Educational intervention for correct pressurised metered dose inhaler technique in Trinidadian patients with asthma
Introduction
The prevalence of asthma among children and young adults [1], [2], [3] is reportedly increasing, particularly in affluent countries and it is now called a disease of the industrialized 20th century [4]. Evidence suggests asthma is an emergent disease in urban areas of developing countries like Africa and Asia too [5]. The International Consensus Report on the Diagnosis and treatment of Asthma [6] recommends first ‘to educate patients to develop a partnership in asthma management’. Current treatment strategies emphasize the importance of self-administered therapy with the inhaler for patients suffering from asthma and chronic pulmonary disease [7], [8], and cost-efficacy education programs encourage patients to take greater control of their condition to enhance self-management [9]. Pressurised metered dose inhalers (pMDI) are the most common drug delivery systems for aerosolized therapy [10], providing a cost-effective and safe method of drug delivery to the lungs. Therapeutic success depends on adequate lung deposition of drug and this factor is influenced by the technique used by the patient to inhale the aerosol [11], [12]. It is a common perception that patients do not use their inhaler in the correct fashion and studies have shown that a large percentage of patients have a faulty technique when using the pMDI [13], [14].
There are no published Caribbean reports on the efficient use of the pMDI by patients with airway disorders. This study was designed to evaluate how well patients with airway disorders in Trinidad use their inhalers and to determine whether any patient sub-groups should be targeted for educational intervention.
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Subjects
The study was conducted at the Chest Clinic after receiving the permission of the Director and consultants. Ethics Committee approval was obtained from the Faculty of Medical Sciences, St. Augustine campus of the University of the West Indies, in Trinidad.
The study was conducted over a period of one year between February 1997 and March 1998. In Trinidad, patients suffering from respiratory diseases (including asthma) are generally managed at the Ministry of Health’s Chest Clinic which operates
Subject characteristics
All patients consented to participate (100% response rate). The sample comprised 331 patients, of whom 274 came from the Eric Williams Medical Sciences Complex (EWMSC) and 57 came from the San Fernando General Hospital (SFGH). Thirty-three responses were from children (10%), 23 from adolescents (8%), 209 from adults (62%), and 66 came from the elderly (20%), (Table 1). There were 212 females (64%) in the sample. The mean age for all subjects was 44.1 (±22.4) years and ranged between 7 and 87
Discussion
The pMDI is difficult to use [14], [16], [17], [18], [19], and as much as 70% of patients reportedly do not perform a correct maneuver [14], [16], [17], [18], [19]. We investigated the technique of pMDI use in patients regularly using the device for asthma management, in Trinidad. It was encouraging to see nearly all our patients (90%) were instructed on technique, compared with data from the UK where only 63% of patients received a demonstration of inhaler technique [20]. That just 60% of them
Acknowledgements
Dr Martyn Partridge made invaluable comments on the patient questionnaire and the manuscript. Dr S. Begley contributed to the pilot study. We are grateful to A. Cassim (GlaxoWellcome Caribbean) for her assistance in liaison with the Institutions and consultants, and to Dr Albert Persaud (Director, Chest Clinic) for permitting the study.
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Inhaler Technique in Children With Asthma: A Systematic Review
2016, Academic PediatricsCitation Excerpt :Eight steps was chosen as correct because prescribing information for MDIs references 8 steps for correct use.39,40 Studies that defined correct use as percent of children with no mistakes reported a range of 0% to 57% of children who could use their inhaler correctly.3,4,15,18,25,27,28,30,31,33 Among studies that defined inhaler technique as a score or percent correct, a range of 18% of steps correct to as high as almost 97% of steps correct was reported.13,14,17,19,20,23,24,34–37
Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time?
2016, ChestCitation Excerpt :The inhalation procedure test protocol checklists were not uniform across studies, but they always included the steps specified in Table 1 and quantified each error as a percentage of the sample. The 144 selected articles3,4,24-165 included data on 54,354 subjects and reported a total of 59,584 tests of technique; the number of tests was higher because the subjects in some studies were tested with more than one device. Data were available for 286 groups (ie, subjects tested with a single device) of varying sizes; the mean (SD) number of subjects in each group was 208 (570), with a median of 86 subjects.
Written information on the use of aerosols in COPD patients. Can we improve their use?
2004, Atencion PrimariaUnderstanding and use of inhaler medication by asthmatics in specialty care in Trinidad: A study following development of Caribbean Guidelines for Asthma Management and Prevention
2002, ChestCitation Excerpt :Their poorer performance was particularly evident at crucial steps with immediate actuation of the inhaler on the second occasion and (along with children) at the breath-hold stage. Previously, we reported that these two age groups should be targeted for intensive patient education to maximize medication benefit and participation in disease management.16 Other work supports our findings of suboptimal inhaler technique,26 the presence of many patients who did not have knowledge about the action of their drugs,27,28 and few elderly patients receiving inhaled steroids20 or having an understanding of the roles of different asthma medications.16
Role of the pharmacist in improving inhaler technique and asthma management in rural areas in Jordan
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