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Tietz F, Adams I, Lücke E, Schreiber J. Inhalation Devices in 7- to 15-Year-Old Children with Asthma - A Patient Preference Study. Patient Prefer Adherence 2023; 17:951-959. [PMID: 37038436 PMCID: PMC10082580 DOI: 10.2147/ppa.s381486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/11/2023] [Indexed: 04/12/2023] Open
Abstract
Background Inhalation therapy is the cornerstone of treatment of bronchial asthma. A patient-specific selection of inhalation devices is necessary, as preference for a device plays an important role in terms of error rates in handling and adherence to therapy. However, there is no industry-independent study providing information on children's preferences for common inhaler types. The aim of the present study was to investigate the preference of asthmatic children for inhaler types commonly used in Germany. The effects of age, gender and the type of school visited on device preferences as well as the frequency of patient education and the role of health care providers in the choice for an inhaler were investigated. Methods Eighty children were included in this prospective cross-sectional study (age: 10.87 ± 2.62 years). The analysis was based on a questionnaire and validated checklists. All participants tested the use of nine placebo inhalers (Breezhaler, Diskus, Respimat, Spiromax, Turbohaler, Autohaler, metered-dose inhaler, Easyhaler and Novolizer) in a randomized order. For each device, patients were asked to assess handling, rate different device characteristics and name the device they would prefer most or least. Results The most favored device was the Novolizer. Moreover, the Spiromax scored highest in numerous categories such as suitability in emergencies and "easiest" device to use. Patient preferences with respect to the addressed inhaler features were not significantly related to age, gender or school type. Conclusion The Novolizer and the Spiromax showed higher preference in pediatric patients as compared to other tested devices. Overall, there were significant differences in terms of preference when comparing the tested inhalers in different aspects.
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Affiliation(s)
- Franziska Tietz
- Department of Pneumonology, University Medicine, Magdeburg, Germany
| | - Ines Adams
- Department of Pediatrics, University Medicine, Magdeburg, Germany
| | - Eva Lücke
- Department of Pneumonology, University Medicine, Magdeburg, Germany
| | - Jens Schreiber
- Department of Pneumonology, University Medicine, Magdeburg, Germany
- Correspondence: Jens Schreiber, Department of Pneumology, University Medicine Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany, Tel +49 391 67 15421, Fax +49 391 67 13356, Email
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Ahmed M, Munir M, Sufyan A, Ayyaz J, Arshad I, Bukhari M, Umar M, Khurram M, Tariq A, Hamza M. Metered Dose Inhaler Technique: A Priority Catch for Physicians. Cureus 2020; 12:e10857. [PMID: 33178510 PMCID: PMC7652015 DOI: 10.7759/cureus.10857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Asthma is a non-curable but preventable disease that can be controlled by a proper approach. Inhalational route is considered to be one of the fastest, non-invasive course for the management of asthma. Despite its importance, compliance towards proper inhalational technique remains quite low. Thus, United Kingdom guidelines and Global Strategy for Asthma Management and Prevention (GINA) recommend regular assessment of inhaler techniques in all asthma patients. OBJECTIVE To evaluate the inhalational technique of asthma patients visiting out-patient departments of public sector tertiary care hospitals of Rawalpindi and correlate with various demographic factors. METHODS A cross-sectional study was conducted on a total of 209 respondents visiting the outpatient department of public sector hospitals in Rawalpindi. Asthmatic patients were included via a non-probability consecutive sampling technique and were assessed for inhaler techniques via a structured checklist. Statistical data were analyzed using IBM Statistical Package for Social Sciences (SPSS®), version 25.0 (IBM Corp., Armonk, NY, USA). RESULTS Two hundred and nine asthma patients were included. Only 10% of patients demonstrated the correct inhaler technique. Continuing inhaling till lungs are full, holding breath for five to 10 seconds, and breathing out slowly after using the inhaler were most poorly followed. CONCLUSION Most asthma patients are using poor inhalation technique, risking sub-optimal drug delivery and inadequate effects. Hence, it is the need of the hour to focus on patient training and education.
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Affiliation(s)
- Muhammad Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Muqadas Munir
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Ali Sufyan
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Jahanzeb Ayyaz
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Imran Arshad
- Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Mujtaba Bukhari
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Muhammad Umar
- Gastroenterology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Muhammad Khurram
- Department of Medicine, Holy Family Hospital/Rawalpindi Medical University, Rawalpindi, PAK
| | - Ahsan Tariq
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Muhammad Hamza
- Department of General Surgery, Benazir Bhutto Hospital, Rawalpindi, PAK
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Evaluation of the knowledge and correct use of metered-dose inhalers by healthcare professionals and medical students in Gauteng Province. Afr J Thorac Crit Care Med 2019; 25. [PMID: 34286261 PMCID: PMC8278855 DOI: 10.7196/ajtccm.2019.v25i3.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2019] [Indexed: 11/08/2022] Open
Abstract
Background
The Global Initiative for Asthma (GINA) estimates that South Africa (SA) has over 3.9 million asthma sufferers, of whom 1.5%
die of the condition annually. SA has the world’s fourth highest asthma death rate among 5 - 35-year-olds. Chronic obstructive pulmonary
disease (COPD) will be the third leading cause of death globally by 2030, and will surpass HIV/AIDS in Africa. Uncontrolled asthma and
COPD are frequent causes of emergency department visits and hospital admissions. Poor metered-dose inhaler (MDI) technique is probably
a major contributory cause. It is the responsibility of all treating doctors and healthcare professionals to educate patients on inhaled therapy
with the correct MDI technique, as well as to routinely check and repeatedly demonstrate the technique to them.
Objectives
This study evaluated study participants’ knowledge of MDI technique, and their compliance in checking and demonstrating
MDI use to patients prescribed inhaled therapy. The study participants included doctors, nurses and final-year medical students at Helen
Joseph Hospital and Chris Hani Baragwanath Academic Hospital, in the Departments of Internal Medicine and Emergency Medicine, and
the Division of Pulmonology.
Methods
A total of 195 study participants volunteered to take part in the study. A questionnaire was administered to participants to gauge
their perceptions, level of knowledge and understanding of MDI technique. They were then requested to demonstrate correct inhaler
technique via a placebo MDI. Participants’ use of a placebo MDI was evaluated by a scoring system.
Results
The total sample of 195 comprised 130 (67%) female and 65 (33%) male participants. Of these, 133 (68%) were qualified medical
staff, and 62 were final-year medical students. Only 32 (16%) could demonstrate correct MDI technique. Over 50% of participants did not
demonstrate MDI technique to patients, or check their patients’ technique at every hospital-related visit.
Conclusion
Healthcare professionals and final-year medical students have poor knowledge of inhaler technique and are ill-prepared to teach
patients. Also of concern is that the majority do not routinely demonstrate or observe patients’ inhaler technique.
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Oliveira MVCD, Pizzichini E, da Costa CH, Fritscher CC, Vianna EO, Teixeira PJZ, Stirbulov R, Rabahi MF, Pinho NCD. Evaluation of the preference, satisfaction and correct use of Breezhaler ® and Respimat ® inhalers in patients with chronic obstructive pulmonary disease - INHALATOR study. Respir Med 2018; 144:61-67. [PMID: 30366585 DOI: 10.1016/j.rmed.2018.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 10/02/2018] [Accepted: 10/06/2018] [Indexed: 11/24/2022]
Abstract
The INHALATOR study was a randomized, multicentre, open label, two-period of 7 days each, crossover study, with 7 days of washout in-between, aiming to evaluate the correct use, satisfaction and preference between Breezhaler® and Respimat® devices in patients under daily use of open Spiriva® or open Onbrize®, as monotherapy for treatment of mild or moderate COPD. Patients aged ≥40 years with a smoking history of at least 10 pack-year were included in the study. Primary endpoint was the rate of correct use of each device at the first day of treatment after reading the drug leaflet information and was evaluated under the supervision of a trained evaluator. At the end of each treatment phase, the inhaler use was re-evaluated and a satisfaction questionnaire was completed. The patients' preference for the inhaler devices was assessed at the end of the study. After exclusions due to screening failures, 140 patients were randomized: 136 received at least one dose of Breezhaler® and 135 of Respimat®. At treatment start, the rate of correct inhaler use was 40.4% (95%CI: 32.2%-48.7%) for Breezhaler® and 36.3% (95%CI: 28.2%-44.4%) for Respimat® (p = 0.451). After 7 days, the rates were 68.9% (95%CI: 61.1%-76.7%) and 60.4% (95%CI: 52.2%-68.7%), respectively (p = 0.077). According to the Feeling of Satisfaction with Inhaler Questionnaire - FSI 10 patients were more satisfied using Breezhaler® than Respimat® and 57.1% preferred using Breezhaler® (p = 0.001) while 30.1% preferred Respimat® (p < 0.001).
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Affiliation(s)
- Maria Vera Cruz de Oliveira
- Hospital do Servidor Público Estadual de São Paulo, Rua Pedro de Toledo, 1800 Bl F. 3° Andar, São Paulo/SP, 04039-901, Brazil
| | - Emilio Pizzichini
- NUPAIVA, Hospital Universitário, UFSC, Campos Universitário S/N, Trindade, Florianópolis /SC, 88040-970, Brazil
| | - Claudia Henrique da Costa
- UERJ, Policlínica Piquet Carneiro, Av. Marechal Rondon 381, São Francisco Xavier, Rio de Janeiro / RJ, 20950-003, Brazil
| | - Carlos Cezar Fritscher
- Hospital São Lucas da PUCRS, Av Ipiranga 6690, 4° andar, Porto Alegre / RS, 90610-000, Brazil
| | - Elcio Oliveira Vianna
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USP, Av. Bandeirantes 3900, CEP 14048-900, Ribeirão Preto, SP, Brazil
| | - Paulo José Zimermann Teixeira
- Irmandade da Santa Casa de Misericórdia de Porto Alegre-UFCSPA, Rua Prof. Annes Dias, 295, Pavilhão Pereira Filho, 1° andar, Porto Alegre / RS, 90020-090, Brazil
| | - Roberto Stirbulov
- Centro de Pesquisa Clínica em Pneumologia da Irmandade Santa Casa de Misericórdia de São Paulo, Rua Dr. Cesário Motta Jr. 112, Vila Buarque, São Paulo / SP, Brazil
| | - Marcelo Fouad Rabahi
- CLARE, Clínica de Pneumologia SS, Av. B 483, Setor Oeste, Goiânia / GO, 74110-030, Brazil
| | - Nadine Cordeiro de Pinho
- Novartis Biociências S.A. Brasil, Av. Prof. Vicente Rao, 90, Santo Amaro, São Paulo / SP, 04636-000, Brazil.
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Plaza V, Giner J, Rodrigo GJ, Dolovich MB, Sanchis J. Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:987-995. [PMID: 29355645 DOI: 10.1016/j.jaip.2017.12.032] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/15/2017] [Accepted: 12/30/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Inefficient inhaler technique (IT) compromises the optimal delivery of medication. However, the IT knowledge of health care professionals (HCPs) has received scant attention. OBJECTIVE The objective of this study was to perform a systematic review of published reports assessing the IT proficiency of HCPs in using pressurized metered dose (pMDI) and dry powder (DPI) inhalers. METHODS Studies published between 1975 and 2014 that directly assessed the IT skills of HCPs were selected according to predefined selection criteria. RESULTS Data were extracted from 55 studies involving 6,304 HCPs who performed 9,996 tests to demonstrate their IT proficiency. Overall, the IT was considered correct in 15.5% of cases (95% confidence interval [CI], 12-19.3), decreasing over time from 20.5% (95% CI, 14.9-26.8) from the early period (defined as 1975-1995) to 10.8% (95% CI, 7.3-14.8) during the late period (1996-2014). The most common errors in the use of pMDIs were as follows: not breathing out completely before inhalation (75%; 95% CI, 56-90), lack of coordination (64%; 95% CI, 29-92), and postinhalation breath-hold (63%; 95% CI, 52-72). The most common errors using DPI were deficient preparation (89%; 95% CI, 82-95), not breathing out completely before inhalation (79%; 95% CI, 68-87), and no breath-hold (76%; 95% CI, 67-84). CONCLUSIONS HCPs demonstrated inadequate knowledge of the proper use of inhalers. The poor understanding of the correct use of these devices may prevent these professionals from being able to adequately assess and teach proper inhalation techniques to their patients.
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Affiliation(s)
- Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Jordi Giner
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gustavo J Rodrigo
- Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Myrna B Dolovich
- Department of Medicine, Division of Respirology, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Joaquin Sanchis
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
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Pirie RS, McGorum BC, Owen C, Carr O, Oakley H, McLachlan G. Factors affecting the efficiency of aerosolized salbutamol delivery via a metered dose inhaler and equine spacer device. J Vet Pharmacol Ther 2016; 40:231-238. [DOI: 10.1111/jvp.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/21/2016] [Indexed: 01/08/2023]
Affiliation(s)
- R. S. Pirie
- Royal (Dick) School of Veterinary Studies and Roslin Institute; Easter Bush Veterinary Centre; Midlothian UK
| | - B. C. McGorum
- Royal (Dick) School of Veterinary Studies and Roslin Institute; Easter Bush Veterinary Centre; Midlothian UK
| | - C. Owen
- Royal (Dick) School of Veterinary Studies and Roslin Institute; Easter Bush Veterinary Centre; Midlothian UK
| | - O. Carr
- Royal (Dick) School of Veterinary Studies and Roslin Institute; Easter Bush Veterinary Centre; Midlothian UK
| | - H. Oakley
- Royal (Dick) School of Veterinary Studies and Roslin Institute; Easter Bush Veterinary Centre; Midlothian UK
| | - G. McLachlan
- Royal (Dick) School of Veterinary Studies and Roslin Institute; Easter Bush Veterinary Centre; Midlothian UK
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Muchão FP, Silva Filho LVRFD, Pastorino AC, Rodrigues JC. Metered-dose inhaler for asthma patients: knowledge and effects of a theoretical and practical guidance for pediatricians. EINSTEIN-SAO PAULO 2016; 9:337-42. [PMID: 26761102 DOI: 10.1590/s1679-45082011ao2115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 08/11/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effect of a theoretical and practical guidance on knowledge of pediatricians regarding the use of metered dose inhalers with spacers. To identify major deficiencies, correct them and train these physicians on the correct use of the devices. METHODS Pediatricians who participated in a theoretical-practical program focusing on the use of inhaler devices answered a questionnaire with five questions about the use of these devices before and after the program. A comparison of the scores obtained in the pre- and post-training tests was performed by Wilcoxon test for related samples, and a significance level of 0.05 was adopted. RESULTS Twenty pediatricians performed pre- and post-training tests. The performance of pediatricians in the post-training test was significantly better than baseline (p<0.001). CONCLUSION A brief orientation program for pediatricians significantly improved their knowledge on the use of metered-dose inhalers with spacers, which may translate into an improvement in quality and quantity of prescriptions of these devices in clinical practice. The questions with higher rates of errors in the pre-training test were the questions about the waiting time between two sprays in successive applications and about the correct way to attach the inhaler to the spacer, both with high levels of success in the post-training test.
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Affiliation(s)
- Fábio Pereira Muchão
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, BR
| | | | - Antonio Carlos Pastorino
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, BR
| | - Joaquim Carlos Rodrigues
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, BR
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Onyedum C, Desalu O, Nwosu N, Chukwuka C, Ukwaja K, Ezeudo C. Evaluation of inhaler techniques among asthma patients seen in Nigeria: an observational cross sectional study. Ann Med Health Sci Res 2014; 4:67-73. [PMID: 24669334 PMCID: PMC3952300 DOI: 10.4103/2141-9248.126617] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: An Adequate and an effective dose of inhalation drugs can be administered only if the correct inhaler-specific technique is followed by asthma patients. There is paucity of data on this subject among Nigerians and Africans. Aims: This observational study was to assess the inhaler techniques among asthma patients in Nigeria and also to identify the factors related to an inaccurate or poor inhaler use. Subjects and Methods: Consenting asthma patients on inhalers, who attended medical out-patients clinic, of two university hospitals in Nigeria were asked to use their inhalers while an inhaler-administration checklist was used to assess each patients inhaler technique. Information on demographics, asthma symptoms history and history of technique education were obtained. Data was analyzed using standard statistical methods. Results: A total of 140 asthma patients participated out of which 75 were females. All the patients used pressurized metered dose inhalers (pMDI) type; 51 of them used dry powder inhalers (DPI) in addition. For pMDI, 22.1% (31/140) completed all required steps while 37.3% (19/51) did so for DPI (P = 0.04). Patients with higher educational qualification (P < 0.01) and those with less frequent asthma symptoms (P < 0.01) are more likely to use the pMDI inhalers more accurately while patients who have been taught previously by a Doctor were more likely to use the DPI better. Conclusion: Majority of asthma patients use their inhalers inaccurately. Patient-dependent factors were identified as the cause of incorrect technique of inhaler use. Asthma patients on inhalation medications should have routine assessment of their inhaler technique at every visit and corrected if found to be poor.
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Affiliation(s)
- Cc Onyedum
- Department of Medicine, Respiratory Unit, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Oo Desalu
- Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Ni Nwosu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Cj Chukwuka
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Kn Ukwaja
- Federal Teaching Hospital, Abakiliki, Ebonyi State, Nigeria
| | - C Ezeudo
- Department of Medicine, Medical Division, Nigerian Ports Authority, Lagos, Nigeria
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Vargas O, Martinez J, Ibanez M, Pena C, Santamaria M. The use of metered-dose inhalers in hospital environments. J Aerosol Med Pulm Drug Deliv 2013; 26:287-96. [PMID: 23458577 DOI: 10.1089/jamp.2011.0940] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Metered-dose inhalers (MDIs) have become a firsthand therapeutic strategy for the management of respiratory diseases, mainly for chronic obstructive pulmonary disease (COPD) and asthma. It has been determined, however, that patients do not always use these devices correctly. Our primary goal was to establish the level of technical knowledge of patients with COPD and/or asthma on the use of MDIs, as well as other associated factors related to the effective use of this delivery method. METHODOLOGY This study was performed with 191 patients (49.2% male, 50.8% female) diagnosed with COPD and/or asthma at Hospital Universitario Mayor (Bogotá, Colombia). The agreement between different observers on nine aspects of the use of the inhaler was assessed by testing the unweighted kappa correlation coefficient and its significance. The correlations between demographic variables, risk factors, and proper knowledge of the adequate use of inhalers were established by means of the Pearson chi-square test (also called Fisher exact test) (expected values less than 5). Statistical tests were evaluated at a significance level equivalent to 5% (p<0.05). RESULTS AND CONCLUSIONS The study detected deficiencies in educational factors, specifically regarding the initial contact with the patient and regular follow-up by the team of health professionals. It also showed insufficient strategies for the training of patients in the use of the inhalers. There were no significant differences by gender (p>0.05) in the implementation of the various aspects of the proper use sequence for MDIs. However, there were significant differences related to education levels, socioeconomic status, age, and current occupation. A worse inhaler technique was associated with lower education level (0.034), higher age (p=0.003), and absence of job (p=0.005). Changes in the education of patients on the issue, together with the use of the spacer/valved holding chamber proved to be valid strategies that, with the support of the patients' health-care team, were able to improve the MDI technique of the studied group.
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Affiliation(s)
- O Vargas
- 1 Rosario University , Program of Physiotherapy, Bogotá, Colombia
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Souza MLDM, Meneghini AC, Ferraz E, Vianna EO, Borges MC. Knowledge of and technique for using inhalation devices among asthma patients and COPD patients. J Bras Pneumol 2010; 35:824-31. [PMID: 19820807 DOI: 10.1590/s1806-37132009000900002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 05/19/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate knowledge of and techniques for using prescribed inhalation devices among patients with asthma or COPD treated at a tertiary teaching hospital. METHODS Patients were assessed after medical visits, and their physicians were blinded to this fact. Patients were asked to demonstrate their inhaler technique and were then interviewed regarding their knowledge of inhalation devices, control of the disease and instructions received during medical visits. RESULTS We included 120 volunteers: 60 with asthma and 60 with COPD. All of the asthma patients and 98.3% of the COPD patients claimed to know how to use inhaled medications. In the sample as a whole, 113 patients (94.2%) committed at least one error when using the inhalation device. Patients committed more errors when using metered-dose inhalers than when using the dry-powder inhalers Aerolizer (p < 0.001) or Pulvinal (p < 0.001), as well as committing more errors when using the Aerolizer inhaler than when using the Pulvinal inhaler (p < 0.05). Using the metered-dose, Pulvinal and Aerolizer inhalers, the COPD group patients committed more errors than did the asthma group patients (p = 0.0023, p = 0.0065 and p = 0.012, respectively). CONCLUSIONS Although the majority of the patients claimed to know how to use inhalation devices, the fact that 94.2% committed at least one error shows that their technique was inappropriate and reveals a discrepancy between understanding and practice. Therefore, it is not sufficient to ask patients whether they know how to use inhalation devices. Practical measures should be taken in order to minimize errors and optimize treatment.
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Giavina-Bianchi P, Aun MV, Bisaccioni C, Agondi R, Kalil J. Difficult-to-control asthma management through the use of a specific protocol. Clinics (Sao Paulo) 2010; 65:905-18. [PMID: 21049219 PMCID: PMC2954742 DOI: 10.1590/s1807-59322010000900014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 05/18/2010] [Accepted: 06/02/2010] [Indexed: 12/21/2022] Open
Abstract
The present study is a critical review of difficult-to-control asthma, highlighting the characteristics and severity of the disease. It also presents a protocol for the management of patients with this asthma phenotype. The protocol, which was based on relevant studies in the literature, is described and analyzed.
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Kim SH, Kwak HJ, Kim TB, Chang YS, Jeong JW, Kim CW, Yoon HJ, Jee YK. Inappropriate techniques used by internal medicine residents with three kinds of inhalers (a metered dose inhaler, Diskus, and Turbuhaler): changes after a single teaching session. J Asthma 2009; 46:944-50. [PMID: 19905924 DOI: 10.3109/02770900903229701] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND While initial education and regular evaluation of inhaler technique in patients are emphasized in the management of asthma and chronic obstructive pulmonary disease, health care professionals are not experienced in using inhalers. This study assessed whether internal medicine residents used common inhalers correctly and whether a single teaching session successfully improved their performance. METHODS We evaluated 142 internal medicine residents from six university hospitals in Korea for their techniques with three different inhaler devices: a metered dose inhaler (MDI), Diskus, and Turbuhaler. We assessed whether participants completed each step in using the three inhalers and classified overall performance as good, adequate, or inadequate for each inhaler type. To estimate the effect of a single teaching session, reassessment was performed 2 months after education. RESULTS Performance grade was inadequate for 50.7% of participants with a MDI, 43.0% for Diskus, and 51.4% for Turbuhaler. An early year of residency was associated significantly with inappropriate technique for Diskus (p = 0.003), but not for MDI and Turbuhaler. After a single teaching session, overall skills improved significantly for all three inhalers. The proportion of subjects with good or adequate skill changed notably from 39.7% to 83.8% for MDI (p = 0.001), from 50.0% to 86.8% for Diskus (p = 0.001), and from 44.1% to 88.2% for Turbuhaler (p = 0.001). CONCLUSIONS These findings demonstrate that a high proportion of internal medicine residents cannot use inhalers correctly and just a single teaching can effectively enhance their inhaler technique.
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Affiliation(s)
- Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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