scholarly journals The Challenge of Delivering Therapeutic Aerosols to Asthma Patients

ISRN Allergy ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-17 ◽  
Author(s):  
Federico Lavorini
Keyword(s):  
Asthma Management ◽  
Dose Inhaler ◽  
Inhalation Technique ◽  
Management Guidelines ◽  
Inhaler Device ◽  
Peripheral Airways ◽  
Metered Dose ◽  
Asthma Patients ◽  
Patient Noncompliance ◽  
Inhaler Devices

The number of people with asthma continues to grow around the world, and asthma remains a poorly controlled disease despite the availability of management guidelines and highly effective medication. Patient noncompliance with therapy is a major reason for poor asthma control. Patients fail to comply with their asthma regimen for a wide variety of reasons, but incorrect use of inhaler devices is amongst the most common. The pressurised metered-dose inhaler (pMDI) is still the most frequently used device worldwide, but many patients fail to use it correctly, even after repeated tuition. Breath-actuated inhalers are easier to use than pMDIs. The rationale behind inhaler choice should be evidence based rather than empirical. When choosing an inhaler device, it is essential that it is easy to use correctly, dosing is consistent, adequate drug is deposited in both central and peripheral airways, and that drug deposition is independent of airflow. Regular checking of inhalation technique is crucial, as correct inhalation is one of the cornerstones of successful asthma management.

scholarly journals A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices

2016 ◽  
Vol 26 (1) ◽  
Author(s):  
Job van der Palen ◽  
Mike Thomas ◽  
Henry Chrystyn ◽  
Raj K Sharma ◽  
Paul DLPM van der Valk ◽  
...  
Keyword(s):  
Dose Inhaler ◽  
Chronic Obstructive ◽  
Information Leaflet ◽  
Metered Dose Inhaler ◽  
Open Label ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Metered Dose ◽  
Asthma Patients ◽  
Inhaler Devices

Abstract Errors in the use of different inhalers were investigated in patients naive to the devices under investigation in a multicentre, single-visit, randomised, open-label, cross-over study. Patients with chronic obstructive pulmonary disease (COPD) or asthma were assigned to ELLIPTA vs DISKUS (Accuhaler), metered-dose inhaler (MDI) or Turbuhaler. Patients with COPD were also assigned to ELLIPTA vs Handihaler or Breezhaler. Patients demonstrated inhaler use after reading the patient information leaflet (PIL). A trained investigator assessed critical errors (i.e., those likely to result in the inhalation of significantly reduced, minimal or no medication). If the patient made errors, the investigator demonstrated the correct use of the inhaler, and the patient demonstrated inhaler use again. Fewer COPD patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS, 9/171 (5%) vs 75/171 (44%); MDI, 10/80 (13%) vs 48/80 (60%); Turbuhaler, 8/100 (8%) vs 44/100 (44%); Handihaler, 17/118 (14%) vs 57/118 (48%); Breezhaler, 13/98 (13%) vs 45/98 (46%; all P<0.001). Most patients (57–70%) made no errors using ELLIPTA and did not require investigator instruction. Instruction was required for DISKUS (65%), MDI (85%), Turbuhaler (71%), Handihaler (62%) and Breezhaler (56%). Fewer asthma patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS (3/70 (4%) vs 9/70 (13%), P=0.221); MDI (2/32 (6%) vs 8/32 (25%), P=0.074) and significantly fewer vs Turbuhaler (3/60 (5%) vs 20/60 (33%), P<0.001). More asthma and COPD patients preferred ELLIPTA over the other devices (all P⩽0.002). Significantly, fewer COPD patients using ELLIPTA made critical errors after reading the PIL vs other inhalers. More asthma and COPD patients preferred ELLIPTA over comparator inhalers.

scholarly journals Metered-dose inhaler for asthma patients: knowledge and effects of a theoretical and practical guidance for pediatricians

2011 ◽  
Vol 9 (3) ◽  
pp. 337-342 ◽  
Author(s):  
Fábio Pereira Muchão ◽  
Luiz Vicente Ribeiro Ferreira da Silva Filho ◽  
Antonio Carlos Pastorino ◽  
Joaquim Carlos Rodrigues
Keyword(s):  
Wilcoxon Test ◽  
Dose Inhaler ◽  
Metered Dose Inhalers ◽  
Significance Level ◽  
Before And After ◽  
Metered Dose ◽  
Asthma Patients ◽  
Practical Program ◽  
Practical Guidance ◽  
Inhaler Devices

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.

scholarly journals Urinary Excretion Post Inhalation Method to Correlate Inhaler Technique with Disease Control in Patients with Obstructive Pulmonary Diseases Using Own Metered Dose Inhaler (MDI)

2021 ◽  
Author(s):  
ethirajan nandagopal ◽  
Sumithra M ◽  
N Meenakshi
Keyword(s):  
Disease Control ◽  
Statistical Significance ◽  
Pulmonary Diseases ◽  
Dose Inhaler ◽  
Urinary Concentration ◽  
Inhaler Technique ◽  
Metered Dose ◽  
The Mean ◽  
Multiple Drugs ◽  
Inhaler Devices

Objectives: Correct use of inhaler devices is critical in ensuring the optimal lung bioavailability of the inhaled drug. The study aimed to assess inhaler technique used in patients with using metered-dose inhalers (MDI) by correlating with urinary salbutamol excretion post inhalation and its correlation with disease control. Methods: Thirty patients with obstructive pulmonary diseases attending outpatients’ services inhaled two doses of salbutamol 100 µg and urine samples were collected after 30 min. Inhaler technique scores were assessed using a standardized 8-point checklist. The 30-minute concentration of urinary salbutamol is then correlated with inhaler technique scores and control status of the disease. Key findings: The mean age of the subjects was 60.8 (SD ± 9.338). The mean (SD) 30 min urinary salbutamol concentration was 3.6±1.6 µg/ml. The mean concentration of salbutamol was found to be 2.3 µg/ml (n=1), 2.3 µg/ml (n=5), 3.1 µg/ml (n=7), 3.9 µg/ml (n=8), 4.7 µg/ml (n=5), 5.3 µg/ml (n=3), and 5.0 µg/ml (n=1) among patients performing 1, 2, 3, 4, 5, 6, 7, 8 steps correctly, respectively. There was a statistically significant correlation (p=0.028) witnessed between the mean 30 min urinary salbutamol concentration and total correct steps. The frequency of exacerbation, use of antibiotics, and oral corticosteroids (OCS) were more in patients with poor inhaler technique scores, although statistical significance was achieved only for frequency of antibiotics use (p=0.032). Conclusions: The 30 min salbutamol urinary concentration evaluation may help to identify patients who were underdosed due to poor handling of inhaler devices. Being a complex procedure, it can at least be initiated in patients reporting frequent exacerbations, hospitalization, and those who need multiple drugs for disease control.

scholarly journals Inhaled medication for asthma management: evaluation of how asthma patients, medical students, and doctors use the different devices

2003 ◽  
Vol 29 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Janaína Barbosa Muniz ◽  
Carlos Roberto Padovani ◽  
Irma Godoy
Keyword(s):  
Health Care ◽  
Medical Students ◽  
Health Care Professionals ◽  
Airflow Obstruction ◽  
Asthma Management ◽  
Outpatient Service ◽  
Inhalation Therapy ◽  
Metered Dose ◽  
Asthma Patients ◽  
Inhaled Medication

Asthma results from a combination of three essential features: airflow obstruction, hyperresponsiveness of airways to endogenous or exogenous stimuli and inflammation. Inadequacy of the techniques to use different inhalation devices is one of the causes of therapeutic failure. The main purpose of this study was to evaluate how 20 medical students, 36 resident physicians of Internal Medicine/Pediatrics, and 40 asthma patients used three devices for inhalation therapy containing placebo. All patients were followed at the Pulmonary Outpatient Service of Botucatu Medical School and had been using inhaled medication for at least six months. The following devices were evaluated: metered dose inhalers (MDI), dry powder inhalers (DPI), and MDI attached to a spacer device. A single observer applied a protocol containing the main steps necessary to obtain a good inhaler technique to follow and grade the use of different devices. Health care professionals tested all three devices and patients tested only the device being used on their management. MDI was the device best known by doctors and patients. MDI use was associated with errors related to the coordination between inspiration and device activation. Failure to exhale completely before inhalation of the powder was the most frequent error observed with DPI use. In summary, patients did not receive precise instruction on how to use inhaled medication and health care professionals were not well prepared to adequately teach their patients.

scholarly journals Outcome of illustrated information leaflet on correct usage of asthma-metered dose inhaler

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Wendy Wrench ◽  
Lynette Van Dyk ◽  
Sunitha Srinivas ◽  
Ros Dowse
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Dose Inhaler ◽  
Metered Dose Inhaler ◽  
Low Literacy ◽  
Post Intervention ◽  
Care Clinic ◽  
Metered Dose ◽  
Asthma Patients

Background: Research globally has shown that metered dose inhaler (MDI) technique is poor, with patient education and regular demonstration critical in maintaining correct use of inhalers. Patient information containing pictorial aids improves understanding of medicine usage; however, manufacturer leaflets illustrating MDI use may not be easily understood by low-literacy asthma patients.Aim: To develop and evaluate the outcome of a tailored, simplified leaflet on correct MDI technique in asthma patients with limited literacy skills.Setting: A rural primary health care clinic in the Eastern Cape, South Africa.Methods: Pictograms illustrating MDI steps were designed to ensure cultural relevance. The design process of the leaflet was iterative and consultative involving a range of health care professionals as well as patients. Fifty-five rural asthma patients were recruited for the pre-post design educational intervention study. Metered dose inhaler technique was assessed using a checklist, and patients were then educated using the study leaflet. The principal researcher then demonstrated correct MDI technique. This process was repeated at follow-up 4 weeks later.Results: The number of correct steps increased significantly post intervention from 4.6 ± 2.2 at baseline to 7.9 ± 2.7 at follow-up (p 0.05). Statistically significant improvement of correct technique was established for 10 of the 12 steps. Patients liked the pictograms and preferred the study leaflet over the manufacturer leaflet.Conclusion: The tailored, simple, illustrated study leaflet accompanied by a demonstration of MDI technique significantly increased correct MDI technique in low-literacy patients. Patients approved of the illustrated, simple text leaflet, and noted its usefulness in helping them improve their MDI technique.

Long-term safety and asthma control with budesonide/ formoterol versus budesonide pressurized metered-dose inhaler in asthma patients

2008 ◽  
Vol 29 (5) ◽  
pp. 499-516 ◽  
Author(s):  
Stephen P. Peters ◽  
Bruce M. Prenner ◽  
William S. Mezzanotte ◽  
Paula Martin ◽  
Christopher D. O'Brien
Keyword(s):  
Asthma Control ◽  
Dose Inhaler ◽  
Metered Dose Inhaler ◽  
Metered Dose ◽  
Asthma Patients ◽  
Pressurized Metered Dose Inhaler
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