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O'Connor A, Sharrad K, King C, Carson-Chahhoud K, Carson-Chahhoud AP. An Augmented Reality Technology to Provide Demonstrative Inhaler Technique Education for Patients With Asthma: Interview Study Among Patients, Health Professionals, and Key Community Stakeholders. JMIR Form Res 2023; 7:e34958. [PMID: 36862496 PMCID: PMC10020912 DOI: 10.2196/34958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many people with asthma use incorrect inhaler technique, resulting in suboptimal disease management and increased health service use. Novel ways of delivering appropriate instructions are needed. OBJECTIVE This study explored stakeholder perspectives on the potential use of augmented reality (AR) technology to improve asthma inhaler technique education. METHODS On the basis of existing evidence and resources, an information poster displaying the images of 22 asthma inhaler devices was developed. Using AR technology via a free smartphone app, the poster launched video demonstrations of correct inhaler technique for each device. In total, 21 semistructured, one-on-one interviews with health professionals, people with asthma, and key community stakeholders were conducted, and data were analyzed thematically using the Triandis model of interpersonal behavior. RESULTS A total of 21 participants were recruited into the study, and data saturation was achieved. People with asthma were confident with inhaler technique (mean score 9.17, SD 1.33, out of 10). However, health professionals and key community stakeholders identified that this perception was misguided (mean 7.25, SD 1.39, and mean 4.5, SD 0.71, for health professionals and key community stakeholders, respectively) and facilitates persistent incorrect inhaler use and suboptimal disease management. Delivering inhaler technique education using AR was favored by all participants (21/21, 100%), particularly around ease of use, with the ability to visually display inhaler techniques for each device. There was a strongly held belief that the technology has the capacity for improving inhaler technique across all participant groups (mean 9.25, SD 0.89, for participants; mean 9.83, SD 0.41, for health professionals; and mean 9.5, SD 0.71, for key community stakeholders). However, all participants (21/21, 100%) identified some barriers, particularly regarding access and appropriateness of AR for older people. CONCLUSIONS AR technology may be a novel means to address poor inhaler technique among certain cohorts of patients with asthma and serve as a prompt for health professionals to initiate review of inhaler devices. A randomized controlled trial design is needed to evaluate the efficacy of this technology for use in the clinical care setting.
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Affiliation(s)
- Antonia O'Connor
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - Kelsey Sharrad
- Translational Medicine and Technology Group, Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
| | - Charmaine King
- Translational Medicine and Technology Group, Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
| | - Kristin Carson-Chahhoud
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Translational Medicine and Technology Group, Australian Centre for Precision Health, University of South Australia, Adelaide, Australia.,Cancer Research Institute, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
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2
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Chokhani R, Gaur V, Gogtay J. Breath-actuated INhalation TheRapy: survey of phySicians' PErCepTion (INTROSPECT) in Nepal. J Asthma 2023:1-8. [PMID: 36519280 DOI: 10.1080/02770903.2022.2158858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Breath-actuated inhalers (BAIs) are gaining attention in the management of obstructive airway diseases (OADs). In Nepal, a BAI containing fluticasone propionate/salmeterol (FPS) has been available for a year. This survey is aimed at determining the perception and experience of physicians in Nepal concerning BAIs. METHODS A cross-sectional, questionnaire-based survey was conducted. A total of 141 physicians participated and filled the survey. RESULTS Most physicians felt that the right device should be easy to teach, learn and remember. They considered coordination and multiple steps as the primary challenges with pressurized metered-dose inhalers and dry powder inhalers, respectively. Most of them agreed that BAIs could address these challenges. BAIs were not only preferred by most of the physicians for asthma and chronic obstructive pulmonary disease but were also the preferred choice in newly diagnosed patients. Physicians believed that if current patients were shifted to BAIs, it could improve inhalation technique (88%) and compliance/adherence (81%). Almost all of them (92-97%) agreed that teaching the breathing technique and the cleaning process was easier and faster in BAIs. BAIs were considered easy and simple to use. Also, BAI's dose-counter helps patients to increase adherence to inhalation therapy. CONCLUSIONS In this INTROSPECT survey, physicians in Nepal believed that BAIs could address the key challenges faced with using pMDIs and DPIs in asthma and COPD patients.
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Affiliation(s)
| | - Vaibhav Gaur
- Global Medical Affairs, Cipla Ltd, Mumbai, India
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3
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George M, Balantac Z, Gillette C, Farooqui N, Tervonen T, Thomas C, Gilbert I, Gandhi H, Israel E. Suboptimal Control of Asthma Among Diverse Patients: A US Mixed Methods Focus Group Study. J Asthma Allergy 2022; 15:1511-1526. [PMID: 36313858 PMCID: PMC9601558 DOI: 10.2147/jaa.s377760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The US National Asthma Education and Prevention Program updates and Global Initiative for Asthma report encourage considering the patient perspective to improve asthma control. The objective of the present study was to collect data about the perceptions, experiences, and concerns of adult patients and caregivers of children with asthma regarding rescue, maintenance, and oral corticosteroid treatments. Patients and Methods In-person focus groups were conducted in three cities across the US. Participants also completed patient-reported outcome measures assessing asthma control and experiences. Results Focus groups were conducted in demographically and clinically diverse adults with asthma (five groups, n=34), caregivers of children with asthma (five groups, n=35), and adults with a dual diagnosis of asthma and chronic obstructive pulmonary disease (one group, n=5). Only 28% of patients were well-controlled by Asthma Control Test/Asthma Control Test-Caregiver Report and 18% by Asthma Impairment and Risk Questionnaire. Forty-four percent of participants reported not following their prescribed medical plan. Four key themes emerged from the focus groups: (1) asthma symptom control and monitoring are often inadequate; (2) treatments are often used incorrectly; (3) communication between health care professionals and patients or caregivers is often ineffective; and (4) concerns related to treatment and desires to improve treatment. Conclusion Control of asthma symptoms is suboptimal in the vast majority of patients and both patients and caregivers do not feel sufficiently informed about asthma. Health care providers should be encouraged to engage patients and caregivers in shared decision making for managing asthma and selecting treatments that integrate patient values, preferences, and lifestyles.
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Affiliation(s)
- Maureen George
- School of Nursing, Columbia University, New York, NY, USA,Correspondence: Maureen George, School of Nursing at CUIMC, Columbia University School of Nursing, 630 West 168th Street Mail Code 6, New York, NY, 10032, USA, Tel +1 212-305-1175; Tel +1 212-305-1175, Email
| | | | - Chris Gillette
- Department of Physician Assistant Studies, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Ileen Gilbert
- Medical Affairs-Respiratory, AstraZeneca, Wilmington, DE, USA
| | - Hitesh Gandhi
- Medical Affairs-Respiratory, AstraZeneca, Wilmington, DE, USA
| | - Elliot Israel
- Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
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4
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Imamoglu D, Yilmaz Z, Koruk I. Comparison of the knowledge and skill levels of pharmacists and pharmacy technicians on the implementation of inhaler drug-delivery devices: a cross-sectional study in Şanlıurfa, Turkey. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Exploring General Practitioners' Preferences and Experience with Respiratory Inhaler Devices. Pulm Ther 2022; 8:283-296. [PMID: 35908142 PMCID: PMC9458836 DOI: 10.1007/s41030-022-00197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Correct inhaler technique is essential for the optimal delivery of inhaled medicines and the successfully management of respiratory conditions. The general practitioner (GP), the prescriber of inhaled medicines, plays a crucial role in educating patients on inhaler technique. However, in the real-world setting, there are barriers. For the GP, it is time and competence and for the patient, it is their ability to recognise inhaler technique as an issue and their ability to maintain correct inhaler technique over time. This study aimed to determine GPs’ experience, skills and priority placed on inhaler technique and to identify factor(s) associated with inhaler technique competence. Methods This cross-sectional observational study design surveyed GPs’ perspectives on inhaler use and preferences for inhaler prescribing within their practice setting. GP inhaler technique was assessed. GPs were recruited through an established network of GP practices. Data collected include (i) practice demographics, (ii) inhaler technique opinions and experience, (iii) inhaler prescribing preferences and (iv) inhaler education history data. Data were analysed descriptively and multivariate logistic regression modelling was used to explore the relationship between outcomes and GPs’ ability to use devices correctly. Results A total of 227 GPs completed the inhaler survey. Sixty-three percent of GPs reported receiving previous inhaler education and 73.3% educated or checked their patients’ inhaler technique; 64.5% felt they were somewhat competent in doing so. GPs who reported not demonstrating inhaler technique believed that a pharmacist or a practice nurse would do so. When prescribing new inhaler devices, GPs considered the disease being treated first and then patient’s experience with inhalers; they often already have an inhaler preference and this was related to familiarity and perceived ease of use. For GPs, inhaler competence was not associated with their previous inhaler education or the priority placed on inhaler technique. Conclusion GPs do recognise the importance of inhaler technique in respiratory management but their technique can be better supported with regular educational updates to inform them about new inhalers and management practices and to support appropriate inhaler choices for their patients. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-022-00197-6.
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Rinaldi A, Katsaros D, Hawthorne J, D'Auria M, Brigham K, Bajars E, Franzese C, Coyne M. The current paradigm for biologic initiation: a mixed-methods exploration of practices, unmet needs, and innovation opportunities in self-injection training. Expert Opin Drug Deliv 2021; 18:1151-1168. [PMID: 33896303 DOI: 10.1080/17425247.2021.1912009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Self-injection, particularly of biologics, has become a mainstay of chronic disease management. Despite labeling requirement for healthcare provider (HCP) training, current injection initiation experiences have been shown to be suboptimal. This study characterizes gaps in training and support during initiation and identifies rationales to inform solutions. METHODS We enrolled HCPs (n = 18) performing routine biologic initiation and patients (n = 24) currently self-injecting biologics. Participants completed activities through an online, remote ethnography tool. We conducted two focus groups with biologic-naïve patients (n = 5). Data was analyzed using thematic frameworks, Q methodology, and quantitative assessments. RESULTS Our results suggest considerable gaps exist. Analysis revealed five common themes that could explain these gaps: 1) minimal biologic-specific professional instruction is provided to HCPs; 2) nuanced injection use-steps are not universally understood; 3) no one stakeholder currently 'owns' training; 4) support offered by HCPs and manufacturers is perceived as biased; and 5) emotional burden is not accounted for. CONCLUSIONS Our study suggests optimizing several elements to facilitate successful initiations, including structured sessions, improved HCP injection device knowledge, demo-device practice, and focus on both emotional and mechanical aspects. Aligning these factors has potential to increase patient confidence, reduce burden on HCPs, and improve probability of success on therapy.
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Affiliation(s)
| | - Dimos Katsaros
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - James Hawthorne
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | | | | | | | - Chris Franzese
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Marty Coyne
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
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7
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Gilbert I, Aslam Mahmood A, Devane K, Tan L. Association of Nonmedical Switches in Inhaled Respiratory Medications with Disruptions in Care: A Retrospective Prescription Claims Database Analysis. Pulm Ther 2021; 7:189-201. [PMID: 33713011 PMCID: PMC8137790 DOI: 10.1007/s41030-021-00147-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction There are limited data on the effects of forced medication switching for a nonmedical reason in patients with obstructive airway conditions. This study evaluated disruption in care resulting from a nonmedical medication switch for patients with asthma and/or chronic obstructive pulmonary disease who previously received the inhaled corticosteroid/long-acting β2-agonist budesonide/formoterol. Methods This retrospective pharmacy benefit prescription claims analysis evaluated Medicare Part D patients who filled a prescription for budesonide/formoterol as their last inhaled corticosteroid/long-acting β2-agonist in 2016 and were affected by a formulary block of budesonide/formoterol in 2017. Changes to respiratory maintenance therapy, length of gaps in care during which a patient was not in possession of a respiratory controller medication, acute medication use indicative of disease exacerbations, and medication adherence were assessed. Results A total of 42,553 patients were included in the analysis. Following the formulary block, 30,016 patients (71%) switched to another controller; 20,628 of these patients (69%) switched to a new inhaled corticosteroid/long-acting β2-agonist, 7081 (23%) stepped down to a monotherapy, and 2307 (8%) switched to a non-inhaled corticosteroid-containing controller. Despite the formulary block, 22,903 patients (54%) attempted to fill budesonide/formoterol as their first postblock controller, and 6624 patients (16%) attempted to return to budesonide/formoterol after switching to another controller. On average, patients experienced a gap in care of approximately 4 months without a controller medication. Also, 9674 (23%) did not fill any controller over the 1-year postblock period. Of those patients who experienced a gap in care, 14,926 (47%) filled a prescription indicative of a possible exacerbation during the gap period (i.e., oral corticosteroids for patients with asthma and oral corticosteroids and/or antibiotics for patients with chronic obstructive pulmonary disease). Conclusions The Medicare Part D formulary block was associated with disruption in the management of patients’ respiratory conditions and may have adversely impacted disease control. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-021-00147-8.
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Affiliation(s)
| | | | | | - Laren Tan
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
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8
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Yoshida T, Kondo R, Horiguchi T. Long-term clinical effects of an inhaler guidance DVD in patients with bronchial asthma. FUJITA MEDICAL JOURNAL 2021; 7:83-86. [PMID: 35111550 PMCID: PMC8749500 DOI: 10.20407/fmj.2020-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/19/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Erroneous use of inhalers is a serious problem. Given the multitude of devices currently available, it can be difficult to convey the correct methods for their efficient use to patients. We previously generated an educational DVD that visually and audibly explains the proper use of all inhaler types available in Japan to provide inhalation guidance to patients. Herein, we report the 1-year follow-up of patients who received or did not receive the DVD guidance. METHODS Sixty-nine bronchial asthma patients undergoing outpatient treatment who received inhalation guidance from a pharmacist using a standard package insert were randomly allocated to a DVD group (n=35) or a no-DVD group (n=34). Their current oral or inhalant drug regimens were unchanged. Various parameters were measured 12 months later. Frequencies of aggravation during the 12-month period were also determined. RESULTS Compared with the no-DVD group, there were significant improvements in asthma control test scores, forced vital capacity, FEV1, impulse oscillometry, resonant frequency, induced sputum eosinophil count, and FeNO in the DVD group after 12 months. Pulmonary function and inflammation parameters improved significantly with the use of the instructive DVD in addition to the package inserts. The frequency of asthma aggravation significantly decreased in the DVD group during the 12-month study period, likely because inhalation procedures were performed accurately. CONCLUSIONS A DVD that provides accurate inhalation guidance enhances the quality of life of asthma patients and has substantial clinical ramifications. Thus, this tool would be beneficial for patients in Japan and worldwide.
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Affiliation(s)
- Takazumi Yoshida
- Department of Internal Medicine (Respiratory Medicine II), Fujita Health
University, School of Medicine, Nagoya, Aichi,
Japan
| | - Rieko Kondo
- Department of Internal Medicine (Respiratory Medicine II), Fujita Health
University, School of Medicine, Nagoya, Aichi,
Japan
| | - Takahiko Horiguchi
- Department of Internal Medicine (Respiratory Medicine II), Fujita Health
University, School of Medicine, Nagoya, Aichi,
Japan
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9
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Kellman DA, Iserson KV, Levy RD, McIntosh B, Maxwell Y. Brief Education Improves Proper Metered-Dose Inhaler Use. J Emerg Med 2020; 58:667-672. [PMID: 32245688 DOI: 10.1016/j.jemermed.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/28/2019] [Accepted: 02/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inhaled β-agonists are the cornerstone of acute treatment for asthma and chronic lung disease. Upon emergency department (ED) discharge, patients optimally receive prescriptions for metered-dose inhalers (MDIs) with instructions on their proper use. Yet prior studies suggest that ED personnel have limited knowledge of proper MDI techniques. It is unclear how effectively brief education will improve this knowledge to enable them to provide adequate patient instructions. OBJECTIVE Our aim was to evaluate ED medical personnel's baseline knowledge of MDI use and the utility of brief education on their ability to use MDIs. METHODS After providing written consent, a spirometry nurse evaluated emergency physicians and nurses on their ability to properly perform three (open-mouth/two-finger, spacer, and closed-mouth) MDI techniques. The same spirometry nurse then gave a short educational session demonstrating the proper MDI techniques. Two weeks later, the nurse re-evaluated the same personnel on their MDI techniques. RESULTS All emergency medical personnel initially performed poorly in demonstrating proper MDI technique, averaging 29.8% steps done correctly. Two weeks after their educational session, they improved greatly, averaging 89.4% steps done correctly. CONCLUSIONS This study demonstrated both that ED personnel had poor initial knowledge about MDI techniques and that a brief educational intervention improved most people's ability to use, and presumably to instruct patients/parents in proper use of, MDIs.
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Affiliation(s)
- Dwayne A Kellman
- Department of Emergency Medicine, Georgetown Public Hospital, Georgetown, Guyana
| | - Kenneth V Iserson
- Department of Emergency Medicine, Georgetown Public Hospital, Georgetown, Guyana; Department of Emergency Medicine, The University of Arizona, Tucson, Arizona
| | - Robert D Levy
- Pulmonary Hypertension Program, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada
| | - Belinda McIntosh
- Spirometry Clinic, Georgetown Public Hospital, Georgetown, Guyana
| | - Yusiny Maxwell
- Spirometry Clinic, Georgetown Public Hospital, Georgetown, Guyana
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10
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Abstract
Appropriate selection and correct use of inhalation devices is an integral component in the management of asthma and chronic obstructive pulmonary disease (COPD). It is well known that there are many challenges with the use of inhalers, and no one device suits all patients. Challenges can range from difficulties related to lung disease severity and pulmonary function to physical considerations, including manual dexterity and comorbidities such as arthritis. In terms of device selection and adherence, patient engagement and satisfaction are also important factors to consider. Furthermore, problems with inhaler use can be most evident in children and older patients. Here, we discuss aspects for consideration with commonly used devices, including nebulizers, pressurized metered-dose inhalers, dry powder inhalers, and the soft mist inhaler. As each inhaler offers varying technical properties, a tailored and personalized approach to the selection of the most appropriate device for the patient is highly recommended in order to increase the likelihood of achieving improved disease outcomes and enhance persistence with device adherence. Importantly, education and support is crucial, not only to enable patients to recognize the need for optimal disease management, but also to help them develop good inhaler technique. In addition, health care professionals should also aim to increase their knowledge of the devices they prescribe, and develop systems to ensure that they offer comprehensive support to patients in clinical practice. Considering these aspects, this review discusses potential strategies to help address the challenges of inhaler use in asthma and COPD.
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Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, Airways Disease Section, London, UK,
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11
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Kerwin EM, Preece A, Brintziki D, Collison KA, Sharma R. ELLIPTA Dry Powder Versus Metered-Dose Inhalers in an Optimized Clinical Trial Setting. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1843-1849. [PMID: 30836228 DOI: 10.1016/j.jaip.2019.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reduced error rates have been demonstrated with the ELLIPTA inhaler versus other commonly used devices. OBJECTIVE This phase IV, randomized, crossover study evaluated correct use of ELLIPTA compared with 2 commonly prescribed metered-dose inhalers (MDIs) in adults with asthma and optimized inhaler technique. METHODS The study comprised 2 crossover substudies (ELLIPTA vs MDI-1 and ELLIPTA vs MDI-2). Inhaler use was assessed at the start of each period, following instruction from a health care professional, and after 28 days of use without instruction. Data for each inhaler were pooled within substudies, irrespective of treatment sequence; study objectives were addressed in each substudy. The primary end point, percentage of participants making 0 errors after 28 days of use, was analyzed separately for each substudy using a Mainland-Gart test for each ELLIPTA versus MDI comparison. RESULTS Correct use rates after 28 days were higher with ELLIPTA than with MDI-1 and MDI-2 (ELLIPTA vs MDI-1, 96% vs 84%; ELLIPTA vs MDI-2, 98% vs 91%). Among discordant cases, statistically significantly more participants correctly used ELLIPTA but made 1 or more overall error with MDIs than did those who correctly used the MDIs but made 1 or more overall error using ELLIPTA (87% vs 13% in both substudies; P < .001 and P = .007 for ELLIPTA vs MDI-1 and ELLIPTA vs MDI-2, respectively). More participants made multiple device errors with MDIs than with ELLIPTA. CONCLUSIONS Inhaler technique can be optimized in trial settings. In such settings, ELLIPTA is associated with higher rates of correct use and lower error rates than are MDIs.
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Affiliation(s)
- Edward M Kerwin
- Clinical Research Institute of Southern Oregon, Medford, Ore.
| | - Andrew Preece
- Respiratory Therapy Area Unit, GlaxoSmithKline plc., Stockley Park West, Uxbridge, Middlesex, United Kingdom
| | - Dimitra Brintziki
- Respiratory Clinical Statistics, GlaxoSmithKline plc., Stockley Park West, Uxbridge, Middlesex, United Kingdom
| | | | - Raj Sharma
- Respiratory Medical Franchise, GlaxoSmithKline plc., Brentford, Middlesex, United Kingdom
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Khurana AK, Dubey K, Goyal A, Pawar KS, Phulwaria C, Pakhare A. Correcting inhaler technique decreases severity of obstruction and improves quality of life among patients with obstructive airway disease. J Family Med Prim Care 2019; 8:246-250. [PMID: 30911514 PMCID: PMC6396621 DOI: 10.4103/jfmpc.jfmpc_259_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Asthma and chronic obstructive lung disease (COPD) together constitute a huge burden on healthcare all around the world. Treatment of these patients is largely dependent on the way the inhalation devices are used. This study aimed at measuring the impact of rectification of inhalation technique on quality of life and severity of obstruction in patients with asthma and COPD. Materials and Methods A total of 45 asthma (partly controlled) and 38 patients with COPD (categories B and C) were enrolled after applying optimal exclusion criteria. These patients underwent Asthma Control Test (ACT)/COPD Assessment Test (CAT) questionnaire as a measure of quality of life and forced expiratory volume in one second (FEV1) as a measure of severity of obstruction at 0 and 4 weeks, respectively. Results In asthmatics, the mean FEV1 improved from 2.0 to 2.15 L after 4 weeks of technique correction (P < 0.001). In addition, the mean ACT scores improved from 18.0 to 20.75 (P < 0.001). In patients with COPD, the mean FEV1 improved slightly from 1.54 to 1.56 L after 4 weeks of technique correction (P = 0.28). In addition, the mean CAT scores improved from 21.86 to 19.83 (P < 0.001). Conclusion Demonstration of correct inhalation technique should be an indispensible part of the treatment prescription of patients with obstructive airway disease. This simple and important task can be undertaken at the level of primary care physicians in a community-based setting to improve patient compliance.
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Affiliation(s)
| | - Kapil Dubey
- MBBS Student, AIIMS, Bhopal, Madhya Pradesh, India
| | - Abhishek Goyal
- Department of Pulmonary Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Kamendra Singh Pawar
- Department of Pulmonary Medicine, Index Medical College, Indore, Madhya Pradesh, India
| | | | - Abhijit Pakhare
- Department of Community and Family Medicine, AIIMS, Bhopal, Madhya Pradesh, India
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Price DB, Thomas V, Richard Dekhuijzen PN, Bosnic-Anticevich S, Roche N, Lavorini F, Raju P, Freeman D, Nicholls C, Small IR, Sims E, Safioti G, Canvin J, Chrystyn H. Evaluation of inhaler technique and achievement and maintenance of mastery of budesonide/formoterol Spiromax® compared with budesonide/formoterol Turbuhaler® in adult patients with asthma: the Easy Low Instruction Over Time (ELIOT) study. BMC Pulm Med 2018; 18:107. [PMID: 29954359 PMCID: PMC6022306 DOI: 10.1186/s12890-018-0665-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/29/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Incorrect inhaler technique is a common cause of poor asthma control. This two-phase pragmatic study evaluated inhaler technique mastery and maintenance of mastery with DuoResp® (budesonide-formoterol [BF]) Spiromax® compared with Symbicort® (BF) Turbuhaler® in patients with asthma who were receiving inhaled corticosteroids/long-acting β2-agonists. METHODS In the initial cross-sectional phase, patients were randomized to a 6-step training protocol with empty Spiromax and Turbuhaler devices. Patients initially demonstrating ≥1 error with their current device, and then achieving mastery with both Spiromax and Turbuhaler (absence of healthcare professional [HCP]-observed errors), were eligible for the longitudinal phase. In the longitudinal phase, patients were randomized to BF Spiromax or BF Turbuhaler. Co-primary endpoints were the proportions of patients achieving device mastery after three training steps and maintaining device mastery (defined as the absence of HCP-observed errors after 12 weeks of use). Secondary endpoints included device preference, handling error frequency, asthma control, and safety. Exploratory endpoints included assessment of device mastery by an independent external expert reviewing video recordings of a subset of patients. RESULTS Four hundred ninety-three patients participated in the cross-sectional phase, and 395 patients in the longitudinal phase. In the cross-sectional phase, more patients achieved device mastery after three training steps with Spiromax (94%) versus Turbuhaler (87%) (odds ratio [OR] 3.77 [95% confidence interval (CI) 2.05-6.95], p < 0.001). Longitudinal phase data indicated that the odds of maintaining inhaler mastery at 12 weeks were not statistically significantly different (OR 1.26 [95% CI 0.80-1.98], p = 0.316). Asthma control improved in both groups with no significant difference between groups (OR 0.11 [95% CI -0.09-0.30]). An exploratory analysis indicated that the odds of maintaining independent expert-verified device mastery were significantly higher for patients using Spiromax versus Turbuhaler (OR 2.11 [95% CI 1.25-3.54]). CONCLUSIONS In the cross-sectional phase, a significantly greater proportion of patients using Spiromax versus Turbuhaler achieved device mastery; in the longitudinal phase, the proportion of patients maintaining device mastery with Spiromax versus Turbuhaler was similar. An exploratory independent expert-verified analysis found Spiromax was associated with higher levels of device mastery after 12 weeks. Asthma control was improved by treatment with both BF Spiromax and BF Turbuhaler. TRIAL REGISTRATION EudraCT 2013-004630-14 (registration date 23 January 2014); NCT02570425 .
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Affiliation(s)
- David B. Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
- University of Aberdeen, Aberdeen, UK
| | - Vicky Thomas
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | | | | | | | | | - Priyanka Raju
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - Daryl Freeman
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - Carole Nicholls
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - Iain R. Small
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - Erika Sims
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Janice Canvin
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
| | - Henry Chrystyn
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
- Inhalation Consultancy Ltd, Leeds, Yeadon UK
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Sari Kundt F, Enthaler N, Dieplinger AM, Studnicka M, Knoll A, Osterbrink J, Johansson T, Flamm M. Multiprofessional COPD care in Austria-challenges and approaches : Results of a qualitative study. Wien Klin Wochenschr 2018; 130:371-381. [PMID: 29808349 PMCID: PMC6008351 DOI: 10.1007/s00508-018-1346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/05/2018] [Indexed: 12/03/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a frequent disease of the lungs. Its prevalence was estimated to be 26% in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I and 11% for GOLD II-IV in Austria. Globally, it ranks third in mortality rate. The particular challenge is that care for these patients falls short due to the lack of structured integrated care. The aim was to assess the current status of multiprofessional COPD care in Austria and identify gaps and potentials. METHODS We conducted guided focus group interviews between March and July 2016 addressing current COPD care and treatment gaps with the following professional and interest groups: general practitioners, nurses, patients, pharmacists, physiotherapists and pulmonologists. We interviewed 23 patients and 27 healthcare professionals. The interviews were transcribed verbatim and coded into 12 relevant categories. RESULTS There needs to be a shift in thinking from treatment-based care to prevention. Patients, just like healthcare professionals, need periodic updates and comprehensive information on this disease. Creating internet platforms with useful information for COPD patients and solving the data privacy issues of the Austrian electronic medical record (ELGA) are also perceived as viable steps. There is a need and request for healthcare professionals to work as a team with clear COPD management guidelines in the outpatient sector, the establishment of outpatient rehabilitation centers as well as creating a new professional profile, the COPD nurse. CONCLUSION Current COPD care needs to be reorganized, particularly in the outpatient sector, to address the needs of patients and healthcare professionals.
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Affiliation(s)
- Firuzan Sari Kundt
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - Nina Enthaler
- Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Anna Maria Dieplinger
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Michael Studnicka
- Department of Pneumology, Salzburger Landeskliniken, Paracelsus Medical University, Salzburg, Austria
| | - Anna Knoll
- Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Tim Johansson
- Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Maria Flamm
- Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
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15
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Ding B, Small M, Scheffel G, Holmgren U. Maintenance inhaler preference, attribute importance, and satisfaction in prescribing physicians and patients with asthma, COPD, or asthma-COPD overlap syndrome consulting for routine care. Int J Chron Obstruct Pulmon Dis 2018; 13:927-936. [PMID: 29588581 PMCID: PMC5859902 DOI: 10.2147/copd.s154525] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background In respiratory disorders, patient- and physician-perceived satisfaction with the maintenance inhaler device is an important factor driving treatment compliance and outcomes. We examine inhaler preferences in asthma and COPD from patient and physician perspectives, particularly focusing on the relative importance of individual device attributes and patient characteristics guiding inhaler choice. Materials and methods Real-world data from >7,300 patients with asthma, COPD, or asthma–COPD overlap syndrome (ACOS) consulting for routine care were derived from respiratory Disease Specific Programs conducted in Europe, USA, Japan, and China. Outcome variables included current pattern of inhaled maintenance therapy and device type, physician preference, patient-reported device attribute importance, and satisfaction. Results The most commonly prescribed inhalers for maintenance therapy of asthma, COPD, and ACOS were dry powder inhalers (62.8%–88.5% of patients) and pressurized metered dose inhalers (18.9%–35.3% of patients). One-third of physicians stated no preference for maintenance device when prescribing treatment, and less than one-third of patients reported being “extremely satisfied” with any attribute of their device. Instructions being “simple and easy to follow” was the inhaler attribute most commonly selected as important. For approximately one-third of patients across all groups, “ease of use/suitability of inhaler device” was a reason for the prescribing decision, as stated by the physician. Device characteristics were more likely to impact the prescribing decision in older patients (in asthma and COPD; P<0.01) and those with worse disease severity (in COPD; P<0.001). Conclusion A relatively high proportion of physicians had no preference for inhaler type across asthma, COPD, and ACOS. Simplicity of use was the most important inhaler attribute from a patient’s perspective. Physicians appeared to place most importance on ease of use and device suitability when selecting inhalers for older patients and those with more severe disease, particularly in COPD.
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Affiliation(s)
- Bo Ding
- Medical Evidence and Observational Research, AstraZeneca Gothenburg, Mölndal, Sweden
| | - Mark Small
- Real World Research (Respiratory), Adelphi Real World, Bollington, UK
| | - Gina Scheffel
- Global Payer Evidence and Pricing, AstraZeneca Gothenburg, Mölndal, Sweden
| | - Ulf Holmgren
- Global Payer Evidence and Pricing, AstraZeneca Gothenburg, Mölndal, Sweden
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16
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Horiguchi T, Kondo R. Determination of the preferred tongue position for optimal inhaler use. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1039-1041.e3. [PMID: 29410307 DOI: 10.1016/j.jaip.2018.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/09/2018] [Accepted: 01/13/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Takahiko Horiguchi
- Department of Respiratory Medicine II, Fujita Health University School of Medicine, Nakagawa-ku, Nagoya, Japan.
| | - Rieko Kondo
- Department of Respiratory Medicine II, Fujita Health University School of Medicine, Nakagawa-ku, Nagoya, Japan
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17
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DePietro M, Gilbert I, Millette LA, Riebe M. Inhalation device options for the management of chronic obstructive pulmonary disease. Postgrad Med 2017; 130:83-97. [PMID: 29210318 DOI: 10.1080/00325481.2018.1399042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by chronic respiratory symptoms and airflow limitation, resulting from abnormalities in the airway and/or damage to the alveoli. Primary care physicians manage the healthcare of a large proportion of patients with COPD. In addition to determining the most appropriate medication regimen, which usually includes inhaled bronchodilators with or without inhaled corticosteroids, physicians are charged with optimizing inhalation device selection to facilitate effective drug delivery and patient adherence. The large variety of inhalation devices currently available present numerous challenges for physicians that include: (1) gaining knowledge of and proficiency with operating different device classes; (2) identifying the most appropriate inhalation device for the patient; and (3) providing the necessary education and training for patients on device use. This review provides an overview of the inhalation device types currently available in the United States for delivery of COPD medications, including information on their successful operation and respective advantages and disadvantages, factors to consider in matching a device to an individual patient, the need for device training for patients and physicians, and guidance for improving treatment adherence. Finally, the review will discuss established and novel tools and technology that may aid physicians in improving education and promoting better adherence to therapy.
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Affiliation(s)
| | - Ileen Gilbert
- a Medical Affairs , AstraZeneca LP , Wilmington , DE , USA
| | | | - Michael Riebe
- b Inhalation Product Development , AstraZeneca LP , Durham , NC , USA
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18
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Takita K, Kondo R, Horiguchi T. Effectiveness of training patients using DVD in the accurate use of inhalers for the treatment of bronchial asthma. Allergol Int 2017; 66:545-549. [PMID: 28336254 DOI: 10.1016/j.alit.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/16/2016] [Accepted: 01/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inhalants are the standard treatment for patients with bronchial asthma. Inaccurate inhaler use leads to inadequate therapeutic effects and unnecessary dosage increases. However, it is a challenge for practitioners to master the various devices available and train patients on the accurate use of inhalers. Thus, establishing a system to instruct patients on how to accurately use inhalers is essential. We prepared a DVD and accompanying user manual explaining the operation of each inhaler device used in Japan. This pilot study aimed to examine the efficacy of these materials. METHODS The subjects were 33 outpatients with bronchial asthma who received treatment in our facility for asthma and had already received conventional inhalant training. The oral medication and inhalants used by the patients were not changed. The patients were randomly assigned to a DVD viewing group or non-viewing group; various parameters were comparatively examined after 4 weeks. RESULTS Significant improvements in Asthma Control Test scores, inhalation technique, forced vital capacity, forced expiratory volume in 1 s, impulse oscillometry resonant frequency, and induced sputum eosinophil count were observed in the DVD viewing group at 4 weeks post training. CONCLUSIONS Pulmonary function and inflammatory parameters improved significantly in the DVD viewing group. These findings suggest that unnecessary step-up of asthma treatment can be avoided, leading to treatment cost reduction. Training patients with asthma in accurate inhaler use improves quality of life and therefore has great clinical significance. Hence, this method should be used more extensively in Japan and worldwide.
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Affiliation(s)
- Koichiro Takita
- Department of Respiratory Medicine II, Fujita Health University School of Medicine, Nagoya, Japan.
| | - Rieko Kondo
- Department of Respiratory Medicine II, Fujita Health University School of Medicine, Nagoya, Japan
| | - Takahiko Horiguchi
- Department of Respiratory Medicine II, Fujita Health University School of Medicine, Nagoya, Japan
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19
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Thomas RM, Locke ER, Woo DM, Nguyen EHK, Press VG, Layouni TA, Trittschuh EH, Reiber GE, Fan VS. Inhaler Training Delivered by Internet-Based Home Videoconferencing Improves Technique and Quality of Life. Respir Care 2017; 62:1412-1422. [PMID: 28720676 DOI: 10.4187/respcare.05445] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND COPD is common, and inhaled medications can reduce the risk of exacerbations. Incorrect inhaler use is also common and may lead to worse symptoms and increased exacerbations. We examined whether inhaler training could be delivered using Internet-based home videoconferencing and its effect on inhaler technique, self-efficacy, quality of life, and adherence. METHODS In this pre-post pilot study, participants with COPD had 3 monthly Internet-based home videoconference visits with a pharmacist who provided inhaler training using teach-to-goal methodology. Participants completed mailed questionnaires to ascertain COPD severity, self-efficacy, health literacy, quality of life, adherence, and satisfaction with the intervention. RESULTS A total of 41 participants completed at least one, and 38 completed all 3 home videoconference visits. During each visit, technique improved for all inhalers, with significant improvements for the albuterol metered-dose inhaler, budesonide/formoterol metered-dose inhaler, and tiotropium dry powder inhaler. Improved technique was sustained for nearly all inhalers at 1 and 2 months. Quality of life measured with the Chronic Respiratory Questionnaire improved following the training: dyspnea (+0.3 points, P = .01), fatigue (+0.6 points, P < .001), emotional function (+0.5 points, P = .001), and mastery (+0.7 points, P < .001). Coping skills measured with the Seattle Obstructive Lung Disease Questionnaire improved (+9.9 points, P = .003). Participants reported increased confidence in inhaler use; for example, mean self-efficacy for using albuterol increased 3 points (P < .001). Inhaler adherence improved significantly after the intervention from 1.6 at the initial visit to 1.1 at month 2 (P = .045). The pharmacist reported technical issues in 64% of visits. CONCLUSIONS Inhaler training using teach-to-goal methodology delivered by home videoconference is a promising means to provide training to patients with COPD that can improve technique, quality of life, self-efficacy, and adherence.
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Affiliation(s)
- Rachel M Thomas
- Health Services Research and Development Service, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Emily R Locke
- Health Services Research and Development Service, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Deborah M Woo
- Health Services Research and Development Service, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Ethan H K Nguyen
- Health Services Research and Development Service, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Valerie G Press
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Troy A Layouni
- Health Services Research and Development Service, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Emily H Trittschuh
- Geriatric Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences
| | - Gayle E Reiber
- Health Services Research and Development Service, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Vincent S Fan
- Health Services Research and Development Service, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care.,Department of Medicine, University of Washington, Seattle, Washington
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20
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Bell D, Mansfield L, Lomax M. A Randomized, Crossover Trial Evaluating Patient Handling, Preference, and Ease of Use of the Fluticasone Propionate/Formoterol Breath-Triggered Inhaler. J Aerosol Med Pulm Drug Deliv 2017; 30:425-434. [PMID: 28683212 DOI: 10.1089/jamp.2017.1385] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Appropriate inhaler selection is of fundamental importance in obstructive lung disease management. Key factors in device selection include a patient's capacity to operate a particular device and their preference for it. METHODS This randomized, open-label, two-period, crossover study (NCT01739387) compared the ability of adolescent and adult patients with obstructive lung disease to correctly handle the fluticasone propionate/formoterol fumarate (FP/FORM; Flutiform®) pressurized metered-dose inhaler (pMDI) and FP/FORM K-haler®, a novel breath-triggered inhaler (BTI), following a simple, standardized training regimen. The primary endpoint was the ability to perform all steps correctly at the first attempt. Secondary endpoints included the ability to perform all critical steps correctly at the first attempt, the requisite number of attempts to successfully use the inhaler, the ability to be trained within 15 minutes, and the ability to trigger the K-haler BTI to actuate at the first attempt. Ease of device use and device preference versus patients' usual maintenance inhalers were also assessed. RESULTS AND CONCLUSIONS At the first attempt, an identical proportion (77.2% [95% confidence interval [CI]: 72.1, 81.8]) of 307 patients performed all pMDI and K-haler BTI handling steps correctly, whereas the corresponding proportions performing all critical steps correctly were 82.4% (95% CIs: 77.7, 86.5) and 87.0% (95% CI: 82.7, 90.5), respectively. For both devices, >90% of patients required only two attempts to master device usage; >99% of patients could be trained to correctly use each device within 15 minutes. Virtually all patients (99.0% [95% CIs: 97.2, 99.8]) were able to successfully trigger the K-haler BTI's dose-release mechanism at first attempt. Ease of use and preference data for FP/FORM pMDI challenged the perceived wisdom that dry powder inhalers are necessarily simpler to use, whereas the corresponding data for FP/FORM K-haler strongly favored this novel BTI over the Turbuhaler®, Accuhaler®, and other pMDIs.
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Affiliation(s)
- David Bell
- 1 BioKinetic Europe Limited , Belfast, Northern Ireland
| | | | - Mark Lomax
- 2 Mundipharma Research Limited , Cambridge, United Kingdom
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21
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Dudvarski Ilic A, Zugic V, Zvezdin B, Kopitovic I, Cekerevac I, Cupurdija V, Perhoc N, Veljkovic V, Barac A. Influence of inhaler technique on asthma and COPD control: a multicenter experience. Int J Chron Obstruct Pulmon Dis 2016; 11:2509-2517. [PMID: 27785007 PMCID: PMC5063589 DOI: 10.2147/copd.s114576] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The successful management of asthma and chronic obstructive pulmonary disease (COPD) mostly depends on adherence to inhalation drug therapy, the usage of which is commonly associated with many difficulties in real life. Improvement of patients' adherence to inhalation technique could lead to a better outcome in the treatment of asthma and COPD. OBJECTIVE The aim of this study was to assess the utility of inhalation technique in clinical and functional control of asthma and COPD during a 3-month follow-up. METHODS A total of 312 patients with asthma or COPD who used dry powder Turbuhaler were enrolled in this observational study. During three visits (once a month), training in seven-step inhalation technique was given and it was practically demonstrated. Correctness of patients' usage of inhaler was assessed in three visits by scoring each of the seven steps during administration of inhaler dose. Assessment of disease control was done at each visit and evaluated as: fully controlled, partially controlled, or uncontrolled. Patients' subjective perception of the simplicity of inhalation technique, disease control, and quality of life were assessed by using specially designed questionnaires. RESULTS Significant improvement in inhalation technique was achieved after the third visit compared to the first one, as measured by the seven-step inhaler usage score (5.94 and 6.82, respectively; P<0.001). Improvement of disease control significantly increased from visit 1 to visit 2 (53.9% and 74.5%, respectively; P<0.001) and from visit 2 to visit 3 (74.5% and 77%, respectively; P<0.001). Patients' subjective assessment of symptoms and quality of life significantly improved from visit 1 to visit 3 (P<0.001). CONCLUSION Adherence to inhalation therapy is one of the key factors of successful respiratory disease treatment. Therefore, health care professionals should insist on educational programs aimed at improving patients' inhalation technique with different devices, resulting in better long-term disease control and improved quality of life.
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Affiliation(s)
- Aleksandra Dudvarski Ilic
- Faculty of Medicine, University of Belgrade
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade
| | - Vladimir Zugic
- Faculty of Medicine, University of Belgrade
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade
| | - Biljana Zvezdin
- Faculty of Medicine, University of Novi Sad, Novi Sad
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica
| | - Ivan Kopitovic
- Faculty of Medicine, University of Novi Sad, Novi Sad
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica
| | - Ivan Cekerevac
- Faculty of Medicine, University of Kragujevac
- Clinic for Pulmonology, Clinical Centre Kragujevac, Kragujevac
| | - Vojislav Cupurdija
- Faculty of Medicine, University of Kragujevac
- Clinic for Pulmonology, Clinical Centre Kragujevac, Kragujevac
| | - Nela Perhoc
- Clinic for Pulmonary Diseases Knez Selo, Clinical Centre Nis, Nis
| | - Vesna Veljkovic
- Clinic for Pulmonary Diseases Knez Selo, Clinical Centre Nis, Nis
| | - Aleksandra Barac
- Faculty of Stomatology, University Academy of Business Novi Sad, Novi Sad, Serbia
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22
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Optimising Inhaled Pharmacotherapy for Elderly Patients with Chronic Obstructive Pulmonary Disease: The Importance of Delivery Devices. Drugs Aging 2016; 33:461-73. [DOI: 10.1007/s40266-016-0377-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Koblizek V, Novotna B, Zbozinkova Z, Hejduk K. Diagnosing COPD: advances in training and practice - a systematic review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2016; 7:219-31. [PMID: 27099544 PMCID: PMC4825818 DOI: 10.2147/amep.s76976] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung syndrome, caused by long-term inhalation of noxious gases and particles, which leads to gradual airflow limitation. All health care professionals who care for COPD patients should have full access to high-quality spirometry testing, as postbronchodilator spirometry constitutes the principal method of COPD diagnosis. One out of four smokers 45 years or older presenting respiratory symptoms in primary care, have non-fully reversible airflow limitation compatible with COPD and are mostly without a known diagnosis. Approximately 50.0%-98.3% of patients are undiagnosed worldwide. The majority of undiagnosed COPD patients are isolated at home, are in nursing or senior-assisted living facilities, or are present in oncology and cardiology clinics as patients with lung cancers and coronary artery disease. At this time, the prevalence and mortality of COPD subjects is increasing, rapidly among women who are more susceptible to risk factors. Since effective management strategies are currently available for all phenotypes of COPD, correctly performed and well-interpreted postbronchodilator spirometry is still an essential component of all approaches used. Simple educational training can substantially improve physicians' knowledge relating to COPD diagnosis. Similarly, a physician inhaler education program can improve attitudes toward inhaler teaching and facilitate its implementation in routine clinical practices. Spirometry combined with inhaled technique education improves the ability of predominantly nonrespiratory physicians to correctly diagnose COPD, to adequately assess its severity, and to increase the percentage of correct COPD treatment used in a real-life setting.
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Affiliation(s)
- Vladimir Koblizek
- Department of Pneumology, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
- Correspondence: Vladimir Koblizek, Department of Pneumology, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Sokolska 581, 500 05 Hradec Králové, Czech Republic, Tel +420 495 834 771, Email
| | - Barbora Novotna
- Department of Pneumology, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zuzana Zbozinkova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Karel Hejduk
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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