scholarly journals Errors in Aerosol Inhaler Use and Their Effects on Maternal and Fetal Outcomes among Pregnant Asthmatic Women (Subanalysis from QAKCOP Study)

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Wanis H. Ibrahim ◽  
Fatima Rasul ◽  
Mushtaq Ahmad ◽  
Abeer S. Bajwa ◽  
Laith I. Alamlih ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Asthma Control ◽  
Primary Objective ◽  
Inhalation Technique ◽  
Breath Hold ◽  
Inhaler Technique ◽  
Fetal Outcomes ◽  
Cross Sectional ◽  
Metered Dose ◽  
Aerosol Inhaler

Data on inhaler technique and its effects on maternal and fetal outcomes during pregnancy are seldom reported. The primary objective of this study was to evaluate inhaler technique and identify errors in inhaler use among pregnant women with asthma. Secondary objectives were to identify factors associated with poor inhaler technique and study the association between inhaler technique and maternal and fetal outcomes. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. Seventy-three and 41 asthmatic pregnant women reported using pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs), respectively. Overall, wrong inhaler technique was observed in 47 (64.4%) subjects. Among pMDI users, correct inhaler use was observed in only 26/73 (35.6%) of the patients, with lack of coordination between inhalation and generation of the aerosol and failure to breathe out gently before using the inhaler, being the most common errors. Among DPI users, 21 (51.2%) demonstrated correct inhaler use, with failure to perform a breath-hold for 10 seconds after inhaling the powder and to exhale gently before using the inhaler being the most common errors. Significant associations between inhaler technique and patient’s understanding of asthma medications and the kind of follow-up clinic (respiratory versus nonrespiratory clinic) were found. No significant associations between inhaler technique and various maternal and fetal outcomes or asthma control were found. In conclusion, improper inhalation technique is significantly prevalent in pregnant asthmatic women, particularly among those being followed in nonspecialized respiratory clinics. The lack of significant association between the inhaler technique and asthma control (and hence maternal and fetal outcomes) may simply reflect the high prevalence of uncontrolled asthma and significant contribution of other barriers to poor asthma control in the current patient’s cohort. Multidisciplinary management of asthma during pregnancy with particular emphasis on patient’s education is imperative.

scholarly journals Factors related to the incorrect use of inhalers by asthma patients

2014 ◽  
Vol 40 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Paulo de Tarso Roth Dalcin ◽  
Denis Maltz Grutcki ◽  
Paola Paganella Laporte ◽  
Paula Borges de Lima ◽  
Samuel Millan Menegotto ◽  
...  
Keyword(s):  
Asthma Control ◽  
Family Income ◽  
Pulmonary Function Tests ◽  
Cross Sectional Study ◽  
Inhaler Technique ◽  
Metered Dose Inhalers ◽  
Porto Alegre ◽  
Asthma Control Questionnaire ◽  
Cross Sectional ◽  
Metered Dose

OBJECTIVE: To evaluate inhaler technique in outpatients with asthma and to determine associations between the correctness of that technique and the level of asthma control. METHODS: This was a cross-sectional study involving patients > 14 years of age with physician-diagnosed asthma. The patients were recruited from the Asthma Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, in the city of Porto Alegre, Brazil. The patients completed two questionnaires (a general questionnaire and an asthma control questionnaire based on the 2011 Global Initiative for Asthma guidelines), demonstrated their inhaler technique, and performed pulmonary function tests. Incorrect inhaler technique was defined as the incorrect execution of at least two of the predefined steps. RESULTS: We included 268 patients. Of those, 81 (30.2%) showed incorrect inhaler technique, which was associated with poor asthma control (p = 0.002). Logistic regression analysis identified the following factors associated with incorrect inhaler technique: being widowed (OR = 5.01; 95% CI, 1.74-14.41; p = 0.003); using metered dose inhalers (OR = 1.58; 95% CI, 1.35-1.85; p < 0.001); having a monthly family income < 3 times the minimum wage (OR = 2.67; 95% CI, 1.35-1.85; p = 0.008), and having > 2 comorbidities (OR = 3.80; 95% CI, 1.03-14.02; p = 0.045). CONCLUSIONS: In the sample studied, incorrect inhaler technique was associated with poor asthma control. Widowhood, use of metered dose inhalers, low socioeconomic level, and the presence of > 2 comorbidities were associated with incorrect inhaler technique.

scholarly journals An Increased Adverse Fetal Outcome Has Been Observed among Teen Pregnant Women in Rural Eastern Ethiopia: A Comparative Cross-Sectional Study

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199915
Author(s):  
Haymanot Mezmur ◽  
Nega Assefa ◽  
Tadesse Alemayehu
Keyword(s):  
Pregnant Women ◽  
Fetal Outcome ◽  
Cross Sectional Study ◽  
World Health ◽  
Adult Women ◽  
Sectional Study ◽  
Fetal Outcomes ◽  
Cross Sectional ◽  
Eastern Ethiopia ◽  
Adverse Fetal Outcome

Background: According to the World Health Organization, teenage pregnancies are high-risk due to increased risks of fetal and infant morbidity and mortality. This study compares adverse fetal outcomes between teen and adult pregnant women from rural Eastern Ethiopia. Methods: Institutional-based cross-sectional study was conducted among women visiting maternity units from surrounding rural areas. A total of 481 teenagers (13-19 years old) and 481 adults (20-34 years old) women with a singleton pregnancy were included in the study. Two hospitals and 3 health centers were selected in Eastern Hararghe Zone, Eastern Ethiopia. Comparative analysis was carried out using the log-binomial regression model to identify factors associated with adverse fetal outcomes in both categories. The results are reported in adjusted prevalence ratios with 95% confidence intervals. Results: High proportion of adverse fetal outcome was observed among teenage women than adult (34.9% vs 21%). Statistically significant difference ( P < .05) in the proportion of low birth weight (21.1% vs 9.3%), preterm birth (18.7% vs 10.6%), APGAR score at 5th minute (9.3% vs 4%) were found in teenagers compared to adult women. Antenatal care attendance (APR = 0.44; 95% CI: 0.23, 0.86); eclampsia (APR = 1.96; 95% CI: 1.26, 3.06); pre-eclampsia (APR = 1.73; 95% CI: 1.12, 2.67); and wealth index (rich) (APR = 0.55; 95% CI: 0.32, 0.94) were significantly associated with adverse fetal outcomes among the teenage women. Whereas intimate partner violence (APR = 2.22; 95% CI: 1.26, 3.90); preeclampsia (APR = 3.05; 95% CI: 1.61, 5.69); antepartum hemorrhage (APR = 2.77; 95% CI: 1.73, 4.46); and hyperemesis gravderm (APR = 1.75; 95% CI: 1.09, 2.79) were significantly associated with adverse fatal outcomes among the adult women. Conclusion: teenage pregnancy is associated with a high rate of adverse fetal outcomes. Early identification and treatment of problems during antenatal follow-up should be the mainstay to avert the massive adverse fetal effects.

scholarly journals Study of inhaler technique in asthma patients: differences between pediatric and adult patients

2015 ◽  
Vol 41 (5) ◽  
pp. 405-409 ◽  
Author(s):  
Pablo Manríquez ◽  
Ana María Acuña ◽  
Luis Muñoz ◽  
Alvaro Reyes
Keyword(s):  
Pediatric Asthma ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Breath Hold ◽  
Therapeutic Effects ◽  
Inhaler Technique ◽  
Cross Sectional ◽  
Common Error ◽  
Oral Inhalation ◽  
Asthma Patients

Objective: Inhaler technique comprises a set of procedures for drug delivery to the respiratory system. The oral inhalation of medications is the first-line treatment for lung diseases. Using the proper inhaler technique ensures sufficient drug deposition in the distal airways, optimizing therapeutic effects and reducing side effects. The purposes of this study were to assess inhaler technique in pediatric and adult patients with asthma; to determine the most common errors in each group of patients; and to compare the results between the two groups. Methods: This was a descriptive cross-sectional study. Using a ten-step protocol, we assessed inhaler technique in 135 pediatric asthma patients and 128 adult asthma patients. Results: The most common error among the pediatric patients was failing to execute a 10-s breath-hold after inhalation, whereas the most common error among the adult patients was failing to exhale fully before using the inhaler. Conclusions: Pediatric asthma patients appear to perform most of the inhaler technique steps correctly. However, the same does not seem to be true for adult patients.

scholarly journals Effectiveness of inhaled corticosteroids and long-acting β-agonists combinations in real clinical practice: results of a multicenter cross-sectional study in Russian patients with asthma

2021 ◽  
Vol 31 (5) ◽  
pp. 613-626
Author(s):  
Vladimir V. Arkhipov ◽  
Zaurbek R. Aisanov ◽  
Sergey N. Avdeev
Keyword(s):  
Clinical Practice ◽  
Adverse Events ◽  
Asthma Control ◽  
Inhalation Technique ◽  
Adherence To Treatment ◽  
Uncontrolled Asthma ◽  
Cross Sectional ◽  
Long Acting ◽  
Adherence To Therapy ◽  
Real Clinical Practice

Asthma management approaches are improving yearly, but the problem of asthma control is still acute. Combinations of inhaled glucocorticosteroids (ICS) and long-acting β2-agonists (LABA) play a crucial role in asthma therapy, but their effectiveness in real practice can be insufficient, and asthma control level in the population remains low. Optimizing the use of these drugs, changing the usual therapy regimens, and implementing upgraded inhalers can improve adherence to treatment and inhalation technique, which affects the effectiveness of the therapy.The study aimed to describe the key characteristics of the patient population getting asthma treatment in real clinical practice and assess factors influencing asthma control, including adherence to therapy.Methods. A single-stage cross-sectional observational study in 124 primary health care centers in 22 cities of the Russian Federation included 3,214 patients > 18 years old, with a clinical diagnosis of asthma for at least 1 year, who were able to perform a spirometry test and fill out the ACQ-5 and TAI-12 questionnaires.Results. Assessment of asthma control with the ACQ-5 questionnaire showed that most patients had uncontrolled asthma (56%). Controlled and partially controlled asthma was diagnosed in 21 and 19% of patients, respectively. 4% of patients had severe uncontrolled asthma. The TAI questionnaire revealed low adherence to therapy in more than half of the patients (53.6%). The rate of patients with controlled asthma and the average annual frequency of exacerbations were significantly lower in subgroups of patients who received therapy with extrafine ICS/LABA and ICS/formoterol in single inhaler regimen, compared with controller therapy using fixed and free combinations of ICS and LABA.Conclusion. The main causes of insufficient asthma control are low adherence to treatment, inhalation errors, monotherapy with ICS, asthma with small airways dysfunction, and adverse events associated with ICS. Prescribing the combinations of ICS/LABA in the form of extra-fine aerosol and using it in the Maintenance and Reliever Therapy (MART) regimen can significantly increase asthma control, reduce the risk of adverse events, and increase patient adherence to treatment. A potential alternative to improve asthma control is administering ICS-LABA combinations once daily.

scholarly journals Urinary Tract infection, Drug Resistance Profile and Fetal Outcomes among Pregnant women in Selected Health Facilites of Addis Ababa, Ethiopia: A cross-sectional study design

2020 ◽  
Author(s):  
Wegayehu zebene ◽  
Dawit Dessalegn ◽  
Abebe Aseffa ◽  
Yohannis Yitagesu ◽  
Hamdiya yussuf ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Pregnant Women ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Fetal Outcomes ◽  
Cross Sectional ◽  
Drug Resistance Profile ◽  
Study Participants

Abstract Background: Urinary tract infection (UTI) is a commonly encountered health problem among pregnant women. Untreated UTI may result in fetal complications like preterm birth, low birth weight, intra uterine growth retardation and intrauterine fetal death.One of the major problems with bacterial pathogens is their ability to develop drug resistance. Determining drug susceptibility pattern of bacteria from urinary tract helps to identify effective drugs and minimize further adverse perinatal outcomes. The purpose of this study was to describe the magnitude and drug resistance profile of pregnant women and related fetal outcomes.Methods: A cross-sectional study was conducted from March to June 2019. Socio-demographic data of the study participants was collected by administering structured questionnaire after obtaining full consent of the participants. Clean catch mid-stream urine was collected from the study participants and the samples were transported to the laboratory with screw-capped container. Blood and MacConkey agar were used to cultivate bacteria from urine sample. Bacterial colonies were isolated and identified using standard biochemical properties. Antibacterial susceptibility test was done on Muller-Hinton agar using antibiotic discs. At the time of delivery, infant’s birth weight and gestational age was recorded on the log book as part of the daily work. Fetal outcome data were recorded from the log book and entered to EPI data management software then transferred to SPSS for analysis.Results: Out of 424 urine samples processed, 63 (14.9%) yielded significant bacteriuria. Fifty-nine out of 63 (93.7%) cases of UTIs were recorded among age group of 15-34 years. Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus were the three dominant bacterial isolates.Most of the gram negative bacterial isolates were resistant to ampicillin and ceftazidime (43.2% each) while gram positive was resistant for tetracycline (36.8%). The result of this study showed that UTI had statistical association with the occurrence of Intrauterine Fetal Death (IUFD) and Prerupture of Membrane (PROM) (P<.05).Conclusion: Adverse fetal outcomes are significantly linked with the presence of UTI during pregnancy. The condition can be managed if early diagnosis and treatments are made for the mother.

scholarly journals Hospital staff practical skills and theoretical knowledge in inhaled aerosol therapy: a single centre cross-sectional observational study

2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Martina Santambrogio ◽  
Marta Lazzeri ◽  
Gianluca Bonitta ◽  
Riccardo Guarise ◽  
Edoardo Simonetta ◽  
...  
Keyword(s):  
Hospital Staff ◽  
University Hospital ◽  
Inhalation Technique ◽  
Theoretical Knowledge ◽  
Practical Skills ◽  
Aerosol Therapy ◽  
Cross Sectional ◽  
Inhaled Therapy ◽  
Metered Dose ◽  
Inhaler Devices

Inhaled therapy is widely used for treatment of many respiratory disorders. Drug delivery in lungs is dependent on the correct use of aerosol devices and patients’ training is vital for a correct therapy administration. Therefore, is very important to assess the skills of professionals involved in training patients to the correct use of inhaler devices. The aim of this study was to check the practical skills and the theoretical knowledge of health care personnel in our University Hospital in using aerosol therapy and to determine differences among professional figures in the management of inhaler devices. Three hundred and fifteen (315) volunteers including physicians, residents, nurses and respiratory physiotherapists were enrolled; an independent professional, not working in our University Hospital, assessed their theoretical knowledge related to aerosol throughout a questionnaire. Practical skills were assessed through placebo simulation with the devices that participants declared to use frequently with patients. None of the respondents correctly answered all questions evaluating theoretical knowledge on the proper use of aerosol therapy. Respiratory physiotherapists obtained significantly better results with 17.2 (1.3) average points compared to 10.3 (3.7) obtained by doctors, 9.0 (3.0) by nurses and 9.1 (4.5) by residents. Analysing in detail physicians’ results, pneumologists showed better theoretical knowledge than other specialists. Concerning the practical skills, about 80% of those stating they knew how to use metered dose inhalers, made mistakes in the basic steps for proper inhalation technique and over 50% of respondents were unable to properly simulate placebo administration of dry powder inhalers. Also here, respiratory physiotherapists and pneumologists had significant better performances, when compared to other health professionals. Our data are in line with those published in the literature in other international clinical settings, noting inadequate practical and theoretical knowledge of the available devices for aerosol therapy.

scholarly journals FACTORS RESTRICT TREATMENT EFFICIENCY IN ASTHMA PATIENTS

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Khaled Hassan
Keyword(s):  
Asthma Control ◽  
Dry Powder Inhaler ◽  
Observational Research ◽  
Inhaler Technique ◽  
Cross Sectional ◽  
Know How ◽  
Modifiable Factors ◽  
Asthma Patients ◽  
Keywords Asthma ◽  
First Time

Background: A number of modifiable factors that contribute to poor asthma control have been identified. We wanted to know how many patients had insufficient therapy, adherence, or major inhaler technique errors, and how they affected asthma control. Methodology: We conducted a cross-sectional multicenter observational research with asthma patients who were referred for the first time from primary to specialized treatment. Adequate prescription according to guidelines, treatment adherence, and illness control were among the data collected. 35.9% of the 1682 patients (age 45-17 years, 64.6 percent men) had insufficient prescriptions, 76.8% had low adherence, and 17 percent had critical inhaler technique errors, with Easyhaler users making significantly fewer critical errors than other dry powder inhaler users (10.3 versus 18.4%; p 0.05). Inadequate prescription (OR: 3.65), non-adherence to therapy (OR: 1.8), and inhaler abuse were all linked to poor asthma control (OR: 3.03). A greater number of risk variables were linked to a greater likelihood of having poorly managed asthma. Keywords: Asthma, interdental cleaning, elderly, prevention, periodontal disease, caries.

scholarly journals Association of Asthma Control and Metered-Dose Inhaler Use Technique among Adult Asthmatic Patients Attending Outpatient Clinic, in Resource-Limited Country: A Prospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Bezie Kebede ◽  
Girma Mamo ◽  
Abebaw Molla
Keyword(s):  
Asthma Control ◽  
Statistical Significance ◽  
Study Patient ◽  
Dose Inhaler ◽  
Inhalation Technique ◽  
Metered Dose Inhaler ◽  
Asthmatic Patients ◽  
Ordinal Logistic Regression Analysis ◽  
Metered Dose ◽  
Adult Asthmatic

Asthma is a heterogeneous disease which is characterized by chronic airway inflammation. It is a common chronic respiratory disease affecting 1–18% of population in different countries. It can be treated mainly with inhaled medications in several forms, including pressurized metered-dose inhaler (MDI). Patients encountered difficulty in using inhaler devices even after repeated demonstration and/re-evaluation. This could highly compromise patient treatment outcome/asthma control. To evaluate relationship between MDI use technique and asthma control among adult asthmatic patients who attend respiratory clinic in Jimma University Medical Center (JUMC), Southwest Ethiopia. A prospective observational study was conducted from March to August 22, 2018. All adult asthmatic patients who met the inclusion criteria were included in the study. Patient baseline assessment was conducted (patient demography, inhalation technique, adherence, and asthma control status). Inhalation technique was obtained using a standard checklist of steps recommended in National Institute of Health (NIH) guidelines. Patient adherence using asthma inhalation test and asthma control status was assessed by 2017 GINA guideline. Independent predictors of outcome were identified, strength of association between dependent and independent variables was determined by using ordinal logistic regression analysis, and statistical significance was considered at P<0.05. One hundred forty patients were included in the analysis. Among these, 26 (18.4%) patients were controlled, 65 (46.1%) partially controlled, and 35% uncontrolled. Proportion of patients with uncontrolled asthma were higher among inefficient as compared to efficient, whereas patients with controlled asthma were higher among efficient as compared to inefficient. Asthma control status is significantly associated with inhalation technique (P=0.006). Since most of the patients were inefficient and it is significantly associated with asthma control status, the hospital tried to adopt video MDI teaching program, and the patient should ask healthcare professionals how to take medication and they should bring their device to receive demonstration during visit. Health professionals should re-evaluate the patient during their hospital visit and encourage bringing their device to give demonstration.

scholarly journals Correlation of Metered Dose Inhaler Use Technique and Asthma Control Level in Asthma Patients at a Hospital in Bandung, West Java, Indonesia.

2021 ◽  
Vol 7 (3) ◽  
pp. 221-230
Author(s):  
Widyastiwi Widyastiwi ◽  
Mohammad Roseno ◽  
Tsania Nurilsyam ◽  
Inne Farida Lhaksmiwati
Keyword(s):  
Asthma Control ◽  
Control Level ◽  
Dose Inhaler ◽  
Control Test ◽  
Metered Dose Inhaler ◽  
Asthma Control Test ◽  
Cross Sectional ◽  
Major Health Problem ◽  
Asthmatic Patients ◽  
Metered Dose

Background: Asthma is still a major health problem in global population, including Indonesia. Antiasthma drugs available in various dosage forms, including inhaler. However, several problems related to inhalation route were found due to its unique device form and spesific use technique. One of the major problems related to inhalation route is inappropriate use technique of inhaler device, which could lead to treatment failure. Therapy outcome can be measured through Asthma Control Test (ACT). Objectives: This study was aimed to evaluate correlation between metered dose inhaler (MDI) use technique and asthma control level in patients. Material and Methods: A cross-sectional analytic study was conducted in May - June 2021. Thirty patients who met inclusion criteria were enrolled in this study. Patients’ MDI use technique and asthma control level were evaluated using a valid and standardized questionnaire. Statistics analysis was performed to determine the correlation between MDI use technique and asthma control level. Results: This study showed that most of asthmatic patients were women in older age, with mild asthma severity for more than 10 years. The most prevalent medication used was Fenoterol HBr, followed by salbutamol, and salmeterol/fluticasone combination. Inappropriate MDI use was found in 70,0% patients, with major problem found in patients’ breathing technique before and during MDI use. Asthma control test was performed and showed that 90,0% of asthmatic patients involved in this study have an uncontrolled asthma. Statistical analysis using Pearson product-moment correlation test showed a positive correlation between proper use of MDI and asthma control level (r=0.425, p<0.05). Conclusions: Patient who properly use MDI may have a higher score in asthma control test, thus have a better control of asthma. This study emphasized pharmacist role as patient educator in ensuring appropriate inhaler use in order to achieve therapeutic goals.

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