Bronchiectasis with accompanying bronchoobstruction: efficacy of nebulizer therapy

Objective. To investigate the efficacy and safety of the combination of salbutamol (Nebutamol®, “Yuria-Pharm”) and hypertonic sodium chloride solution with sodium hyaluronate (Lorde® gial, “Yuria-Pharm”) in complex nebulizer therapy of bronchiectasis with concomitant bronchoobstruction. Materials and methods. As a result of initial screening, 74 patients with confirmed bronchiectasis using high-resolution computed tomography of thoracic organs were selected for further study of 45 patients who had <90 % postbronchodilation forced expiratory volume in 1 sec (FEV1) at the first visit. Patients on the second visit (V2) were prescribed 14-day nebulizer therapy with the bronchodilator salbutamol at a dosage of 2 mg / 2 ml and mucolytic sodium chloride solution 3 % with sodium hyaluronate 30 mg and respiratory gymnastics. Inhalation of mucolytic was prescribed 20 min after inhalation of bronchodilators. Subjective assessment of the severity of cough and sputum was performed using the scales of V.M. Savchenko (2001), assessment of the severity of dyspnea – on a modified scale of dyspnea of the Medical Research Council (mMRC). The daily amount of sputum (DAS) was measured by laboratory scales of high accuracy (MOMERT Model 6000). The respiratory function (RF) was measured using computer spirometry MasterLab (Viasis, Germany). Indicators were evaluated before and 15 min after inhalation of 400 μg salbutamol using a metered aerosol inhaler through a spacer. Indicators such as DAS, the severity of cough and sputum according to the Savchenko questionnaire, the severity of shortness of breath according to the mMRC and RF were determined at the first (screening – V1), the third (day 14 – V3), the fourth (day 28 – V4) and the fifth (day 42 – V5) visits. The safety of this therapy was assessed by recording all adverse events and further processing of the data. Results and discussion. The average age of patients was 58 (43; 66) years, 14 of them (31.1 %) were men. A comparison of all clinical and laboratory characteristics of patients on four visits was performed using Friedman’s rank analysis of variance (ANOVA). Among patients, no statistically significant differences were found between visits in the severity of dyspnea on the mMRC scale (p=0.05), FEV1 (p=0.22) and the ratio of FEV1/FVCpost (p=0.61). However, there were statistically significant differences in such indicators: subjective assessment of the severity of cough on the scale of Savchenko (F29.3=22.5; p=0.00005) was statistically significantly lower by V3 compared with V1 (p=0.0003), on V4 in comparison with V1 (p=0.006), on V5 in comparison with V1 (p=0.008). Subjective assessment of the amount of sputum on the scale of Savchenko (F29,3=22,2; p=0,00009) was significantly higher before treatment than after: on V1 in comparison with V3 (p=0,0005), on V1 in comparison with V4 (p=0.0005) and on V1 in comparison with V5 (p=0.002). DAS was also lower after treatment (F29.3=26.4; p=0.00001): V3 compared to V1 (p=0.000013), V4 compared to V1 (p=0.000006) and on V5 in comparison with V1 (p=0,00005). The following side effects were identified during therapy: tachycardia – in 4 patients (8.9 %), throat irritation after inhalation – in 2 patients (4.4 %), heartburn – in 1 patient (2.2 %). Conclusions. The use of salbutamol in a dosage of 2 mg / 2 ml and a solution of sodium chloride 3 % with sodium hyaluronate 30 mg by inhalation for 14 days had statistically and clinically significant effectiveness in reducing DAS, subjective feelings of the patient regarding the severity of cough and sputum in patients with bronchial obstruction. The use of Nebutamol® and Lorde® gial in complex nebulizer therapy of bronchiectasis has shown its effectiveness and safety, which is confirmed by the results of the study.

SPECIALIZUOTOS VAISTININKO TEIKIAMOS PASLAUGOS ASTMA SERGANTIEMS PACIENTAMS POREIKIO ANALIZĖ LIETUVOJE

Lietuvoje astma sergančių pacientų skaičius nuosekliai didėja. 2017 m. duomenimis, astma sirgo daugiau nei 121300 pacientų, iš kurių daugiau nei 43500 suaugę asmenys. Tyrimo tikslas – įvertinti, ar vaistininko teikiama specializuota išplėstinė konsultacija apie paskirtus vaistus astmai gydyti gali turėti įtakos pacientų ligos kontrolei. Metodai – grindžiamosios teorijos pagrindu atliktas kokybinis tyrimas bei kiekybinis tyrimas. Naudo-tas dedukcijos metodas buvo paremtas astmos valdymo ir vaistų vaidmens publikacijomis. Duomenų statistiniam apdorojimui buvo naudojama Smirnovo-Kolmogorovo (Smirnov-Kolmagorov) χ 2 kvadrato, Stjudento t bei Stjudento t (Student) porinių imčių kriterijai, Mano Vitney (Mann Whitney) kriterijus bei Spirmeno (Spearman) koreliacijos koeficientas. Rezultatai – kokybinio tyrimo metu buvo nustatyta, kad farmacijos specialistai astma sergantiems pacientams turi pateikti informaciją apie vartojamų vaistų profilį ir veikimą, gydymosi rėžimo nesilaikymo pasekmes, inhaliatoriaus technikos ypatumus, ligos simptomus, nekontroliuojamų simptomų įtaką sveikatai, astmos kontrolės lygmenis. Nustatyta, kad prieš atlekant tyrimą iš 244 tiriamųjų visiškai užbaigusių paslaugos ciklą 73,8 proc. nepakankamai kontroliavo ligos simptomus. Po intervencijos nepakankamai kontroliuojančių ligos simptomus sumažėjo iki 54,92%. Daugiausia inhaliavimo klaidų darė tiriamieji, vartojantys Aerolizer bei Aerosol inhaler inhaliatorius. Mažiausiai Easyhaler, Turbohaler bei Accuhaler. Po atliktos konsultacijos, vidutinis klaidų skaičius sumažėjo nuo 2,284 iki 1,110 (kai p&lt;0,05). Išvada – tiriamosios grupės statistiškai reikšmingas ligos simptomų kontroliavimo didėjimas bei daromų inhaliavimo klaidų skaičiaus sumažėjimas įrodo, kad astma sergančių pacientų priežiūros grandinėje, greta gydytojo ir slaugytojos integruojant farmacijos specialistą, galima pasiekti racionalaus vaistų vartojimo bei geresnių ligos simptomų kontroliavimo.

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

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.