiratory versus nonrespiratory clinic) were found. No significant associations between inhaler technique and various maternal and fetal outcomes or asthma control were found. In conclusion, improper inhalation technique is significantly prevalent in pregnant asthmatic women, particularly among those being followed in nonspecialized respiratory clinics. The lack of significant association between the inhaler technique and asthma control (and hence maternal and fetal outcomes) may simply reflect the high prevalence of uncontrolled asthma and significant contribution of other barriers to poor asthma control in the current patient's cohort. Multidisciplinary management of asthma during pregnancy with particular emphasis on patient's education is imperative.
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4
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Bozejac BV, Stojšin I, Ðuric M, Zvezdin B, Brkanić T, Budišin E, Vukoje K, Sečen N. Impact of inhalation therapy on the incidence of carious lesions in patients with asthma and COPD. J Appl Oral Sci 2017; 25:506-514. [PMID: 29069148 PMCID: PMC5804387 DOI: 10.1590/1678-7757-2016-0147] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/01/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this study was to investigate the incidence of carious lesions, the amount of salivary flow rate and pH value in patients with asthma and chronic obstructive pulmonary diseases (COPD), using inhalation therapy. The obtained results were compared with the results of adult healthy subjects, forming a control group. Material and Methods: The study included 80 participants aging between 18 and 65 years. The experimental group (EG) was comprised of 40 participants, previously diagnosed with asthma or COPD undergoing inhalation therapy for more than five years. The control group (CG), comprised of 40 participants, mirrored the same age and gender status of the EG. Dental status was determined by decayed, missing, and filled teeth (DMFT index). Quantity and pH value of saliva were determined in the laboratory. Results: In the EG, the mean value of the salivary flow rate and pH value were statistically significantly lower than in the CG (p<0.001). Patients in the EG had a higher value of DMFT index when compared with the CG, although the difference was not statistically significant (p=0.199). Mean number of decayed teeth, as well as missing teeth, in the EG was statistically significantly higher than in the CG (p<0.001). Mean number of filled teeth in the EG was statistically significantly lower than in the CG (p<0.001). Conclusion: It was found that patients undergoing inhalation therapy face increasing risk of dental caries due to the lower salivary flow rate and pH value along with the inhalation therapy. They should receive intensive preventive care, including oral hygiene instruction and dietary advice.
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Affiliation(s)
- Branislava Velicki Bozejac
- Stomatološka poliklinika Dentaland Novi Sad, Srbija.,Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Srbija
| | - Ivana Stojšin
- Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Srbija.,Odeljenje za bolesti zuba i endodonciju, Klinika za stomatologiju Vojvodine, Novi Sad, Srbija
| | - Mirna Ðuric
- Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Srbija.,lnstitut za plućne bolesti Vojvodine, Sremska Kamenica, Srbija
| | - Biljana Zvezdin
- Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Srbija.,lnstitut za plućne bolesti Vojvodine, Sremska Kamenica, Srbija
| | - Tatjana Brkanić
- Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Srbija.,Odeljenje za bolesti zuba i endodonciju, Klinika za stomatologiju Vojvodine, Novi Sad, Srbija
| | - Evica Budišin
- Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Srbija.,lnstitut za plućne bolesti Vojvodine, Sremska Kamenica, Srbija
| | - Karolina Vukoje
- Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Srbija
| | - Nevena Sečen
- Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Srbija.,lnstitut za plućne bolesti Vojvodine, Sremska Kamenica, Srbija
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5
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Klijn SL, Hiligsmann M, Evers SMAA, Román-Rodríguez M, van der Molen T, van Boven JFM. Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: a systematic review. NPJ Prim Care Respir Med 2017; 27:24. [PMID: 28408742 PMCID: PMC5435089 DOI: 10.1038/s41533-017-0022-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/02/2017] [Accepted: 02/14/2017] [Indexed: 01/01/2023] Open
Abstract
With the current wealth of new inhalers available and insurance policy driven inhaler switching, the need for insights in optimal education on inhaler use is more evident than ever. We aimed to systematically review educational inhalation technique interventions, to assess their overall effectiveness, and identify main drivers of success. Medline, Embase and CINAHL databases were searched for randomised controlled trials on educational inhalation technique interventions. Inclusion eligibility, quality appraisal (Cochrane's risk of bias tool) and data extraction were performed by two independent reviewers. Regression analyses were performed to identify characteristics contributing to inhaler technique improvement. Thirty-seven of the 39 interventions included (95%) indicated statistically significant improvement of inhaler technique. However, average follow-up time was relatively short (5 months), 28% lacked clinical relevant endpoints and all lacked cost-effectiveness estimates. Poor initial technique, number of inhalation procedure steps, setting (outpatient clinics performing best), and time elapsed since intervention (all, p < 0.05), were shown to have an impact on effectiveness of the intervention, explaining up to 91% of the effectiveness variation. Other factors, such as disease (asthma vs. chronic obstructive pulmonary disease), education group size (individual vs. group training) and inhaler type (dry powder inhalers vs. pressurised metered dose inhalers) did not play a significant role. Notably, there was a trend (p = 0.06) towards interventions in adults being more effective than those in children and the intervention effect seemed to wane over time. In conclusion, educational interventions to improve inhaler technique are effective on the short-term. Periodical intervention reinforcement and longer follow-up studies, including clinical relevant endpoints and cost-effectiveness, are recommended.
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Affiliation(s)
- Sven L Klijn
- Department of Health Services Research, CAPHRI, Maastricht University, P.O. Box 616, 6200, Maastricht, The Netherlands.
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI, Maastricht University, P.O. Box 616, 6200, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI, Maastricht University, P.O. Box 616, 6200, Maastricht, The Netherlands
| | | | - Thys van der Molen
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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6
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Takaku Y, Kurashima K, Ohta C, Ishiguro T, Kagiyama N, Yanagisawa T, Takayanagi N. How many instructions are required to correct inhalation errors in patients with asthma and chronic obstructive pulmonary disease? Respir Med 2016; 123:110-115. [PMID: 28137486 DOI: 10.1016/j.rmed.2016.12.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/28/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
Abstract
In the treatment of asthma and chronic obstructive pulmonary disease (COPD), errors in handling and wrong techniques in using inhalation devices are associated with poor disease control. The aim of this study was to evaluate the number of instructions that are necessary to minimize errors in using pressurized metered-dose inhaler (pMDI), soft mist inhaler (SMI), and dry powder inhaler (DPI). Among 216 patients with asthma (n = 135) and COPD (n = 81), we studied 245 cases that used different types of inhalation devices. After initial guidance, 145 of 245 cases (59%) made at least one error that could affect efficacy. For every device, at least three instructions were required to achieve entirely no errors or less than 10% errors in total. The most common error on the use of pMDI was device handling, whereas that of DPI was inhalation manner. Both errors were associated with low peak flow rate. In both patients with asthma and in patients with COPD, the most common error was inhalation manner. We concluded that it is necessary to repeat at least three times of instructions to achieve effective inhalation skills in both asthma and COPD patients.
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Affiliation(s)
- Yotaro Takaku
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Itai, 1696, Kumagaya city, Saitama, Japan.
| | - Kazuyoshi Kurashima
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Itai, 1696, Kumagaya city, Saitama, Japan
| | - Chie Ohta
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Itai, 1696, Kumagaya city, Saitama, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Itai, 1696, Kumagaya city, Saitama, Japan
| | - Naho Kagiyama
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Itai, 1696, Kumagaya city, Saitama, Japan
| | - Tsutomu Yanagisawa
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Itai, 1696, Kumagaya city, Saitama, Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Itai, 1696, Kumagaya city, Saitama, Japan
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