Educação de pacientes com asma: atuação do enfermeiro

Most frequent errors in inhalation technique of patients with asthma treated at a tertiary care hospital

OBJECTIVE

To demonstrate the most frequent errors in inhalation technique in patients with asthma undergoing treatment at a tertiary care hospital.

METHODS

A cross-sectional study with a convenience sample of asthma patients aged 18 years or over, treated at a pulmonology outpatient clinic of a tertiary care hospital. The assessment of inhalation technique of users of the dry powder inhalers Aerolizer®, Aerocaps and Diskus®, or metered-dose inhalers was based on the manufacturer's instructions for use of each inhaler device. Patients demonstrated the inhalation technique with empty inhaler devices, and it was considered correct when all stages were performed properly, or when errors probably did not interfere with the treatment outcome.

RESULTS

Among 71 participants, 43 (60.5%) performed inhalation technique incorrectly. Among metered-dose inhalers and dry powder inhalers users, inhalation technique errors were found in 84.2% and 51.9%, respectively (p=0.013). Errors were more frequent at the exhalation stage (67.4%), followed by breathing in (58.1%) and apnea (51.2%). In the group using dry powder inhalers, the most common errors occurred during exhalation and, for those using metered-dose inhalers, the most compromised stage was aspiration.

CONCLUSION

Errors were more frequent among those using metered-dose inhalers compared with dry powder inhalers. Misconceptions are more common at the expiration stage among users of dry powder inhalers and in aspiration among those on metered-dose inhalers.

Incorrect use of inhalation devices among patients with bronchial asthma. A hospital-based cross-sectional study in Rio de Janeiro, Brazil

CONTEXT AND OBJECTIVE

Treatment of asthma implies inhalation of specific drugs to reach high concentrations in the respiratory tree and ensure low drug bioavailability and few adverse effects. This study aimed to evaluate the effectiveness of the inhalation technique among outpatients with asthma.

DESIGN AND SETTING

Tertiary-care hospital-based cross-sectional study in Rio de Janeiro.

METHODS

We evaluated inhalation practices in a convenience sample. A questionnaire was used to investigate sociodemographic data and assess disease control level, duration of use of the inhalation device, length of treatment and previous instructions provided by the prescribing physician. Patients demonstrated their inhalation technique using empty devices, and their technique was considered correct when all steps were appropriately performed or when errors did not interfere with the treatment outcome.

RESULTS

Among the 71 participants, 53 (74.7%) had been using the same inhaler device for at least two years and 41 (57.8%) had been under treatment for two years or more. Twelve (17.1%) said that they had been taught once and 57 (81.4%) at least twice, while one (1.4%) reported not having received any guidance regarding use of inhaler devices. Eighteen patients (25.3%) presented controlled asthma and 28 (39.5%) performed the inhalation technique correctly. Incorrect technique was associated with fewer evaluations of the inhalation technique (P =0.04) and uncontrolled asthma (P = 0.01).

CONCLUSIONS

Less than half of the sample performed the inhalation technique correctly. Incorrect inhalation technique was related to lower number of evaluations of the use of the inhalation device and uncontrolled asthma.

Asthma self-management model: randomized controlled trial

Information for patients provided by the pharmacist is reflected in adhesion to treatment, clinical results and patient quality of life. The objective of this study was to assess an asthma self-management model for rational medicine use. This was a randomized controlled trial with 60 asthmatic patients assigned to attend five modules presented by a pharmacist (intervention group) and 59 patients in the control group. Data collection was performed before and after this 4-month intervention and included an evaluation of asthma knowledge, lifestyle, inhaler techniques, adhesion to treatment, pulmonary function and quality of life. An economic viability analysis was also performed. The intervention group obtained an increase in asthma knowledge scores of 58.3-79.5% (P < 0.001). In this group, there was also an increase in the number of individuals who practiced physical exercise (36-43%), in the number of correct replies regarding the use of inhalers, in the percentage of adherent patients, and in quality of life scores for all domains. We concluded that this asthma self-management model was effective in improving the quality of life of asthma patients.

Level of asthma control and its impact on activities of daily living in asthma patients in Brazil

OBJECTIVE:

To evaluate the impact of asthma on activities of daily living and on health status in patients with controlled, partially controlled, or uncontrolled asthma in Brazil.

METHODS:

We used data related to 400 patients in four Brazilian cities (São Paulo, Rio de Janeiro, Salvador, and Curitiba), obtained in a survey conducted throughout Latin America in 2011. All study subjects were > 12 years of age and completed a standardized questionnaire in face-to-face interviews. The questions addressed asthma control, hospitalizations, emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. The level of asthma control was determined in accordance with the Global Initiative for Asthma criteria.

RESULTS:

Among the 400 respondents, asthma was controlled in 37 (9.3%), partially controlled in 226 (56.5%), and uncontrolled in 137 (34.2%). The numbers of patients with uncontrolled or partially controlled asthma who visited the emergency room, who were hospitalized, and who missed school/work were higher than were those of patients with controlled asthma (p = 0.001, p = 0.05, and p = 0.01, respectively). Among those with uncontrolled asthma, the impact of the disease on activities of daily living, sleep, social activities, and normal physical exertion was greater than it was among those with controlled or partially controlled asthma (p < 0.001).

CONCLUSIONS:

In Brazil, asthma treatment should be monitored more closely in order to increase treatment adherence and, consequently, the level of asthma control, which can improve patient quality of life and minimize the negative impact of the disease.

[Themes addressed in nursing consultation: integrative literature review]

The study aimed to analyze the aspects of the nursing consultation (NC) in scientific publications. It was conducted an integrative literature review available in databases: LILACS, PUBMED, CINAHL and COCHRANE. 31 articles were selected that met the inclusion criteria. The themes most addressed on the NC were: factors affecting the NC, time and cost of consultations, assessment of nursing records, use of interview scripts, communication, systematization of nursing care, meaning and importance of the NC to promote health. It was concluded that various aspects of nursing consultation are being addressed in the articles analyzed. However, studies are needed to confirm its efficacy.

Knowledge of and technique for using inhalation devices among asthma patients and COPD patients

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.

Two-year evaluation of an educational program for adult outpatients with asthma

OBJECTIVE

To evaluate the understanding of asthma and the clinical improvement in patients with moderate or severe persistent asthma prior to and after their participation in an educational program presented during the routine outpatient visits.

METHODS

This was a prospective pilot study involving 164 patients over a two-year period. The educational program, presented to small groups on outpatient visit days, consisted of lectures divided into three parts: pathophysiology; environmental control; and treatment, including training in the inhalation technique. The program was evaluated using standardized questionnaires on clinical improvement and understanding of the disease.

RESULTS

By the end of the first year, 120 patients had completed three visits, and 51 of those patients were re-evaluated at the end of the second year. The mean age of the patients was 44 years, 70% were female, and 43% had up to eight years of schooling. The educational intervention significantly increased the understanding of the disease (p < 0.001), and allowed greater clinical improvement (p < 0.05) with a decrease in the use of oral corticosteroids, fewer visits to the emergency room and fewer days missed from work or school.

CONCLUSIONS

The educational program offered during the routine outpatient visits of adult patients with asthma at our clinic resulted in a progressive long-term increase in knowledge, as well as in clinical improvement.

[Knowledge and impact on disease management by asthmatic patients]

Asthma is a disorder characterized by obstruction episodes of the respiratory tract. A qualitative study was conducted to evaluate the knowledge of the asthmatic patients and its impact on disease management. The sample size formed by 30 asthmatic patients was directed by the research question and analytical requirements. The data was collected at Emergency Department Attendance of Health System located at Coronel Fabriciano, Ipatinga and Timóteo. Interviews were performed during the months of June and July 2005. The results showed that the knowledge of the asthmatic patients was regular or insufficient to prevent asthmatic crisis. The knowledge was associated to the individuals experience through the contact with risk factors. Then, is important to designed asthma education and prevention program.

Drug-related problems observed in a pharmaceutical care service, Belo Horizonte, Brazil

This present observational, longitudinal, and non-concurrent study was developed with the purposes of evaluate the profile of patients attended by a pharmacotherapeutic follow-up service and describe the Drug-Related Problems (DRPs) found over there; determine the proportion of DRPs between the health problems presented by the studied population, classifying them and identifying the situations related with their appearance. The study was developed at the School Pharmacy of Newton Paiva University Center, Belo Horizonte, MG, during the period from 2001 November up to 2003 November. Ninety seven patients have been evaluated, the majority of female sex (66.0%), with up to 8 years of scholarship (45.4%), mean age of 56.7 ± 13.0 years; mean of 4 ± 2 diagnosed diseases; 7 ± 6 complaints and 4 ± 2 medications per patient. Nine hundred and twelve health problems have been identified: 56.5% uncontrolled. From the uncontrolled problems, 380 (73.6%) were DRPs and between these, 81 (21.3%) were risks for DRP. From the 97 followed-up patients, 89 (91.7%) have presented at least one DRP during the follow-up. The more frequent DRPs were related to effectiveness (53.2%), to necessity (25.2%) and to safety (21.6%). A great number of uncontrolled problems was observed, as well as the possibility to resolve them by means of pharmaceutical care, indicating so the resolutive potential of this practice.

Freqüencia de publicações sobre a asma em periódicos de enfermagem indexados em bases de dados brasileiros: uma revisão da literatura

OBJETIVO: Analisar a freqüência das publicações sobre asma nos periódicos de enfermagem estrangeiros, presentes nos índices de referências informatizados da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e nacionais indexados em bases de dados informatizadas, considerando-se origem, índice de referência, periódico, ano de publicação, método utilizado, tipo de publicação e objeto de estudo. MÉTODOS: Os dados foram coletados através de formulário, utilizando-se os descritores de assunto asthma e asma para busca das produções. RESULTADOS: Foram identificados 56 artigos estrangeiros e três nacionais nos anos de 1994 a 2004. Os estudos sobre asma aparecem com maior freqüência nos anos de 2002 (12 estrangeiros e 1 nacional) e 2004 (14 estrangeiros). CONCLUSÕES: Este trabalho revelou a necessidade de maior produção e/ou divulgação do conhecimento produzido, principalmente em publicações brasileiras.

Associação entre controle ambiental domiciliar e exacerbação da asma em crianças e adolescentes do município de Camaragibe, Pernambuco

INTRODUÇÃO: A hipersensibilidade aos ácaros da poeira doméstica, mofo e pêlos de animais é comum entre pacientes com asma. As medidas de controle ambiental estão entre as várias ações terapêuticas, e buscam reduzir a exposição aos alérgenos. OBJETIVO: Verificar a prevalência de controle ambiental adequado em uma população atendida pelo programa de saúde da família e a possível associação com exacerbações de asma em crianças e adolescentes na faixa etária de 5 a 14 anos no município de Camaragibe (PE). MÉTODO: Estudo transversal com 210 mães/responsáveis por crianças/adolescentes em que se aplicaram os formulários do International Study of Asthma and allergies in children para caracterizar a exacerbação das crises de asma, e em que se utilizou o Guia de Avaliação Ambiental do Alérgico na observação direta do quarto e da sala das residências. RESULTADOS: Entre as 210 crianças/adolescentes que apresentaram asma em 2001, foi observado controle ambiental adequado em 141 casos (67,1%), não havendo associação entre o grau de controle ambiental e menor freqüência (< 3) de crises de asma (p = 0,39). Por outro lado, acessórios inadequados estavam presentes em 93 dormitórios (44,3%), inclusive com presença de cortinas de pano em 84 deles (40,2%). Exposição passiva ao fumo foi constatada em 77 asmáticos (36,7%). CONCLUSÃO: Na grande maioria das residências dos asmáticos encontrou-se nível de controle ambiental satisfatório. Esse fato pode ter contribuído para a não existência de associação significativa de controle ambiental adequado com menor freqüência de crises agudas na população estudada.