Importance of Following Proper Inhalation Techniques and Awareness Regarding Asthma among Clinical Patients

Aims: Asthma is one of the biggest health burdens on the Sri Lankan population. Achievement of treatment goals isdetermined mainlythrough pharmacological management. The main objective of this study was to evaluate the patient inhaler handling techniques and their awareness regarding their disease condition, as well as to find out how an educational intervention effects patients‘ inhaler handling techniques. Study Design: A Prospective cross sectional study used. Place and Duration of Study: National Hospital for Respiratory Diseases, Welisara and Colombo South Teaching Hospital, Kalubowila between June 2017 to August 2017. Methodology: Clinically diagnosed asthma patients were randomly divided into Control and Test groups. Control comprised 94 patients and the test comprised 93 patients. Their baseline knowledge about asthma and inhaler-using technique were assessed in 1st month by using an interviewer-administered questionnaire and checklist respectively. The test group was given both information leaflet and verbal instructions. Again, all the participants were assessed for the inhaler techniques on their next clinic day by using the same questionnaire and the checklist. Results: After the educational intervention, there was a statistically significant improvement in the test group, in the adherence to the nine steps, including critical steps, regarding all 3 device types (PMDI, DPI, and PMDI with Spacer) in the 2nd-month visit. (at P =.05) When considering awareness about asthma in the total population, most participants were knowledgeable regarding asthma. Conclusion: We observed gaps in knowledge between current practice and what is expected in patients with asthma regarding their inhaler therapy. This might be due to the quality of instructions delivered by health care providers being insufficient and them lacking the time to observe patients individually for the inhaler techniques. Awareness regarding asthma and inhalation techniques can be raised by using information leaflets as well as through verbal counseling.

The Influence of the Pharmacists’ Training on the Patients’ Education in the Field of Inhalation Techniques in Community Pharmacies in Poland

Background: Following the example of other countries, it is very important to educate patients on the correct use of inhalers by properly trained healthcare professionals, including pharmacists.Objectives: The aim of the study was to assess the quality and comprehensiveness of professional advice given by pharmacists on the use of inhalers, which was determined by the pharmacists’ level of training. Methods: The study was conducted from June 2019 to March 2020. 150 pharmacists from Poznan and Warsaw (Poland) were involved. Before the study began, the professional education of 240 pharmacists was conducted in Warsaw to implement standard operating procedures. The study used the model of a mystery patient.Results: The conversation with a trained pharmacist lasted on average 5.5 minutes, with an untrained one - 3.0 minutes. Placebo inhalers were used more often by trained pharmacists during patients’ education. 10.3% of untrained pharmacists did not provide any education. Additionally, untrained employees quality of advice were assessed on an average of 3.5 points, while trained ones - 7.6 points. Conclusions: This study has shown that there is a need for professional training among pharmacists in Poland, which translates into better patient education in the field of inhalation techniques.

Investigating the validity and reliability of the traditional checklist for assessment of specific inhalation techniques with pressurized metered-dose inhalers using the Aerosol Inhalation Monitor

Background: Correct inhalation techniques are essential for optimum delivery of drugs to the airways for patients with asthma and chronic obstructive pulmonary disorder. Checklists often are used to assess the techniques, but the validity of checklists is unknown and few studies have been conducted to date. We investigated the validity and reliability of checklists.Methods: A prospective, observational study was conducted at a tertiary care teaching hospital in Taiwan using an objective tool, the aerosol inhalation monitor (AIM). Inhalation techniques using pressurized metered-dose inhalers (pMDIs) were assessed by checklist and AIM. The κ coefficient and prevalence and bias-adjusted κ (PABAK) were calculated to determine the consistency between the checklist and AIM in four specific techniques, including actuation, inspiratory flow, inhalation time, and breath hold time. Sensitivity and specificity were used to evaluate the validity of the checklist using these techniques.Results: The κ and PABAK values were −0.023 and −0.176 for actuation, 0.43 and 0.529 for inspiratory flow, −0.046 and −0.412 for inhalation time, and 0.12 and 0.686 for breath hold time, respectively. Sensitivity and specificity for the four individual steps were 0.706 versus 0.265, 0.833 versus 0.600, 1 versus 0.1, and 0.955 versus 0.143, respectively.Conclusion: Our results invalidate use of the checklist alone as a reliable tool to assess inhalation techniques. The low specificity indicates that the checklist tends to overestimate the accuracy of inhalation techniques. AIM can be added as an objective tool to assess and quantify specific steps for MDIs.

Inhalation therapy for bronchial asthma in the conditions of paediatric section

The prevalence of bronchial asthma among children in different regions of Russia ranges from 10.9–9.6‰ to 50–55‰. The frequency of bronchial asthma among lyceum students is 33.1‰, while in the most overcrowded school it is 45.8‰. Bronchial asthma occurs more frequently in the mild, less frequently in the medium form. Therefore, the main burden on the management of such patients falls on the ambulatory segment. Diagnosed on the basis of respiratory symptoms such as wheezing, difficulty breathing, strain and bloating of the chest, coughing. Asthmatic attack with bronchial asthma of any degree of severity can be as severe or even asthmatic status, which, along with the prevalence of bronchial asthma, determines the primary importance of ambulatory control of the disease. It is fundamental to suppress local bronchial inflammation and remove bronchospasm. Adequacy and systematic treatment is essential for the outcome of bronchial asthma in children. Timely anti-inflammatory treatment can lead to remission. Inhalation techniques of anti-inflammatory drugs and bronchodilators are the most optimal. The possibility of application of beclometasone (inhalation glucocorticosteroid), a combination of fluticasone and salmeterol, ipratropium bromide of Russian manufacture, which efficiency is proved in practical work and economically justified, is considered. IGCS, acting locally, have a pronounced anti-inflammatory activity, suppressing both acute and chronic inflammation. Clinical examples of children with atopic dermatitis and the revealed diagnosis of bronchial asthma, with an optimum choice of treatment are given. It is proved that application of modern inhalation drugs in complex treatment leads to bronchial asthma remission.

Administration of inhaled medications during noninvasive ventilation and/or tracheostomy

Objectives: To describe the clinical and demographic profile of hospitalized patients undergoing noinvasive ventilation (NIV) and/or tracheostomy (TQT) with prescription of the pressurized inhaler (pMDI) and the difficulties and interventions performed to adapt the inhalation technique. Methods: This is an observational, retrospective and descriptive study of a series of cases, carried out in three clinical units of a university hospital in the years 2017 and 2018. Results: We analyzed data from 25 patients who received NIV and/or TQT for whom guidance has been requested from the Inhalation Techniques Guidance and Training Group (GOTTI). Of these, 15 patients (60%) were using NIV, 5 (20%) were tracheostomized and 5 (20%) were tracheostomized with NIV. The difficulties identified in these patients were insecurity in removing the support, preference for nebulization, adaptation of the pMDI to the cannula and asynchrony between the jet firing and the beginning of inspiration. Conclusions: The use of aero-chamber coupled to the pMDI and tidal volume were the mostly made interventions. Masks and guidelines on the access route to the ventilation system were adapted in most cases This group of patients has particularities and difficulties in the inhalation technique that justify a specific educational intervention by professionals with more in-depth knowledge in the area.

Uncontrolled asthma: what is behind it?

Authors describe the clinical features and causes of severe uncontrolled asthma. Algorithm of evaluation of the patient with persisting clinical symptoms receiving treatment with the highest doses of inhaled corticosteroids in combination with long-acting β­-agonists and/or systemic corticosteroids, should include: a preliminary exclusion of an alternative diagnosis, eliminating the influence of concomitant diseases, preventing exposure to trigger factors, achieving high adherence to prescribed treatment, improving the inhalation techniques. Further steps on the path of regaining control should be aimed at determining phenotype of asthma. Difficulties in achieving control can be expected in patients with severe atopic asthma, late-onset persistent eosinophilic asthma, obesity-related severe nonatopic asthma, neutrophilic asthma.