Journal articles on the topic 'Inhalers'
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Chaudhary, K., and A. Kumar. "An analysis of inhalation technique errors in metered-dose inhaler and dry powder inhaler users." International Journal of Science Annals 6, no. 1 (June 30, 2023): 47–52. http://dx.doi.org/10.26697/ijsa.2023.1.5.
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Background and Aim of Study: Decreased efficacy of metered dose inhaler and dry powder inhalers are associated with errors in inhalational techniques. The aim of the study: to study the association of errors in the technique for using two types of inhalers with demographic and other variables. Material and Methods: Five hundred adult patients with respiratory diseases who were currently using an inhaler device were enrolled in this study. Patient’s demographics and duration of inhaler therapy and assessment of inhaler technique were recorded by interview and direct observation. Results: Out of 500 enrolled patients, 465 patients were using the device with wrong technique. Among 465 patients, 188 patients were using metered dose inhaler and 277 patients were using dry powder inhalers. Technical errors were common in both the devices but more common with metered dose inhaler device. Failure to exhale before the inhale through device was most common error with metered dose inhaler (68.6%) and dry powder inhalers (71.4%). Association of errors with female gender is seen in both metered dose inhaler and dry powder inhalers users. Reduction in the numbers of errors is seen with increase in the duration of therapy and regular training on follow-up visits. Conclusions: Dry powder inhalers and metered dose inhalers are commonly used in management of respiratory patients. Therefore, the errors in using these devices, technique and handling errors are common in both dry powder inhalers and metered dose inhaler users. More error was found in old age, female and short-term users. However regular training on follows up visits can solve this current problem.
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Padmini, Anaswara K., and Shabna Basheer. "Evaluating metered dose inhaler and dry powder inhaler use technique among bronchial asthma and COPD patients attending tertiary health care centre in South India." International Journal Of Community Medicine And Public Health 8, no. 9 (August 27, 2021): 4545. http://dx.doi.org/10.18203/2394-6040.ijcmph20213567.
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Background: Inhaler is a device used by patients who have chronic respiratory illness. Inhaled medication is directly deposited in the lungs, which is its site of action. Improper use of inhalers can lead to worsening of disease, over medication and side effects including oral candidiasis. This study aims to evaluate the inhaler use technique.Methods: A hospital based cross sectional study was conducted among patients who were using inhalers for one year or more attending respiratory medicine OPD using pretested semi-structured questionnaire.Results: The majority of 81 patients were MDI users. Only 8.64% of them performed all the steps according to NIH guidelines regarding proper technique of inhaler use properly. Among the 39 patients who used dry powder Inhaler, 33% correctly performed all the steps according to the guidelines.Conclusions: Only a low proportion of patients properly performed the steps in the technique of using inhalers. Improper use of inhalers leads to poor efficacy of the treatment. So health care providers should take measures to ensure that the patients on inhalers are aware of the proper technique and are following the steps in using inhalers correctly.
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P., Abdul Hashim K., and Muhammed Anas Ayoob. "An evaluation of proper inhaler technique and adherence to treatment in asthma patients." International Journal of Research in Medical Sciences 7, no. 6 (May 29, 2019): 2382. http://dx.doi.org/10.18203/2320-6012.ijrms20192533.
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Background: Medications used to manage Asthma is delivered via inhaler devices. Proper usage of these devices are required for effective medication delivery. Aim of this study is assess the degree of proper inhaler technique and adherence to treatment among adult asthma patients.Methods: Patients using inhalers were identified and interviewed regarding inhaler use. Checklists were used to document the adherence to manufacturers’ directions for each respective inhaler, and data were then tabulated and assessed for the types of inhalers used, incorrectly performed steps in using the inhalers, as well as demographic information of patients.Results: Out of 120 patients that taken as subjects, twenty-four percent of inhalers (29/120) used incorrectly, with the most common errors being improper priming, lack of proper exhalation prior to inhaling the medication, and absence of rinsing mouth following the use of inhaled corticosteroid. Furthermore, only 60% of the patients are adherent to asthma medications.Conclusions: Inhaler technique among adult patients is substandard and is considered a key area for physicians to more proactive in educating patients. For obtaining most accurate therapeutic advantage among patients with inhalers, proper instruction and demonstration regarding inhaler use need to be given to all patients, particularly elderly patients.
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Hamzavi, Mohammad. "Combination Therapy with Budesonide and Formoterol in Single Inhaler of Asthma." Clinical Medicine Insights: Therapeutics 2 (January 2010): 1179559X1000200. http://dx.doi.org/10.1177/1179559x1000200002.
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Inhaled corticosteroids are the mainstay of asthma therapy, but there is now compelling evidence that addition of a long-acting inhaled β2-agonist, such as formoterol, gives better control in terms of reduced symptoms, improved lung function and reduced exacerbations in patients with mild to severe persistent asthma than increasing the dose of corticosteroids in patients not fully in control by low dose. This has led to development of fixed dose combination inhalers such as budesonide/formoterol. Budesonide/formoterol combination in a single inhaler represents a safe, effective and convenient treatment option for management of patients with unstable asthma than inhaled steroid alone. This combination has shown effectiveness for both maintenance and rescue therapy. Clinical results show that the budesonide/formoterol by SMART approach prolongs the time to first severe asthma exacerbation, reduces frequency of exacerbation and maintains day to day asthma control at a reduced corticosteroid load and cost when compared with higher fixed maintenance dose of combination inhalers. With regular maintenance therapy by this approach it is more likely to improve patient compliance. Budesonide/formoterol combination inhaler has shown to have a faster bronchodialatory effect compared with other combination inhalers, a quality highly in demand during exacerbation episodes. Due to this rapid onset of action, budsonide/formoterol in a single inhaler lends itself to be used as a rescue medication, as well.
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Wilkinson, Alexander J. K., Rory Braggins, Ingeborg Steinbach, and James Smith. "Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England." BMJ Open 9, no. 10 (October 2019): e028763. http://dx.doi.org/10.1136/bmjopen-2018-028763.
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ObjectivesMetered-dose inhalers (MDIs) contain propellants which are potent greenhouse gases. Many agencies propose a switch to alternative, low global warming potential (GWP) inhalers, such as dry powder inhalers (DPIs). We aimed to analyse the impact on greenhouse gas emissions and drug costs of making this switch.SettingWe studied National Health Service prescription data from England in 2017 and collated carbon footprint data on inhalers commonly used in England.DesignInhalers were separated into different categories according to their mechanisms of action (eg, short-acting beta-agonist). Within each category we identified low and high GWP inhalers and calculated the cost and carbon impact of changing to low GWP inhalers. We modelled scenarios for swapping proportionally according to the current market share of each equivalent DPI (model 1) and switching to the lowest cost pharmaceutically equivalent DPI (model 2). We also reviewed available data on the carbon footprint of inhalers from scientific publications, independently certified reports and patents to provide more accurate carbon footprint information on different types of inhalers.ResultsIf MDIs using HFA propellant are replaced with the cheapest equivalent DPI, then for every 10% of MDIs changed to DPIs, drug costs decrease by £8.2M annually. However if the brands of DPIs stay the same as 2017 prescribing patterns, for every 10% of MDIs changed to DPIs, drug costs increase by £12.7M annually. Most potential savings are due to less expensive long-acting beta-agonist (LABA)/inhaled corticosteroids (ICS) inhalers. Some reliever inhalers (eg, Ventolin) have a carbon footprint over 25 kg CO2e per inhaler, while others use far less 1,1,1,2-tetrafluoroethane (HFA134a) (eg, Salamol) with a carbon footprint of <10 kg CO2e per inhaler. 1,1,1,2,3,3,3-Heptafluoropropane (HFA227ea) LABA/ICS inhalers (eg, Flutiform) have a carbon footprint over 36 kg CO2e, compared with an equivalent HFA134a combination inhaler (eg, Fostair) at <20 kg CO2e. For every 10% of MDIs changed to DPIs, 58 kt CO2e could be saved annually in England.ConclusionsSwitching to DPIs would result in large carbon savings and can be achieved alongside reduced drug costs by using less expensive brands. Substantial carbon savings can be made by using small volume HFA134a MDIs, in preference to large volume HFA134a MDIs, or those containing HFA227ea as a propellant.
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Lavorini, Federico, Christer Janson, Fulvio Braido, Georgios Stratelis, and Anders Løkke. "What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape." Therapeutic Advances in Respiratory Disease 13 (January 2019): 175346661988453. http://dx.doi.org/10.1177/1753466619884532.
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Inhaled therapies are the cornerstone of treatment in asthma and chronic obstructive pulmonary disease, and there are a multitude of devices available. There is, however, a distinct lack of evidence-based guidance for healthcare providers on how to choose an appropriate inhaler. This review aims to summarise recent updates on topics related to inhaler choice, and to offer practical considerations for healthcare providers regarding currently marketed devices. The importance of choosing the right inhaler for the right patient is discussed, and the relative merits of dry powder inhalers, pressurised metered dose inhalers, breath-actuated pressurised metered dose inhalers, spacers and soft mist inhalers are considered. Compiling the latest studies in the devices therapy area, this review focuses on the most common types of handling errors, as well as the comparative rates of incorrect inhalation technique between devices. The impact of device-specific handling errors on inhaler performance is also discussed, and the characteristics that can impair optimal drug delivery, such as inhalation flow rate, inhalation volume and particle size, are compared between devices. The impact of patient perceptions, behaviours and problems with inhalation technique is analysed, and the need for appropriate patient education is also highlighted. The continued development of technology in inhaler design and the need to standardise study assessment, endpoints and patient populations are identified as future research needs. The reviews of this paper are available via the supplemental material section.
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Bhattacharyya, Neil, and Lynn Kepnes. "Bacterial Colonization of Nasal Steroid Inhalers in Chronic Rhinosinusitis." American Journal of Rhinology 16, no. 6 (November 2002): 319–21. http://dx.doi.org/10.1177/194589240201600607.
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Background The aim of this study was to determine if nasal steroid inhalers harbor bacteria. Methods Nasal steroid inhalers were randomly selected from an adult patient population with chronic rhinosinusitis. Swab cultures of the tip of the nasal inhaler were obtained and submitted for microbiological analysis. Contemporaneous control cultures were obtained from freshly opened nasal steroid inhalers. Comparisons were conducted between bacterial recovery rates and types of organisms recovered from the patient and control groups. Results Among 31 nasal inhalers in use, 14 inhalers (45%) were found to harbor bacteria. The most common organisms were coagulase negative Staphylococci (11 inhalers) followed by oral flora (2 inhalers) and bacillus species (1 inhaler). None of the 10 control cultures were found to harbor bacteria. Nasal steroid inhalers in use were more likely to have bacterial colonization than new inhalers (p = 0.008, chi-square). Conclusions Nasal steroid inhalers may harbor pathogenic bacteria. Therefore, they may serve as a vehicle for subsequent reinfection.
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Vieira-Marques, Pedro, Rute Almeida, João F. Teixeira, José Valente, Cristina Jácome, Afonso Cachim, Rui Guedes, Ana Pereira, Tiago Jacinto, and João A. Fonseca. "InspirerMundi—Remote Monitoring of Inhaled Medication Adherence through Objective Verification Based on Combined Image Processing Techniques." Methods of Information in Medicine 60, S 01 (April 27, 2021): e9-e19. http://dx.doi.org/10.1055/s-0041-1726277.
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Abstract Background The adherence to inhaled controller medications is of critical importance for achieving good clinical results in patients with chronic respiratory diseases. Self-management strategies can result in improved health outcomes and reduce unscheduled care and improve disease control. However, adherence assessment suffers from difficulties on attaining a high grade of trustworthiness given that patient self-reports of high-adherence rates are known to be unreliable. Objective Aiming to increase patient adherence to medication and allow for remote monitoring by health professionals, a mobile gamified application was developed where a therapeutic plan provides insight for creating a patient-oriented self-management system. To allow a reliable adherence measurement, the application includes a novel approach for objective verification of inhaler usage based on real-time video capture of the inhaler's dosage counters. Methods This approach uses template matching image processing techniques, an off-the-shelf machine learning framework, and was developed to be reusable within other applications. The proposed approach was validated by 24 participants with a set of 12 inhalers models. Results Performed tests resulted in the correct value identification for the dosage counter in 79% of the registration events with all inhalers and over 90% for the three most widely used inhalers in Portugal. These results show the potential of exploring mobile-embedded capabilities for acquiring additional evidence regarding inhaler adherence. Conclusion This system helps to bridge the gap between the patient and the health professional. By empowering the first with a tool for disease self-management and medication adherence and providing the later with additional relevant data, it paves the way to a better-informed disease management decision.
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Mitta, Sandeep Goud, Sannidhi Tanvi, Uppu Bhargavi, and Vemunoori Ruchitha. "An Overview on Pulmonary Insulin." Global Academic Journal of Pharmacy and Drug Research 6, no. 02 (June 6, 2024): 12–19. http://dx.doi.org/10.36348/gajpdr.2024.v06i02.001.
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Pulmonary insulin as an alternative to intravascular, intramuscular, and subcutaneous insulin administration, non-invasive insulin administration was created and implemented. It enters the lungs' alveoli through an as-yet-unidentified paracellular process, traverses the alveolar wall, and then circulates throughout the bloodstream. Inhaled insulin was divided into two categories based on its mechanism of action: 1. Rapid acting pulmonary insulin, which quickly disintegrates in the alveoli and circulates throughout the bloodstream as fine powder particles; and 2. slow acting pulmonary insulin. Recently, two technologies were developed: pulmosol powder technology, which employs a rapid drying procedure to make insulin particles of the right size and chemical stability, and AIR technology, which is a porous dry particle aerosol technology. Dry powders, liquid aerosols in cartridge-shaped inhalers, passive inhalers, Microprocessor-controlled inhalers, and liquid nebulizers were the various ways that inhaled insulin was delivered. Many studies have been conducted to examine various intrapulmonary delivery methods, and in January 2006, the US Food and Drug Administration authorized exubera, a dry powder passive inhaler, as the first pulmonary inhaled insulin. The pharmacokinetics of inhaled insulin, dosage guidelines, administration tools, benefits and drawbacks, and candidates for inhaled insulin administration are all discussed in this article.
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Sahay, Sandeep, Royanne Holy, Shirley Lyons, Edwin Parsley, Mari Maurer, and Jeffry Weers. "Impact of human behavior on inspiratory flow profiles in patients with pulmonary arterial hypertension using AOS™ dry powder inhaler device." Pulmonary Circulation 11, no. 1 (January 2021): 204589402098534. http://dx.doi.org/10.1177/2045894020985345.
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Relative to healthy subjects, patients with pulmonary arterial hypertension often present with decreased respiratory muscle strength, resulting in decreased maximum inspiratory pressure. Little is known about the impact of reduced respiratory muscle strength on the ability to achieve the peak inspiratory pressures needed for effective drug delivery when using portable dry powder inhalers (≥1.0 kPa). The objective of this study was to assess the impact of inhaler resistance and patient instruction on the inspiratory flow profiles of pulmonary arterial hypertension patients when using breath-actuated dry powder inhalers. The inspiratory flow profiles of 35 patients with pulmonary arterial hypertension were measured with variants of the RS01 dry powder inhaler. Profiles were determined with a custom inspiratory flow profile recorder. Results showed that going from the low resistance RS01 dry powder inhaler to the high resistance AOS® dry powder inhaler led to increases in mean peak inspiratory pressures for pulmonary arterial hypertension subjects from 3.7 kPa to 6.5 kPa. Instructions that ask pulmonary arterial hypertension subjects to inhale with maximal effort until their lungs are full led to a mean peak inspiratory pressures of 6.0 kPa versus 2.1 kPa when the same subjects are asked to inhale comfortably. Significant decreases in mean peak inspiratory pressures are also observed with decreases in lung function, with a mean peak inspiratory pressures of 7.2 kPa for subjects with FEV1 > 60% predicted, versus 3.3 kPa for those subjects with FEV1 < 50% predicted. In conclusion, despite having reduced respiratory muscle strength, subjects with pulmonary arterial hypertension can effectively use a breath-actuated dry powder inhaler. The probability of achieving effective dose delivery may be increased by using dry powder inhalers with increased device resistance, particularly when subjects do not follow the prescribed instructions and inhale comfortably.
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Ngo, Chau, Dung Phan, Giap Vu, Phu Dao, Phuong Phan, Hanh Chu, Long Nguyen, et al. "Inhaler Technique and Adherence to Inhaled Medications among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Vietnam." International Journal of Environmental Research and Public Health 16, no. 2 (January 10, 2019): 185. http://dx.doi.org/10.3390/ijerph16020185.
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Sub-optimal chronic obstructive pulmonary disease (COPD) management has been found largely due to patients’ medication non-adherence and incorrect inhaler technique. This study aimed to examine inhaler use technique and medication adherence among Vietnamese COPD patients as well as potential associated factors. A cross-sectional study involving 70 COPD exacerbators was conducted. Inhaler technique and adherence were evaluated by the 10-item and 12-item Test of Adherence to Inhaler (TAI). Data on the history of COPD, home prescription of inhalers and duration of hospitalization were also collected. Generalized linear regression models were used to determine the associated factors with inhaler use and medication adherence. The results showed that the proportion of patients with good inhaler technique was 22.7% for metered-dose inhalers (MDI), 30.4% for dry powder inhalers (DPI) and 31.8% for soft-mist inhalers (SMI). Full exhalation was the most common mistake. The rates of non-compliance patterns were: “ignorant” (77.1%), “sporadic” (58.6%), and “deliberate” (55.7%). Worse dyspnea, greater health condition impairment, and an increased frequency of exacerbations and hospitalizations were found to be associated negatively with correct inhaler use and treatment adherence. Instructions to COPD patients about using inhalers should focus on correct inhaler technique and adherence even when feeling healthy.
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Terry, Paul D., and Rajiv Dhand. "Maintenance Therapy with Nebulizers in Patients with Stable COPD: Need for Reevaluation." Pulmonary Therapy 6, no. 2 (May 20, 2020): 177–92. http://dx.doi.org/10.1007/s41030-020-00120-x.
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AbstractPatients with stable COPD rely heavily on inhaled bronchodilators and corticosteroids to control symptoms, maximize quality of life, and avoid exacerbations and costly hospitalizations. These drugs are typically delivered by hand-held inhalers or nebulizers. The majority of patients are prescribed inhalers due to their perceived convenience, portability, and lower cost, relative to nebulizers. Unfortunately, poor inhaler technique compromises symptom relief in most of these patients. In contrast to one or two puffs through an inhaler, nebulizers deliver a drug over many breaths, through tidal breathing, and hence are more forgiving to poor inhalation technique. To what extent susceptibility to errors in their use may influence the relative effectiveness of these two types of inhalation device has received little attention in COPD research. In 2005, a systematic review of the literature concluded that nebulizers and inhalers are equally effective in patients who are adequately trained to use their inhalation device. This conclusion was based on two small clinical trials that only examined objective measures of lung function. Since then, additional studies have found that maintenance therapy administered by nebulizers could improve patients’ reported feelings of symptom relief, quality of life, and satisfaction with treatment, compared to therapy administered by inhalers. Because it has been 15 years since the publication of the systematic review, in this article we summarize the results of studies that compared the effectiveness of inhalers with that of nebulizers in patients with stable COPD and discuss their implications for clinical practice and need for future research.
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Lorensia, Amelia, Soedarsono ., Rivan Virlando Suryadinata, and Havida Ainin Badri. "Effect of Inhaler Technique Health Education in Improving Symptoms and Lung Function in COPD Outpatient in a Private Hospital in Gresik, Indonesia: Pilot Studies." INTERNATIONAL JOURNAL OF DRUG DELIVERY TECHNOLOGY 14, no. 02 (June 24, 2024): 768–76. http://dx.doi.org/10.25258/ijddt.14.2.26.
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Inhalers are the most effective therapy in the treatment of Chronic obstructive pulmonary disease (COPD). Research shows that a large number of COPD patients do not use inhalers properly. Incorrect inhaler use technique can reduce drug delivery and poor disease control. Education on how to use inhalers is an important part of COPD management. The study was conducted to determine the effect of education on symptom assessment, lung function assessment and inhaler use skill assessment in COPD patients. The research was in the form of a pre-experimental one-group pre-test post-test. The results showed that there was a significant difference in the effect of education on how to use the inhaler on the assessment of symptoms (p = 0.000), a significant difference in the assessment of lung function (p = 0.001) and a significant difference in the assessment of skills in using the inhaler (p = 0.000). Education on how to use inhalers has an influence on the assessment of symptoms, lung function and skills in using inhalers in COPD patients.
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Susanti, Indah Kusumawati, Rani Sauriasari, Anna Rozaliyani, and Dodi Sudiana. "Accuracy of Inhaler Use in COPD Patients and Factors Affecting It." Jurnal Respirologi Indonesia 43, no. 4 (October 31, 2023): 231–38. http://dx.doi.org/10.36497/jri.v43i4.508.
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Background: An inhaler is a type of dosage form used in the treatment of chronic obstructive pulmonary disease (COPD). The inhaler has a unique technique for use; however, the percentage of accuracy in inhaler use is still low. Proper inhaler use is expected to improve quality of life and decrease the occurrence of exacerbations. This study aimed to observe the percentage of accuracy in using inhalers and the factors that influence it.Method: This study was conducted with a cross-sectional design on COPD patients in two different hospitals. Primary data were collected using a questionnaire. The accuracy of inhaler use was assessed using a checklist.Results: The total number of patients in this study was 110, with an average age of 62 years. Patients were given single inhaler therapy, which included Dry Powder Inhalers (DPI) for 34 patients with 70.7% accuracy, Pressurized Metered-Dose Inhalers (pMDI) for 9 persons with 45.74% accuracy, and Soft Mist Inhalers (SMI) for one person with 66.67% accuracy. Furthermore, patients who used a combination of pMDI and DPI inhalers had an accuracy value of 68.53%, while a combination of pMDI and SMI had an accuracy value of 72.72%. The stage with the lowest level of accuracy in the pMDI-type inhaler used alone was exhaling before the inhaler was supplied.Conclusion: According to the findings, the accuracy of inhaler use in COPD patients is still relatively low. Furthermore, gender is a factor that has a statistically significant relationship with inhaler accuracy.
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Vizel, A. A., A. I. Rezyapova, and I. Yu Vizel. "Comparison of the Correct Use of Different Types of Inhalers in Patients with COPD and Bronchial Asthma." Tuberculosis and Lung Diseases 101, no. 3 (July 1, 2023): 6–14. http://dx.doi.org/10.58838/2075-1230-2023-101-3-6-14.
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The objective: to compare the correct use of different types of inhalers in patients with COPD and bronchial asthma.Subjects and Methods. 100 patients with COPD and 108 patients with BA were examined. Nine devices were evaluated – a metered dose inhaler (MDI), Rapihaler, Respimat, Breezhaler, CDM, Turbuhaler, Genuair, Spiromax, and Ellipta. The application technique was assessed before the patient read the use instructions and was governed by his intuition, after reading the use instructions, and after training in the inhalation technique by the investigating physician.Results. When COPD patients used inhalers by intuition, they managed to use them successfully in more than 30% of cases with Ellipta, Breezhaler, and Spiromax. After reading the use instructions, the correct use was achieved in 80% of cases when using CDM inhaler, Spiromax, Genuair, and Ellipta. Training conducted by the physician resulted in 100% success rate for Spiromax, Genuair, Ellipta, Breezhaler, and CDM inhaler. With asthma patients using inhalers by intuition, the correct use was observed in more than 50% of cases with Spiromax, Ellipta, Rapihaler, and MDI. After reading the instructions, the correct use was achieved in 80% of cases with CDM inhaler, Spiromax, Ellipta, CDM inhaler, Breezhaler, and Genuair. Training conducted by the physician allowed achieving 100% success rate for Spiromax, Ellipta, Breezhaler, and CDM inhaler.Conclusion. Inhalers vary significantly by the patients’ ability to use them correctly. Asthma patients master the correct inhalation technique better versus COPD patients. Liquid inhalers were more difficult to be used correctly, and the best results were observed with multi-dose powder inhalers. The patient’s training by a healthcare professional is critical to assure the correct use of inhalers.
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Haridas, R. P. "William TG Morton's Early Ether Inhalers: A Tale of three Inhalers and their Inscriptions." Anaesthesia and Intensive Care 37, no. 1_suppl (July 2009): 30–35. http://dx.doi.org/10.1177/0310057x090370s109.
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Three ether inhalers with inscriptions stating that they had been used in early ether anaesthesia were found. All three inhalers were initially linked to WTG Morton. Two of the inhalers were probably among several types of inhalers used by Morton. The third inhaler was found to have been incorrectly attributed to Morton. It was first used by John Foster Brewster Flagg, a dentist in Philadelphia.
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Tian, J., A. McGrogan, and M. D. Jones. "Low carbon footprint inhalers in England: a review of dispensing data." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i38. http://dx.doi.org/10.1093/ijpp/riac019.053.
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Abstract Introduction Due to propellants, metered dose inhalers (pMDIs) have a higher carbon footprint than low carbon footprint inhalers (LCFIs), such as dry powder or soft mist inhalers (1). Consequently, pMDIs contribute 3.5% of the NHS’s CO2 equivalent emissions (2). Local and national guidelines (NICE, British Thoracic Society) have attempted to increase use of LCFIs, but their effects and factors influencing success are unknown. Aim To investigate temporal and geographical variation in LCFI dispensing in England over five years. Methods Clinical commissioning group (CCG) dispensed items (March 2016-February 2021) were obtained from openprescribing.net for five classes of inhaler where a choice between pMDIs and LCFIs is available: short-acting beta-agonists (SABAs), long-acting beta-agonists (LABAs), inhaled corticosteroids (ICS), ICS plus LABA inhalers (ICS/LABA) and ICS/LABA plus long-acting muscarinic antagonist inhalers (ICS/LABA/LAMA). CCG population age profiles were obtained from the Office for National Statistics. CCG emergency hospital admission and mortality rates were obtained from Public Health England. CCG formularies and guidelines were reviewed to identify where guidance is available to prescribers. To control for total inhaler dispensing, the key measure used is the %LCFI: the number of LCFI items dispensed relative to the total number of pMDI and LCFI items. Multivariate regression models were used to investigate geographical variation. Results The total annual %LCFI increased from 19.5% to 26.3% over the study period. This was driven by the introduction of ICS/LABA/LAMA inhalers in 2018, as %LCFI decreased for SABA, ICS and ICS/LABA inhalers. %LCFI varied between classes. In the final year, it ranged from 6% for both SABA and ICS inhalers, to 41.2% and 43.9% for ICS/LABA and ICS/LABA/LAMA inhalers, respectively. Interestingly, the cost per item for ICS/LABA and ICS/LABA/LAMA inhalers was similar for both pMDIs and LCFIs, but for SABA and ICS inhalers LCFIs were more expensive. %LCFI in the final year varied between CCGs (10.7% to 30.9%). The North West, and Birmingham and London areas had consistently higher %LCFI for all classes. For SABA and ICS inhalers, both the presence of advice on climate change in CCG guidelines or formularies, and greater CCG asthma prevalence, were significantly associated with higher %LCFI (p<0.05). The proportion of CCG population <15 years had a significant negative association with %LCFI for ICS and ICS/LABA inhalers (p<0.05). There were no clinically significant associations between %LCFI and either emergency hospital admission or mortality rates. Conclusion Current initiatives have not been successful in increasing the use of LCFIs, indicating limited implementation of guidelines for unknown reasons. Further action is required to reduce the carbon footprint of inhaler prescribing. Actions to address the financial disincentives to LCFI prescribing, CCG leadership (e.g. guidelines) and the appropriate use of LCFI in young people should be considered. Research into facilitators and barriers to LCFI use would support this. An important limitation is the use of dispensed items data rather than the number of inhalers, although there is no evidence that the number of inhalers per item varies between pMDIs and LCFIs. In addition, the Covid-19 pandemic disrupted prescribing patterns and long-term NHS projects. References (1) Wilkinson AJK, Braggins R, Steinbach I, Smith K. Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open. 2019; 9:e028763. (2) Environmental Audit Committee. UK progress on reducing F-Gas emissions inquiry: Fifth report of session 2017-19. London (UK): House of Commons Environmental Audit Committee; 25 April 2018. Available from https://publications.parliament.uk/pa/cm201719/cmselect/cmenvaud/469/469.pdf: [Accessed 27 September 2021].
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Acharya, Rucha B., Tina Joseph, Cynthia Moreau, Genevieve Hale, Alexandra Perez, and Elaina Rosario. "Effects of a Therapeutic Interchange Between Branded and Generic Inhaled Therapy on Chronic Obstructive Pulmonary Disease." Senior Care Pharmacist 36, no. 12 (December 1, 2021): 687–92. http://dx.doi.org/10.4140/tcp.n.2021.687.
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Objective To evaluate the difference in the occurrence of chronic obstructive pulmonary disease (COPD) exacerbations six months preconversion compared with six months postconversion from the branded inhaled corticosteroid/long-acting beta 2-agonist inhalers to the generic fluticasone/salmeterol inhalers. Design Retrospective cohort study using a six-month pre-/post-test design Setting Three primary care offices within a Management Service Organization (MSO) in South Florida. Patients, Participants Patients were included in the study if they had a diagnosis of COPD (in electronic medical record [EMR]), were at least 18 years of age, were under the care of a provider at one of the three primary care clinics within an MSO, and were switched from a branded ICS/LABA inhaler to a generic ICS/LABA inhaler between May 2019 and February 2020. This study included a total of 22 patients. Interventions Not applicable; this was a retrospective chart review. Main Outcome Measure The prevalence of COPD exacerbations leading to hospitalizations, emergency room visits, urgent care visits, or clinic visits. Results In this study, 10 (45.5%) patients experienced at least one exacerbation while on generic inhaler therapy compared with four (18.2%) patients while on branded inhaler therapy (P = 0.05). Those on a generic inhaler were 3.8 times more likely to have a COPD exacerbation. Conclusion While changing patients from branded to generic inhalers may be appealing because of the potential benefits in cost-reduction, the results of this study conclude that the inhaler switch may lead to increased exacerbations. Prescribers need to be aware of potential complications that may be related to a therapeutic interchange.
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Pernigotti, Daniele, Carol Stonham, Sara Panigone, Federica Sandri, Rossella Ferri, Yasemin Unal, and Nicolas Roche. "Reducing carbon footprint of inhalers: analysis of climate and clinical implications of different scenarios in five European countries." BMJ Open Respiratory Research 8, no. 1 (December 2021): e001071. http://dx.doi.org/10.1136/bmjresp-2021-001071.
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BackgroundInhaled therapies are key components of asthma and chronic obstructive pulmonary disease (COPD) treatments. Although the use of pressurised metered-dose inhalers (pMDIs) accounts for <0.1% of global greenhouse gas emissions, their contribution to global warming has been debated and efforts are underway to reduce the carbon footprint of pMDIs. Our aim was to establish the extent to which different scenarios led to reductions in greenhouse gas emissions associated with inhaler use, and their clinical implications.MethodsWe conducted a series of scenario analyses using asthma and COPD inhaler usage data from 2019 to model carbon dioxide equivalent (CO2e) emissions reductions over a 10-year period (2020–2030) in the UK, Italy, France, Germany and Spain: switching propellant-driven pMDIs for propellant-free dry-powder inhalers (DPIs)/soft mist inhalers (SMIs); transitioning to low global warming potential (GWP) propellant (hydrofluoroalkane (HFA)-152a) pMDIs; reducing short-acting β2-agonist (SABA) use; and inhaler recycling.ResultsTransition to low-GWP pMDIs and forced switching to DPI/SMIs (excluding SABA inhalers) would reduce annual CO2e emissions by 68%–84% and 64%–71%, respectively, but with different clinical implications. Emission reductions would be greatest (82%–89%) with transition of both maintenance and SABA inhalers to low-GWP propellant. Only minimising SABA inhaler use would reduce CO2e emissions by 17%–48%. Although significant greenhouse gas emission reductions would be achieved with high rates of end-of-life recycling (81%–87% of the inhalers), transition to a low-GWP propellant would still result in greater reductions.ConclusionsWhile the absolute contribution of pMDIs to global warming is very small, substantial reductions in the carbon footprint of pMDIs can be achieved with transition to low-GWP propellant (HFA-152a) inhalers. This approach outperforms the substitution of pMDIs with DPI/SMIs while preserving patient access and choice, which are essential for optimising treatment and outcomes. These findings require confirmation in independent studies.
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Kotoulas, Serafeim-Chrysovalantis, Ioanna Tsiouprou, Kalliopi Domvri, Polyxeni Dontsi, Athanasia Pataka, and Konstantinos Porpodis. "Open and Closed Triple Inhaler Therapy in Patients with Uncontrolled Asthma." Advances in Respiratory Medicine 91, no. 4 (July 4, 2023): 288–300. http://dx.doi.org/10.3390/arm91040023.
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Long-acting muscarinic antagonists (LAMAs) are a class of inhalers that has recently been included as add-on therapy in the GINA guidelines, either in a single inhaler device with inhaled corticosteroids plus long-acting β2-agonists (ICS + LABA) (closed triple inhaler therapy) or in a separate one (open triple inhaler therapy). This review summarizes the existing evidence on the addition of LAMAs in patients with persistently uncontrolled asthma despite ICS + LABA treatment based on clinical efficacy in the reduction of asthma symptoms and exacerbations, the improvement in lung function, and its safety profile.
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Graham, L. E. "The Ineffective Use of Inhalers in Chronic Obstructive Pulmonary Disease." Journal of Institute of Medicine Nepal 23, no. 1 & 2 (June 30, 2001): 22–25. http://dx.doi.org/10.59779/jiomnepal.151.
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Chronic Obstructive Pulmonary Disease (COPD) is the most common adult respiratory disease in Nepal. It is disabling condition and requires the use of inhaled and/or oral medications for stabilisation. Inhaled medications are preferable to oral medications because of their superior effect and lack of side effects. Spacer device are also available; these reduce the need for inhaler co-ordination.The aims of this study were to determine a) the percentage of patients with COPD attending the medical clinic who use inhaled medication. b) the skill level of patients regarding inha ler technique. c) the benefit of inhaler technique counselling for improving patient skill level.In this prospective randomised study we interviewed 95 patients with COPD over a4-month period. Thirty-three patients were regularly using inhalers, but 100% had anunsatisfactory inhaler technique. Only one patient used a spacer device.Thirty percent of patients claimed that they had never been shown how to use theinhaler.Subsequent demonstration of inhaler technique by a doctor improved skill level in85% of patients but resulted in a satisfactory inhaler technique score for only onepatient.Although this is a small study, it is probably representative of the patient populationwith COPD who attend our clinics. Patients, especially the elderly, have considerabledifficulty activating and using MDI – despite demonstration. Doctors infrequentlyprescribe spacers and the cost of these excludes many patients from using them.
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Giner, Jordi, Pere Roura, Berta Torres, Felip Burgos, Diego Castillo, Eduard Tarragona, and Vicente Plaza. "KNOWLEDGE, ATTITUDES AND PREFERENCES AMONG SPANISH COMMUNITY PHARMACISTS REGARDING INHALED THERAPY (THE OPTIM PHARMACY STUDY)." International Journal of Pharmacy and Pharmaceutical Sciences 8, no. 9 (September 1, 2016): 53. http://dx.doi.org/10.22159/ijpps.2016v8i9.11796.
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<p><strong>Objective: </strong>To assess knowledge, attitudes, and preferences regarding inhaled therapy among Spanish community pharmacists.</p><p><strong>Methods: </strong>An 11-item questionnaire was developed and distributed to community pharmacists throughout the country. Data collected included demographics, the source of knowledge of inhaler use, known and preferred devices, steps for correct use of metered-dose (pMDI) and dry-powder (DPI) inhalers, important variables when prescribing an inhaler device, patient education, and checking inhaler technique.</p><p><strong>Results: </strong>Of a total of 3000 questionnaires delivered, 1722 (57.4%) were returned. The most common source of knowledge was the package insert (46.9%) followed by personal experience (33.3%). Diskus<sup>TM</sup> and Turbuhaler<sup>TM</sup> were the best-known devices (96.4% and 93.4%), and DPIs the preferred inhalers. Although more than half of the surveyed pharmacists were aware of the most important step for correct inhalation with pMDI and DPI, only 18% identified the correct answer ‘Patient’s preference’ as the most important variable when prescribing an inhaler device. Most of the respondents had inadequate knowledge of inhaled therapies. Statistically, significant differences were found according to geographical areas. Moreover, the mean score on inhaled therapy with one knowledge source was higher than for those with none (P<0.05). Additionally, patient education was poor.</p><strong>Conclusion: </strong>In spite of the increasing involvement of Spanish community pharmacists in patients’ care, their knowledge of inhaler use and attitudes towards inhaled therapy needs to improve, so that they can provide better patient education.
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Oliveira, Paula Duarte de, Ana Maria Baptista Menezes, Andrea Damaso Bertoldi, and Fernando Cesar Wehrmeister. "Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil." Jornal Brasileiro de Pneumologia 39, no. 3 (June 2013): 287–95. http://dx.doi.org/10.1590/s1806-37132013000300005.
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OBJECTIVE: To evaluate the characteristics of users of inhalers and the prevalence of inhaler use among adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema. METHODS: A population-based study conducted in the city of Pelotas, Brazil, involving 3,670 subjects ≥ 10 years of age, evaluated with a questionnaire. RESULTS: Approximately 10% of the sample reported at least one of the respiratory diseases studied. Among those individuals, 59% reported respiratory symptoms in the last year, and, of those, only half reported using inhalers. The use of inhalers differed significantly by socioeconomic status (39% and 61% for the lowest and the highest, respectively, p = 0.01). The frequency of inhaler use did not differ by gender or age. Among the individuals reporting emphysema and inhaler use, the use of the bronchodilator-corticosteroid combination was more common than was that of a bronchodilator alone. Only among the individuals reporting physician-diagnosed asthma and current symptoms was the proportion of inhaler users higher than 50%. CONCLUSIONS: In our sample, inhalers were underutilized, and the type of medication used by the individuals who reported emphysema does not seem to be in accordance with the consensus recommendations.
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Shammer, Noor Hassan, and Ali Salih Baay. "ASSESSMENT OF INHALERS TECHNIQUE PROPER USE FOR PATIENTS WITH CHRONIC RESPIRATORY DISEASES IN PRIMARY AND SECONDARY CLINICS IN BABYLON CITY." Asian Journal of Pharmaceutical and Clinical Research 11, no. 3 (March 1, 2018): 199. http://dx.doi.org/10.22159/ajpcr.2018.v11i3.23481.
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Objective: Although the inhalers are the preferred method of medications delivery, evidences suggest that many patients are unable to use their inhalers effectively due to improper technique so patients must know the right way of their inhaler use. The aim of the study is to assess the patient’s ability to use their inhalers properly, identify the most common error made, assess the benefit of single education session, compare the property of the use between the primary and secondary clinics patients, determine which type of the inhaler devices is associated with more errors, and to identify the association between the inhaler technique and the disease control.Methods: Non-randomized interventional study was done on 100 inhaler users of three inhaler types (metered-dose inhaler [p MDI], Turbuhaler, or Handihaler) for chronic respiratory diseases. Inhaler technique was evaluated by a scoring system before and after single session of training.Results: It had been shown that the current education about inhalers techniques was not sufficient. The response to single session of education was higher with high level of education, urban area, and specialized respiratory center. Better disease control with the better score. After training, the younger patients have higher score.Conclusion: We conclude that we need to stress on the most reported defect, metered-dose inhaler had the lowest mean score; therefore, it needs more training. Furthermore, single class of training can be beneficial but need follow-up to see if this effect can be maintained.
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Funston, Wendy, and Simon J. Howard. "A cross-sectional questionnaire study of the rules governing pupils’ carriage of inhalers for asthma treatment in secondary schools in North East England." PeerJ 4 (May 5, 2016): e2006. http://dx.doi.org/10.7717/peerj.2006.
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Objectives.The primary objective of this study was to assess the rules governing secondary school pupils’ carriage of inhalers for emergency treatment of asthma in the North East of England.Design.This study was based upon a postal questionnaire survey.Setting.The setting for this study was mainstream free-to-attend secondary schools which admit 16 year old pupils within the 12 Local Authority areas which make up the North East of England.Participants.All 153 schools meeting the inclusion criteria were invited to participate in the study, of which 106 (69%) took part.Main Outcome Measures.Our three main outcome measures were: whether pupils are permitted to carry inhalers on their person while at school; whether advance permission is required for pupils to carry inhalers, and from whom; and whether the school has an emergency ‘standby’ salbutamol inhaler for use in asthma emergencies, as permitted since October 2014 under recent amendments to The Human Medicines Regulations 2012.Results.Of 98 schools submitting valid responses to the question, 99% (n= 97) permitted pupils to carry inhalers on their person while at school; the remaining school stored pupils’ inhalers in a central location within the school. A total of 22% of included schools (n= 22) required parental permission before pupils were permitted to carry inhalers. Of 102 schools submitting valid responses to the question, 44% (n= 45) had purchased a ‘standby’ salbutamol inhaler for use in asthma emergencies.Conclusions.Most secondary schools in North East England permit pupils to carry inhalers on their person. The requirement in a minority of schools for parental permission to be given possibly contravenes the standard ethical practices in clinical medicine for children of this age. Only a minority of schools hold a ‘standby’ salbutamol inhaler for use in asthma emergencies. Wider availability may improve outcomes for asthma emergencies occurring in schools.
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Shin, Sun Hye, Deog Kyeom Kim, Sang-Heon Kim, Tae Rim Shin, Ki-Suck Jung, Kwang Ha Yoo, Ki-Eun Hwang, Hye Yun Park, and Yong Suk Jo. "Lack of Association between Inhaled Corticosteroid Use and the Risk of Future Exacerbation in Patients with GOLD Group A Chronic Obstructive Pulmonary Disease." Journal of Personalized Medicine 12, no. 6 (May 31, 2022): 916. http://dx.doi.org/10.3390/jpm12060916.
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Background: As most clinical trials have been performed in more symptomatic and higher-risk patients, evidence regarding treatment in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A chronic obstructive pulmonary disease (COPD) is limited. We assessed the distribution of inhaler treatment and sought to investigate the association between inhaled corticosteroid (ICS) use and future exacerbation in GOLD group A COPD patients. Methods: Patients with GOLD group A COPD who received maintenance inhalers were identified from a multicentre, prospective cohort in South Korea. Patients were categorized as group A when they had fewer symptoms and did not experience severe exacerbation in the previous year. Development of moderate or severe exacerbation during the 1-year follow-up was analysed according to baseline inhaler treatment. Results: In 286 patients with GOLD group A COPD, mono-bronchodilator (37.8%), dual-bronchodilator (29.0%), triple therapy (17.5%), and ICS/long-acting beta-2 agonist (15.4%) were used. Compared to patients without ICS-containing inhalers (N = 191), those using ICS (N = 95) were more dyspnoeic, and more likely to have asthma history, lower lung function, and bronchodilator response. During the 1-year follow-up, moderate or severe exacerbations occurred in 66 of 286 (23.1%) patients. In the multivariable logistic regression analysis, ICS-containing inhaler use was not associated with the development of exacerbation, even in the subgroup with a high probability of asthma–COPD overlap. Conclusion: Although about one-third of patients with GOLD group A COPD were using ICS-containing inhalers, use of ICS was not associated with a reduction in the future development of exacerbation.
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Godse, Ajay, Rakesh Gurjar, Namrata Rao, Shivanjali Gore, and Ria Vijay. "Evaluation of impact of adherence to inhaled therapy and critical mistakes in inhalation technique on clinical outcomes in patients with obstructive airway diseases in India." IP Indian Journal of Immunology and Respiratory Medicine 9, no. 2 (July 15, 2024): 62–70. http://dx.doi.org/10.18231/j.ijirm.2024.013.
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Adherence to inhaled therapy is more relevant in respiratory diseases because, to achieve therapeutic efficacy, it is necessary that the patient adhere to the recommended therapy as well as use their inhalers correctly with appropriate inhalation technique.This was a prospective, observational study that included 126 patients >18 years of age of all genders, diagnosed with an obstructive airway disease, and prescribed inhaler medication. Adherence was assessed using the Test of Adherence to Inhalers (TAI) questionnaire, and inhaler device technique was assessed every 3 months. At the end of one year, outcome data like the number of exacerbations, the number of admissions, including critical-care admissions, the number of days of hospitalization, adverse events, and their associations were analyzed.Poor adherence to inhaled therapy was found in 40.48% of patients, with the majority of patients (69.05%) having an unwitting or ignorant pattern of non- adherence. Out of 75 patients using MDI (Metered Dose Inhaler), 34.67% had critical mistakes in technique, and out of 51 patients using Rotahaler, 23.53% had critical mistakes in technique. There was no significant relationship between level of adherence and critical mistakes with gender, BMI category, or past history of smoking. Patients with poor adherence and those with critical mistakes in inhalation technique had poor health outcomes.This study highlights the role of adherence and identifies barriers responsible for non-adherence to inhaled therapy. Identifying the behaviors responsible for non-adherence and counseling the patients on the correct inhalation technique can improve the health outcomes of chronic respiratory diseases.
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Fulford, Brett, Karen Mezzi, Simon Aumônier, and Matthias Finkbeiner. "Carbon Footprints and Life Cycle Assessments of Inhalers: A Review of Published Evidence." Sustainability 14, no. 12 (June 10, 2022): 7106. http://dx.doi.org/10.3390/su14127106.
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Respiratory inhalers have a substantial impact on the carbon footprint of the healthcare sector. Environmental factors, including carbon footprints, are gaining importance in choosing inhalers once medical considerations have been addressed. This paper provides a review of the carbon footprint (CFP) and life cycle assessment (LCA) environmental profile of dry powder inhalers (DPIs) and pressurized metered-dose inhalers (pMDIs). Despite methodological challenges, our analysis reveals that the CFP varies between DPIs ranging from 359 gCO2e per inhaler (Enerzair Breezhaler® DPI without digital companion 30-day pack) to 1250 gCO2e per inhaler (Seretide Accuhaler® 50/500) and from 6.13 gCO2e per dose (Enerzair Breezhaler® without digital companion 90-day pack) to 27 gCO2e per dose (Relvar Elipta 92/22). The breakdown of inhaler CFP by life cycle stage reveals that, although the use and end-of-life stages together contribute to most of the CFP of the MDIs, the largest contributions to the CFP of the DPI/SMI are made by the API and manufacturing stages of the life cycle. Although from a climate perspective our review aligns with the findings of Jeswani and Azapagic that DPIs have a lower CFP than pMDIs, we conclude that the performance against other environment impact categories depends on the design, choice of material and manufacturing process of the DPIs. The challenge of comparing the CFP of different inhalers can be made easier by the standardization of study boundaries and methods.
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Iqbal, Tahir, Qaisar Iqbal, Bahar Ali, Raza Ullah, Shahida Naz, and Haleema. "Assessment of Metered-Dose Inhalers with Spacer Technique among Postgraduate Trainees." Journal of Gandhara Medical and Dental Science 10, no. 1 (January 1, 2023): 41–44. http://dx.doi.org/10.37762/jgmds.10-1.342.
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OBJECTIVES Most obstructive airway disease medications are used via inhalers, and their proper use is significant for effectively treating these diseases. Most patients misuse it. However, some studies showed that many physicians also do not know the proper meter dose inhaler with the spacer technique. This study aimed to assess metered-dose inhalers with spacer technique among postgraduate trainee doctors. METHODOLOGY This cross-sectional study was carried out in the Khyber Teaching Hospital Peshawar. The total time was six months, from Dec 6 2020, to Jun 5 2021. Postgraduate trainee (PGT) doctors of either gender with an age range of 25 to 35 years were included in the study from different departments. Those with every use of inhalers were excluded from the study. Demographic details of PGTs, like age and gender, were recorded. RESULTS Among 96 patients, males were 85 (88.54%), and females were 11 (11.46%). The mean age was 30.02±1.84 years, and the mean training experience was 2.0521 ±0.89. Inhaler technique was Proper in 20 (20.83%), Improper in 51 (53.13%) and Poor in 25 (26.04%) doctors. Those with more training periods, pulmonology rotation, attended workshops on inhaler techniques and with relatives using inhalers were more acknowledged of proper meter dose inhalers (MDIs) with spacer technique. CONCLUSION Only one-fifth of the postgraduate trainees know proper MDIs techniques. The attendance of workshops and pulmonology rotation is encouraged to enhance the knowledge of physicians regarding MDIs techniques.
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Phan, Anh Dang Thuc, Thi Kim Cuc Ngo, Chi Van Le, Phuoc Bich Ngoc Nguyen, Nhi Nguyen-Thi-Y, and Thi Hong Phuong Vo. "Effect of Pharmacist-Led Training on Adherence and Practice of Inhaler Use: A Pre‐Post Interventional Study in Outpatients With Asthma at Hue University Hospital." Senior Care Pharmacist 39, no. 2 (February 1, 2024): 78–86. http://dx.doi.org/10.4140/tcp.n.2024.78.
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Objective This study aimed to evaluate the impact of a pharmacist-led intervention on improving adherence and practice of inhaler use in outpatients with asthma at a hospital in Vietnam. Methods A pre-post interventional study was conducted at Hue University Hospital. An adapted checklist for both metered-dose inhalers and/or dry powder inhalers was used to evaluate the inhaler technique. Adherence was assessed by using the Test of Adherence to Inhalers questionnaire. The means of interventions comprised “Face-to-face training,” “Creating the leaflet for patients,” and “Watching guidance video.” Results The number of participants with complete data was 79. Before the intervention, 54.4% of patients had misused inhalers, especially inappropriate posture when using devices (70.2%) and not exhaling before inhalation (46.8%). Non-adherence accounted for 55.7% of patients, and the erratic pattern was the highest, with 83.5%. The intervention had remarkably raised the number of good practice and good adherence patients after three months (P < 0.001). Conclusion Pharmacist-led intervention has a positive impact on improving the adherence to inhalers and inhalation techniques of patients with asthma. Practice Implications The pharmacist-led education model could be considered as an effective and feasible solution for asthma management in outpatients and better medication use. Key Points (1) The most frequently observed mistakes in this study were inappropriate posture and inhalation skill when using devices. (2) Pharmacist-led training remarkably improved patients’ practice of inhaler use as well as medication adherence.
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Misik, Ondrej, Frantisek Lizal, Vahid Farhikhteh Asl, Miloslav Belka, Jan Jedelsky, Jakub Elcner, and Miroslav Jicha. "Inhalers and nebulizers: basic principles and preliminary measurements." EPJ Web of Conferences 180 (2018): 02068. http://dx.doi.org/10.1051/epjconf/201818002068.
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Inhalers are hand-held devices which are used for administration of therapeutic aerosols via inhalation. Nebulizers are larger devices serving for home and hospital care using inhaled medication. This contribution describes the basic principles of dispersion of aerosol particles used in various types of inhalers and nebulizers, and lists the basic physical mechanisms contributing to the deposition of inhaled particles in the human airways. The second part of this article presents experimental setup, methodology and preliminary results of particle size distributions produced by several selected inhalers and nebulizers.
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Shayo, Grace A., Amina Omary, and Ferdinand Mugusi. "Inhaler Non-Adherence, Associated Factors and Asthma Control among Asthma Patients in a Tertiary Level Hospital in Tanzania." East African Health Research Journal 6, no. 1 (July 27, 2022): 78–85. http://dx.doi.org/10.24248/eahrj.v6i1.682.
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Background: Inhaled medications including corticosteroids are the most effective long-term controller medicines for asthma-related chronic airway inflammation. Despite this fact, 30% to 70% of the uncontrolled asthma patients report non-adherence to their inhalers. The study investigated factors affecting inhaler non-adherence among outpatient asthma patients in Muhimbili National Hospital, Dar es Salaam Tanzania and related the level of inhaler adherence to the extent of asthma control. Methods: A cross-sectional hospital-based study was conducted among patients with bronchial asthma in the pulmonology clinic of Muhimbili National Hospital in Dar-es-salaam, Tanzania. Patients’ demographic, clinical and socio-economic factors were collected using a structured questionnaire. Medication adherence was self-reported using a 10-item Test of Adherence to Inhalers (TAI) questionnaire. Adherence was gauged as good when the score was 50, intermediate (score 46-49) or poor (score ≤ 45). Asthma control was assessed using a 5-question Asthma Control Test (ACT). A score of ≥20 meant well controlled asthma while a score of ≤19 meant poorly controlled asthma. Patients’ inhaler use technique was assessed using a 12-step checklist. Patient’s technique was regarded correct when all the steps were performed correctly. Categorical data were summarised as proportions. Binary logistic regression was performed to identify factors associated with inhaler non-adherence. Significance level was set at p-value less than .05. Results: A total of 385 asthma patients were enrolled in the study. Females were 206 (53.5%), 232(60.3%) were nonadherent to medications and 283(73.5%) had poorly controlled asthma. Lack of health insurance, fear of medication side effects, being too busy, having alternative medication for asthma and incorrect inhaler technique were significantly associated with non-adherence to inhalers, all p-values <.05. Conclusion: The magnitude of inhaler non-adherence and poorly controlled asthma were very high. Promoting adherence through patients’ education on asthma and its management, emphasis on patients’ insurance coverage and setting aside time to care for ones’ self are fundamental in optimising asthma care and treatment.
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Sodhi, Mandeep Kaur. "Incorrect inhaler techniques in Western India: still a common problem." International Journal of Research in Medical Sciences 5, no. 8 (July 26, 2017): 3461. http://dx.doi.org/10.18203/2320-6012.ijrms20173541.
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Background: To assess and evaluate the incorrect use of inhalers in patients with asthma and chronic obstructive pulmonary disease (COPD) in the outpatient department of pulmonary medicine at RUHS college of medical sciences Jaipur, Rajasthan, India.Methods: Patients visiting the outpatient department of respiratory medicine were asked to demonstrate the inhaler technique and were assessed by the physician.Results: The study included 200 patients with Asthma or COPD. Among patients with COPD, 80 (63.4%) were males and 46 (36.5%) were females. In the asthma group, there were 50 (67.5%) females and 24 (32.4%) males. Patients with COPD were in the age group between 46-82 years with a mean age of 64 years while patients with asthma were in the age group between 18-70 years with a mean age of 44 years. Only 28 (14%) patients could perform all steps correctly in use of inhaler devices. 172 patients (86%) were unable to use inhalers properly. Most common error for metered dose inhalers (MDIs) was in step 7 that is (i.e.) not holding breath for 10 seconds which was seen in 46 patients (51.7%). The most common error seen for dry powder inhalers (DPIs) was in step 5 i.e. exhalation to residual volume before inhalation seen in 50 patients (47.1%).Conclusions: This study revealed that majority of patients use the inhaler devices incorrectly. Proper education regarding inhaler use is crucial for effective treatment with use of these inhaler devices.
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Tervonen, Tommi, Natalia Hawken, Nicola A. Hanania, Fernando J. Martinez, Sebastian Heidenreich, and Ileen Gilbert. "Maintenance inhaler therapy preferences of patients with asthma or chronic obstructive pulmonary disease: a discrete choice experiment." Thorax 75, no. 9 (July 6, 2020): 735–43. http://dx.doi.org/10.1136/thoraxjnl-2019-213974.
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BackgroundA variety of maintenance inhaler therapies are available to treat asthma and COPD. Patient-centric treatment choices require understanding patient preferences for the alternative therapies.MethodsA self-completed web-based discrete choice experiment was conducted to elicit patient preferences for inhaler device and medication attributes. Selection of attributes was informed by patient focus groups and literature review.ResultsThe discrete choice experiment was completed by 810 patients with asthma and 1147 patients with COPD. Patients with asthma most valued decreasing the onset of action from 30 to 5 min, followed by reducing yearly exacerbations from 3 to 1. Patients with COPD most and equally valued decreasing the onset of action from 30 to 5 min and reducing yearly exacerbations from 3 to 1. Both patients with asthma and patients with COPD were willing to accept an additional exacerbation in exchange for a 15 min decrease in onset of action and a longer onset of action in exchange for a lower risk of adverse effects from inhaled corticosteroids. Patients with asthma and COPD valued once-daily over twice-daily dosing, pressurised inhalers over dry powder inhalers and non-capsule priming over single-use capsules, although these attributes were not valued as highly as faster onset of action or reduced exacerbations.ConclusionsThe most important maintenance inhaler attributes for patients with asthma and COPD were fast onset of symptom relief and a lower rate of exacerbations. Concerns about safety of inhaled corticosteroids and device convenience also affected patient preferences but were less important.
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Attar-Zadeh, Darsuh, Harriet Lewis, and Martina Orlovic. "Health-care Resource Requirements and Potential Financial Consequences of an Environmentally Driven Switch in Respiratory Inhaler Use in England." Journal of Health Economics and Outcomes Research 8, no. 2 (September 23, 2021): 46–54. http://dx.doi.org/10.36469/jheor.2021.26113.
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Background: To reduce greenhouse gas emissions, national initiatives advocate the phasing down of respiratory inhalers that use a fluorinated gas as a propellant (pressurised metered-dose inhalers [pMDI]). Nevertheless, pMDIs continue to be an effective and common choice. Objective: To assess the potential financial impact of patients with asthma or chronic obstructive pulmonary disease (COPD) switching from pMDIs to dry powder inhalers (DPIs) in a representative primary care network (PCN) population of 50 000 and the English National Health Service (NHS). Methods: Epidemiological data were combined with current inhaler use patterns to estimate the resources and costs associated with this transition, varying patient acceptance scenarios. Results: Depending on the approach, resource requirements ranged from £18 000 – £53 000 for a PCN, and from £21 – £60 million for the English NHS. Discussion: Significant funds are needed to successfully manage targeted inhaler transitions, together with counselling and follow-up appointment with an appropriately skilled clinician to assess the patient’s inhaler technique and ensure disease control. Conclusions: Targeted transition of inhalers must achieve a balance between environmental impacts, organisational factors, and patient requirements. The resources for managing a switch can be substantial but are necessary to appropriately counsel and support patients, whilst protecting the environment.
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Kang, Sung-Yoon, and Taek Ki Min. "Principles of the use of inhaler devices in asthma treatment." Journal of the Korean Medical Association 65, no. 9 (September 10, 2022): 606–15. http://dx.doi.org/10.5124/jkma.2022.65.9.606.
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Background: Inhaler therapy is the most critical route of administering drugs in the management of asthma due to its rapid onset of action, better pulmonary efficacy, and reduced risk of side effects, compared with other routes of administration.Current Concepts: Although many physicians and patients believe they know how to use inhaler devices, most do not know the correct techniques. To achieve better and more effective treatment results, the inhalation device should be appropriate for the characteristics and wishes of each patient. Available inhaler devices include pressurized metered dose inhalers, dry powder inhalers, soft mist inhalers, and nebulizers. To improve disease outcomes and treatment adherence, a personalized stepwise approach, based on each patient’s conscious inhalation, inspiratory flow, and hand-lung coordination, is recommended in the selection of the most appropriate device.Discussion and Conclusion: Common problems with inhaler usage include failure to exhale completely before inhaling, insufficient inhalation efforts, and inadequate breath-hold after inhalation. Therefore, continuing education and support are warranted to ensure optimal outcomes and enable patients to improve inhaler usage techniques. Health care providers should also know the devices and develop systems in order to provide comprehensive support to patients in clinical practice.
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Bryant, Linda, Christine Bang, Christopher Chew, Sae Hee Baik, and Diane Wiseman. "Adequacy of inhaler technique used by people with asthma or chronic obstructive pulmonary disease." Journal of Primary Health Care 5, no. 3 (2013): 191. http://dx.doi.org/10.1071/hc13191.
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INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) are ongoing concerns to the health system. Poor inhaler technique results in less than optimal delivery of medicine to the lungs and consequent inadequate symptom control. AIM: This study aimed to assess inhaler technique amongst people with asthma and/or COPD. The secondary aims were to investigate who provided education on inhaler technique and whether age, gender or ethnicity was associated with poor inhaler technique. METHODS: People with asthma or COPD who presented to a community pharmacy with a prescription for a respiratory inhaler were invited to participate in the study. Participants completed a brief questionnaire and had their inhaler technique assessed against a standard checklist. RESULTS: There were 103 participants from 26 pharmacies, 86 with asthma and 17 with COPD. Just over half (52.5%) of the assessments indicated good inhaler technique, with 68% of people using the Turbuhaler having good technique compared to 53% for the pressurised metered dose inhaler (pMDI) with spacer and 47% for the pMDI alone. The majority of people (76%) received their initial inhaler technique instruction from their doctor. Over half of participants did not recall having their inhaler technique rechecked. DISCUSSION: After prescribing appropriate therapy, correct inhaler technique is a cornerstone of achieving adequate therapy. Rechecking inhaler technique is a gap in care that needs to be addressed from an interdisciplinary perspective. KEYWORDS: Asthma; chronic obstructive pulmonary disease; dry powder inhalers; metered dose inhalers; spacer inhalers
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Badia, Xavier, Alicia Huerta, Laura Vallejo, and Lilia Inderbaeva. "Is patients’ perspective incorporated when choosing an inhaler device for COPD treatment? A framework value assessment based in Multi Criteria Decision Analysis." Economía de la Salud 15 (July 2020): 55–68. http://dx.doi.org/10.61679/1503055068.
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PURPOSE: To develop a MCDA framework for the value assessment of inhaler devices in COPD from patients’ perspective. METHODS: A literature review was conducted to identify relevant criteria in inhaler devices in COPD from patients’ perspective. Findings were validated in two workshops with COPD patients and COPD healthcare professionals. The final criteria were validated with 68 COPD patients and applied to different inhaler devices, using a specific questionnaire. All criteria were scored by patients using an ordinal scale of 5 points. Final criteria were weighted based on their relative importance by a subgroup of patients. RESULTS: Pilot MCDA framework included 11 criteria. After the workshop with HCPs, 2 additional criteria were included. In the field work validation, one criterion was excluded, and another was adapted. The final framework consisted of 12 criteria grouped into 3 dimensions (comfort and ease of use, degree of technical innovation and patient satisfaction). Criteria were weighed by importance: visible dose counter, confirmation of correct dose taking, easy manipulation, comfortable mouthpiece, intuitive mechanism of use, duration of the device, preloaded device, dose-taking reminder, ergonomic shape, no need of hand-breath coordination, cover remains attached while opened and steps for dose taking. The devices more positively valued by patients were Multidose Dry Powder Inhalers, followed by Monodose Dry Powder Inhalers, Soft Mist Inhalers and pressurised Metered Dose Inhalers. CONCLUSIONS: The developed MCDA framework can help in decision-making, allowing to assess the value of inhaler devices from the patients’ perspective and to select the inhaler device that might suit better each COPD patient. Keywords: MCDA, COPD, patient perspective, inhaler device.
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Herrera, H., M. Charalambous, H. Dean, D. Youles, P. Rutter, and N. Warren. "Patients’ views and behaviours in relation to asthma inhalers use and their impact on environmental sustainability: a cross-sectional survey study." International Journal of Pharmacy Practice 32, Supplement_1 (April 1, 2024): i35. http://dx.doi.org/10.1093/ijpp/riae013.043.
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Abstract Introduction Approximately 60 million inhalers are used annually in England, contributing 3% to the National Health Service (NHS) carbon footprint. Of these, 2 out of 3 are metered-dose inhalers (MDIs) containing greenhouse gas propellants.[1] The carbon footprint of an MDI device is around 500g CO2 equivalent, in contrast with the 20g CO2 equivalent of a dry powder inhaler (DPI).[2] The NHS Long Term Plan introduced measures on environmental sustainability, leading to the National Institute of Health Care and Excellence (NICE) launching a ‘shared decision aid’ to promote the discussion of options for inhaler devices. This landmark policy step could be more effective if received with patient support and informed behaviours of patients with regard to inhalers. Research is therefore needed to identify patients’ views and behaviours on this matter. Aim To identify patients’ views and behaviours related to environmental sustainability aspects of their use of inhalers for the management of asthma. Methods An anonymous self-completion paper-based questionnaire was administered to patients with a clinical diagnosis of asthma. These were recruited opportunistically via 10 community pharmacies in the South of England during the month of February 2020. They were provided information about the study and invited to participate by pharmacy staff when collecting prescriptions. Participants had to be prescribed at least one MDI inhaler and not to be using a DPI, and report on the use, disposal and views regarding their environmental impact. Responses to the questionnaire were coded and analysed using descriptive statistics. Results A total of 149 surveys were completed by patients, of which 47% (n=70) were male and 53% (n=79) were female. The age range of respondents varied with the majority 45.6% being 18-29 years old, followed by 21.5% in the 60-69 years category. Of these, 30.2% (n=48) were aware of MDI inhalers having an impact on carbon footprint, and 53% (n=79) on plastic pollution. A majority (81%) of patients stated that they were involved or partially involved in their inhaler choice. Only 62% (n=92) said they would be willing to switch their MDI to a more environmentally friendly inhaler with equal effectiveness, 15.4% (n=23) reported they would not be willing to do so and 22.1% (n=33) were not sure. Unwanted inhalers were returned by 43% (n=64) of participants for appropriate disposal, with 55% (n=82) of respondents being unaware of this option. A majority (91%, n=136) of participants said they would like further information about their inhalers and their impact on the environment. Conclusion There is scope for a more environmentally friendly management of asthma and the use of inhalers. Healthcare professionals are involving patients in decision making when prescribing, and pharmacists could contribute to this when dispensing. Patients would welcome information on the impact of inhalers on the environment and further research could identify more precisely on what aspects, alongside barriers preventing a switch to more environmentally friendly options. A small sample size and geographical area were limitations of this study, which could be overcome by further researching issues identified in this survey. References 1. Greener NHS: Improving health outcomes for respiratory patients while reducing carbon emissions. Available from: https://www.england.nhs.uk/greenernhs/whats-already-happening/improving-health-outcomes-for-respiratory-patients-while-reducing-carbon-emissions/ 2. Wilkinson AJK, Braggins R et al. Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open. 2019;9(10).
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Trushenko, Natalia V., Anna A. Stoliarevich, Boris G. Andriukov, Galiya S. Nuralieva, Natalya A. Tsareva, Baina B. Lavginova, and Sergey N. Avdeev. "Assessment of inhalation technique in patients with bronchial asthma and chronic obstructive pulmonary disease." Terapevticheskii arkhiv 95, no. 3 (April 26, 2023): 210–16. http://dx.doi.org/10.26442/00403660.2023.03.202151.
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Abstract
Aim. Investigate inhalation techniques using different inhalers types and their effect on the course of disease.
Materials and methods. This cross-sectional study included 110 patients with asthma, chronic obstructive pulmonary disease using the inhaler at least one month. Inhaler errors performed during demonstration were evaluated for each patient and entered in the check-lists. We also collected information about co-morbidities, education, mMRC dyspnea score, rate of exacerbations, and performed spirometry.
Results. 80.9% of patients used metered-dose inhaler, 20.9% single-dose and 21.8% multiple-dose dry powder inhaler, 22.7% soft-mist inhaler. Inhaler errors were made by 80.9% patients. The mean number of mistakes in metered-dose inhaler use was 21.6, single-dose powder inhaler 1.51.3, multiple-dose dry powder inhaler 1.251.4, soft-mist inhaler 0.680.7 (р=0.003). Age, diagnosis, duration of disease, education level, inhalers usage by relatives have no influence on the inhalation technique. A number of errors was related to female gender (р=0.007) and usage of more than 2 inhalers (r=0.3, p=0.002), previous instruction about inhalation technique (r=0.3, p=0.001). On the other hand, there were correlations between the number of errors and degree of bronchial obstruction, asthma control, severity of dyspnea by mMRC score, exacerbation rate.
Conclusion. Patients with bronchoobstructive diseases perform many inhaler errors, that substantially influences the severity and course of asthma and chronic obstructive pulmonary disease.
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Perkins, Elizabeth L., Saikat Basu, Guilherme J. M. Garcia, Robert A. Buckmire, Rupali N. Shah, and Julia S. Kimbell. "Ideal Particle Sizes for Inhaled Steroids Targeting Vocal Granulomas: Preliminary Study Using Computational Fluid Dynamics." Otolaryngology–Head and Neck Surgery 158, no. 3 (November 21, 2017): 511–19. http://dx.doi.org/10.1177/0194599817742126.
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Objectives Vocal fold granulomas are benign lesions of the larynx commonly caused by gastroesophageal reflux, intubation, and phonotrauma. Current medical therapy includes inhaled corticosteroids to target inflammation that leads to granuloma formation. Particle sizes of commonly prescribed inhalers range over 1 to 4 µm. The study objective was to use computational fluid dynamics to investigate deposition patterns over a range of particle sizes of inhaled corticosteroids targeting the larynx and vocal fold granulomas. Study Design Retrospective, case-specific computational study. Setting Tertiary academic center. Subjects/Methods A 3-dimensional anatomically realistic computational model of a normal adult airway from mouth to trachea was constructed from 3 computed tomography scans. Virtual granulomas of varying sizes and positions along the vocal fold were incorporated into the base model. Assuming steady-state, inspiratory, turbulent airflow at 30 L/min, computational fluid dynamics was used to simulate respiratory transport and deposition of inhaled corticosteroid particles ranging over 1 to 20 µm. Results Laryngeal deposition in the base model peaked for particle sizes 8 to 10 µm (2.8%-3.5%). Ideal sizes ranged over 6 to 10, 7 to 13, and 7 to 14 µm for small, medium, and large granuloma sizes, respectively. Glottic deposition was maximal at 10.8% for 9-µm-sized particles for the large posterior granuloma, 3 times the normal model (3.5%). Conclusion As the virtual granuloma size increased and the location became more posterior, glottic deposition and ideal particle size generally increased. This preliminary study suggests that inhalers with larger particle sizes, such as fluticasone propionate dry-powder inhaler, may improve laryngeal drug deposition. Most commercially available inhalers have smaller particles than suggested here.
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Boldero, R., S. Griffiths, and J. Coulson. "Introducing a new national tool to monitor the carbon footprint of inhalers." International Journal of Pharmacy Practice 32, Supplement_1 (April 1, 2024): i26—i27. http://dx.doi.org/10.1093/ijpp/riae013.033.
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Abstract Introduction The Welsh Government launched its National Health Service (NHS) Wales decarbonisation strategic delivery plan in March 2021.[1] The plan includes a number of actions related to the carbon footprint of inhalers. The National Prescribing Support Unit was requested to provide data for the carbon footprint of inhalers, and develop an analysis tool to measure progress in reducing the carbon footprint and movement towards the all Wales target of 20,000 carbon dioxide (CO2) tonnes per annum. Aim To introduce a new tool for monitoring the carbon footprint of inhalers used in Wales. Methods The data requirements for the tool were determined using a nominal group technique. A literature search was conducted to identify any available sources of inhaler carbon footprint values that would be used to inform the required analyses. A collaborative approach with specialist groups was adopted to develop and pilot the dashboard. Results The nominal group technique identified the essential minimal dataset required. These were data relating to quantity, cost, and carbon footprint of the inhalers prescribed. Data for quantity and cost of inhalers used were already available to the unit. A literature search revealed a reliable source of inhaler carbon footprint values for developing the initial dashboard, and any updating required as additional inhalers are presented within the dataset.[2] Through the collaborative approach with specialist groups, a dashboard was developed and piloted with selected individuals within Wales. Feedback was then attained and actioned upon where appropriate, before the dashboard was made readily available to all NHS Wales employees. Conclusion The new monitoring tool went live in January 2022 and provides data on inhaler quantity, spend and carbon footprint at an all Wales, Health Board, cluster and GP practice level. This enables reporting at a national and organisational level, as well as lower down to specific geographies. Ongoing work involves the addition of new inhalers, refreshing with the most recent data, and updating the background carbon footprint values held within the tool. These are instigated on an issuing of changes in the supporting reference data values.[2] The availability of a tool to report on the carbon footprint of inhalers used within Wales provides a consistent data source to support the strategic delivery plan targets. A strength of this work has been to deliver a meaningful tool in support of this aim. Whilst a limitation is that we do not know the exact impact of the tool in making the change happen, we are aware that the tool is used on a regular basis by stakeholders. References 1. Powlesland D, Joyce C. NHS Wales Decarbonisation Strategic Delivery Plan 2021-2030. 2021. Available from: https://www.gov.wales/sites/default/files/publications/2021-03/nhs-wales-decarbonisation-strategic-delivery-plan.pdf 2. Homan K. Bulletin 295. Inhaler carbon footprint. 2021. Available from: https://www.prescqipp.info/umbraco/surface/authorisedmediasurface/index?url=%2Fmedia%2F5719%2F295-inhaler-carbon-footprint-22.pdf
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Ignatova, G. I., V. N. Antonov, and I. A. Zakharova. "Clinical case of indacaterol / glycopyrronium bromide prescription in a patient with severe copd and concomitant pathology." Meditsinskiy sovet = Medical Council, no. 9 (June 5, 2024): 27–30. http://dx.doi.org/10.21518/ms2024-207.
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Combinations of inhaled glucocorticosteroids (IHGC) and long-acting bronchodilator inhalers (LABA inhalers) have been widely used to treat chronic obstructive pulmonary disease (COPD) over the past two decades. Prescription of these drugs was based on large studies showing that this therapeutic regimen was more effective compared to placebo and monotherapy. The article presents a clinical case report of a patient with severe course of COPD and coronary heart disease (CHD). Up-to-date concepts of using dual bronchodilator therapy when switching from combinations of inhaled glucocorticosteroids and long-acting bronchodilator inhalers (IHGC/LABA) is discussed. A patient with COPD and coronary artery disease, atrial fibrillation while using IHGC/LABA had progressive respiratory failure, frequent exacerbations, and acute symptomatology. As there is evidence that the use of IHGC/LABA has a number of limitations in the combined course of COPD and cardiovascular diseases, first of all in coronary artery disease and arrhythmias, it was recommended to replace therapy with a combination of dual bronchodilators – a long-acting muscarinic antagonist (LAMA) and a long-acting β agonist (LABA). The therapy resulted in stabilization of the condition, reduction of clinical symptoms, and absence of cardiovascular complications. It has been concluded that the dual bronchodilator therapy with a combination of glycopyrronium bromide and indacaterol is prioritized in COPD, including COPD combined with cardiovascular pathology; no increase in cardiovascular events in patients with COPD combined with coronary artery disease is observed; Breezhaler inhaler is user-friendly for the patients and has advantages over other delivery devices.
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Almira, Sarah, Vincent Pratama, Muh Ronike Yunus, Anna Rozaliyani, and Rani Sauriasari. "Education on Inhaler Technique by Pharmacists To Improve The Quality of Life of COPD Patients: A Systematic Review and Meta-Analysis." Jurnal Respirologi Indonesia 43, no. 4 (October 31, 2023): 288–97. http://dx.doi.org/10.36497/jri.v43i4.479.
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Background: This systematic review aimed to analyze the importance of education on using inhalers by pharmacists in improving quality of life, correct inhaler use steps, and medication adherence in patients with Chronic Obstructive Pulmonary Disease (COPD).Methods: The databases used to search for articles in this systematic review include Scopus, ScienceDirect, and Pubmed. The papers submitted were published between 2009 and 2022, with the most recent search being conducted in December 2022. This review included a randomized controlled trial evaluating education on inhaler use techniques by pharmacists to improve COPD patients' quality of life in inpatient and outpatient settings. This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) writing guidelines.Results: This systematic review used six articles from five different countries. The articles involved share similar characteristics so that analysis can be carried out. The total number of research subjects included was 913 subjects. Most studies show an increase in the quality of life among COPD patients who are given education on how to use inhalers by pharmacists using print or digital media. Measurements using the St. George's Respiratory Questionnaire (SGRQ) showed a decrease in scores at the 6-month and 12-month periods (-0.75 [95% CI (-1.46 - (-.005)]. Furthermore, two articles reported that education on the technique of using inhalers by pharmacists can also increase the accuracy of using inhalers, and three articles reported increasing medication adherence.Conclusion: Interventions such as education on using inhalers by pharmacists in inpatient and outpatient settings can improve the quality of life of COPD patients, the accuracy of the steps in using inhalers, and medication adherence.
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Bao, Le Khac, Nguyen Dang Khoa, Le Thi Kim Chi, and Nguyen Tuan Anh. "Prevalence and Factors Affecting Appropriate Inhaler Use in Elderly Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study." Journal of Clinical Medicine 12, no. 13 (June 30, 2023): 4420. http://dx.doi.org/10.3390/jcm12134420.
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Background: Chronic obstructive pulmonary disease (COPD) mainly affects individuals aged 60 and older. The proper use of inhalers is crucial for managing COPD. This study aimed to evaluate the prevalence and factors affecting the appropriate use of inhalers among elderly patients with COPD. Methods: We enrolled 91 elderly patients with COPD admitted to the Department of Respiratory, University Medical Center HCMC between October 2020 and May 2021. Patients who were capable of using the inhaler would have their inhaler usage recorded through video footage. Two respiratory experts carefully analyzed 133 video-recorded demonstrations for evaluation purposes. Results: 18.7% of the patients demonstrated the correct inhaler technique. Pressurized metered dose inhaler (pMDI) and Turbuhaler had the lowest documented correct usage rates (11.9% and 10.0%, respectively). Two critical steps, namely “holding breath for about five seconds or as long as comfortable” and “breathing out gently,” were commonly performed incorrectly when using pMDI, Respimat, Breezhaler, or Turbuhaler. Multivariable logistic regression analysis showed that lower mMRC scores (AOR = 5.3, CI 1.1–25.5, p = 0.037) and receiving inhaler instruction within the past three months (AOR = 5.2, CI 1.3–20.1, p = 0.017) were associated with increased odds of using the inhaler correctly. Conclusions: Our study found that less than 20% of elderly patients with COPD use inhalers correctly. Common errors include inadequate breath-holding and gentle exhalation. mMRC scores and recent inhaler instruction were predictors of proper use. These findings can aid clinicians in improving inhaler management for elderly patients with COPD.
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Alotaibi, Mansour M., Louise Hughes, and William R. Ford. "Assessing Inhaler Techniques of Asthma Patients Using Aerosol Inhalation Monitors (AIM): A Cross-Sectional Study." Healthcare 11, no. 8 (April 13, 2023): 1125. http://dx.doi.org/10.3390/healthcare11081125.
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A high percentage of asthma patients have symptoms that are not well controlled, despite effective drugs being available. One potential reason for this may be that poor inhaler technique limits the dose delivered to the lungs, thereby reducing the therapeutic efficacy. The aim of this study was to assess the prevalence of poor inhaler technique in an asthma patient population and to probe the impact of various demographic parameters on technique quality. This study was conducted at community pharmacies across Wales, UK. Patients diagnosed with asthma and 12 years or older were invited to participate. An aerosol inhalation monitor (AIM, Vitalograph®) was used to measure the quality of patient inhaler technique. A total of 295 AIM assessments were carried out. There were significant differences in the quality of inhaler technique across the different inhaler types (p < 0.001, Chi squared). The best technique was associated with dry-powder inhalers (DPI devices, 58% of 72 having good technique), compared with pressurized metered-dose inhalers (pMDI) or pMDIs with a spacer device (18% of 174 and 47% of 49 AIM assessments, respectively). There were some significant associations between gender, age, and quality of inhaler technique, as determined with adjusted odds ratios. It seems that the majority of asthmatic patients were not using their inhalers appropriately. We recommend that healthcare professionals place more emphasis on assessing and correcting inhaler technique, as poor inhaler technique might be responsible for the observed lack of symptom control in the asthma patient population.
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Emeryk, Andrzej, Justyna Emeryk-Maksymiuk, and Kamil Janeczek. "Inspiratory flows and the aerosol cloud from dry powder inhalers." Alergoprofil 17, no. 2 (May 31, 2021): 25–33. http://dx.doi.org/10.24292/01.ap.172310521.
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The relationship between the delivered dose, the fine particle fraction and the fine particle dose and the value of inspiratory flow generated by the patient is one of the most important features of dry powder inhalers (DPIs). It significantly affects the amount of pulmonary deposition of the inhaled drug and the clinical effect of the drug. The results of research evaluating these relationships for popular in Poland dry powder inhalers are presented. Flow-dependent, relatively flow-dependent and relatively flow-independent inhalers are demonstrated.
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Eslami, Roghayeh, Hossein Ebrahimi, Solmaz Talebi, Mehdi Mansouri, and Hossein Bagheri. "The Effect of Teaching the Use of Inhaler to a Family Caregiver on its Correct Use By the Elderly Patients: A Randomized Clinical Trial." Jundishapur Journal of Medical Sciences 21, no. 1 (March 1, 2022): 2–15. http://dx.doi.org/10.32598/jsmj.21.1.2251.
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Background and Objectives Due to the high rate of inhalers’ incorrect use by the elderly, this study aims to evaluate the effect of teaching the use of inhalers to a family caregiver on its correct use by the elderly patients. Subjects and Methods This is a parallel-group randomized clinical trial on 80 older people with a lung disease aged >60 years who use the inhaler incorrectly and their family caregivers. Participants were randomly assigned to group A (education) and group B (control) using a block randomization method (4×4 blocks). In group A, teaching of the correct use of inhaler was provided to the caregivers of the elderly orally and practically in one session, while in group B, training was provided only to the elderly. Three weeks later, the two groups were evaluated using a researcher-made inhaler use checklist. Results There was no significant difference in the use of inhaler before and after the intervention in group A (2.58±1.26) and B (2.55±1.22) (P<0.05). Pearson correlation test results showed a significant decrease in the correct use of inhaler with the increase of patients’ age (r=-0.24). Conclusion Further studies on the use of family members in elderly patients care, various educational programs by health care providers, and periodic evaluation of the performance of the elderly regarding the use of inhalers are recommended.
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Almutairi, Aisha, Abdullah M. Alolayan, Afrah H. Alazmi, Raghad Y. Alghurayr, Rehab A. Alrashidi, and Jolan S. Alsaud. "Incorrect use for Inhalation Techniques of Inhaled Medication among Children with Asthma in Qassim Region: Prevalence and its Risk." Pakistan Journal of Medical and Health Sciences 16, no. 2 (February 26, 2022): 896–902. http://dx.doi.org/10.53350/pjmhs22162896.
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Introduction: Asthma is one of the world's most common chronic respiratory disorders, and inhalers are frequently recommended to help manage allergy symptoms, improve quality of life, and reduce the risk of exacerbations or flare-ups. In Saudi Arabia, the prevalence of asthma is relatively high. Inhaler misuse can result in a variety of problems. This study aims to measure the prevalence of correct use of inhalation techniques of inhaled medication among children with asthma and investigate whether improper inhaler use can lead to uncontrolled bronchial asthma and its problems. Material and Methods: A cross-sectional study used a validated self-administered Arabic questionnaire given to 180 participants who visit paediatrics pulmonology clinic at Qassim University Medical City and Dr. Sulaiman Alhabib Hospital in Buraydah from June to December 2021. This study used a completed questionnaire consisting of sociodemographic characteristics, questions assess the participants’ condition and its severity, and questions to evaluate their inhalation technique of inhaled medication and if they were educated about the correct inhalation technique or not. Results and Conclusion: Findings demonstrate that number of ED visits is significantly associated with the time of diagnosis and frequency of using an inhaler (P=0.032) and (P=0.010) respectively. When we looked at the relationship between several characteristics and the timing of diagnosis, we discovered that age and times of using an asthma inhaler (Ventolin) in one week were significantly related (P=0.000). Revealing association between variables and frequency of using inhaler; the significant association with the source of advice about on the correct use of inhaler (P=0.005), and way of fixing the mask (P=0.040). Although our study showed enhanced knowledge and techniques using inhalers, physicians and other health workers should teach children and their caregivers how to use their inhalation devices properly whenever possible, and rectify errors when they occur, to ensure that medication is delivered effectively. As a result, future awareness campaigns should focus more resources on educating families and caregivers of asthmatics on correct medication use to avoid asthma complications and control asthma episodes for children.
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almutairi, Aisha, Abdullah M. Alolyan, Afrah H. Alazmi, Raghad Y. Alghurayr, Rehab A. Alrashidi, and Jolan S. Alsaud. "Incorrect use for Inhalation Techniques of Inhaled Medication among Children with Asthma in Qassim Region: Prevalence and its Risk." Pakistan Journal of Medical and Health Sciences 16, no. 1 (January 31, 2022): 1329–35. http://dx.doi.org/10.53350/pjmhs221611329.
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Introduction: Asthma is one of the world's most common chronic respiratory disorders, and inhalers are frequently recommended to help manage allergy symptoms, improve quality of life, and reduce the risk of exacerbations or flare-ups. In Saudi Arabia, the prevalence of asthma is relatively high. Inhaler misuse can result in a variety of problems. This study aims to measure the prevalence of correct use of inhalation techniques of inhaled medication among children with asthma and investigate whether improper inhaler use can lead to uncontrolled bronchial asthma and its problems. Material and Methods: A cross-sectional study used a validated self-administered Arabic questionnaire given to 180 participants who visit paediatrics pulmonology clinic at Qassim University Medical City and Dr. Sulaiman Alhabib Hospital in Buraydah from June to December 2021. This study used a completed questionnaire consisting of sociodemographic characteristics, questions assess the participants’ condition and its severity, and questions to evaluate their inhalation technique of inhaled medication and if they were educated about the correct inhalation technique or not. Results and Conclusion: Findings demonstrate that number of ED visits is significantly associated with the time of diagnosis and frequency of using an inhaler (P=0.032) and (P=0.010) respectively. When we looked at the relationship between several characteristics and the timing of diagnosis, we discovered that age and times of using an asthma inhaler (Ventolin) in one week were significantly related (P=0.000). Revealing association between variables and frequency of using inhaler; the significant association with the source of advice about on the correct use of inhaler (P=0.005), and way of fixing the mask (P=0.040). Although our study showed enhanced knowledge and techniques using inhalers, physicians and other health workers should teach children and their caregivers how to use their inhalation devices properly whenever possible, and rectify errors when they occur, to ensure that medication is delivered effectively. As a result, future awareness campaigns should focus more resources on educating families and caregivers of asthmatics on correct medication use to avoid asthma complications and control asthma episodes for children.