Uso de inhaladores para la enfermedad pulmonar obstructiva crónica en un grupo de pacientes colombianos

Introducción: En Colombia son escasos los datos sobre el uso de los inhaladores en pacientes con EPOC. Objetivo: Describir la técnica de uso de inhaladores de dosis medida y polvo seco en pacientes de un hospital colombiano. Materiales y métodos: Estudio descriptivo en pacientes mayores de 40 años con EPOC atendidos en un hospital en La Virginia, Risaralda, Colombia, entre el 1 de septiembre de 2019 al 31 de enero de 2020. La unidad de análisis fueron los pacientes. Se incluyeron variables sociodemográficas, clínicas y lista de chequeo para uso de inhaladores. Se aplicaron frecuencias y proporciones para variables discretas, estadísticas de tendencia central y dispersión para variables continuas. Resultados: Se incluyeron 104 pacientes con edad media de 73,6 ± 10,1 años; 57 eran mujeres (54,8 %). Además, 48 pacientes estaban clasificados como GOLD-D (46,2 %). Igualmente, 89 pacientes manifestaron haber recibido educación sobre el uso de broncodilatadores (85,6 %). Los más frecuentes fueron los inhaladores de dosis medida (DM) en 95 casos (91,3 %), seguido de los de polvo seco unidosis (7,7 %). Así mismo, 37 pacientes que usaron DM sin inhalocámara (35,6 %) no cumplieron los pasos de la lista de chequeo. En el sistema multidosis, el más realizado fue cerrar de manera adecuada el inhalador y el menos ejecutado, expulsar el aire lentamente evitando hacerlo cerca del inhalador (n = 6; 5,7 %). Discusión: Se lograron describir las características de la técnica de uso de los inhaladores en pacientes con EPOC. A pesar de que ningún paciente logró utilizar el inhalador de forma "perfecta", la mayoría han recibido educación por parte de los profesionales de la salud. Conclusión: Un alto porcentaje de pacientes usa inadecuadamente los dispositivos para suministrar los broncodilatadores. Esto puede impactar negativamente en el control de la enfermedad.

Introduction: In Colombia, there is limited data on the use of inhalers in patients with COPD. Objective: The objective was to describe the technique of using metered-dose inhalers and dry powder in patients in a Colombian hospital. Methods: Observational, descriptive study of patients over 40 years of age with COPD, treated in a hospital in La Virginia, Risaralda, Colombia, between September 1st, 2019 and January 31st, 2020. The unit of analysis were patients in consultation. Sociodemographic and clinical variables, and a checklist for use of inhalers were included. Frequencies and proportions were applied for discrete variables, statistics of central tendency and dispersion for continuous variables. Results: A total of 104 patients with an average age of 73.6 ± 10.1 years were included; 57 were women (54.8%). In addition, 48 patients were classified as GOLD-D (46.2%). Similarly, 89 patients reported having received education on the use of bronchodilators (85.6%). The most common were metered-dose (MD) inhalers in 95 cases (91.3%), followed by single-dose dry powder inhalers in eight patients (7.7%). Likewise, 37 patients who used DM without inhalochamber (35.6%) did not comply with the steps of the checklist. In the multidose system, the most performed was to properly close the inhaler and the least performed was to expel the air slowly, avoiding doing so near the inhaler (n=6; 5.7%). Discussion: The characteristics of the technique of using inhalers in patients with COPD were described. Although no patient was able to use the inhaler "perfectly", most have received education from health professionals. Conclusion: A high percentage of patients misuse the devices to deliver bronchodilators. This can negatively impact the control of the disease.

A prospective and observational study on the variation in Hemoglobin A1c levels among asthmatic children using inhaled corticosteroids

Background: The studies in children regarding the effects of inhaled corticosteroids (ICS) on the carbohydrate metabolism are scant in India. This study was undertaken to determine if there is any effect of inhaled steroids on the glycemic control. Aims and Objectives: The aim of the study was to analyze the pattern of glycated hemoglobin (HbA1c) levels in children with persistent asthma, before and after using prophylactic doses of ICS and to evaluate and compare HbA1c levels separately in those taking budesonide and in those taking fluticasone or other steroids. Materials and Methods: It was a prospective and observational study, based on a study proforma. Children of 2–12 years of age, diagnosed with mild-to-moderate persistent asthma, attending the Asthma Clinic at Paediatrics Department of SAT Hospital, Government Medical College, Thiruvananthapuram were included in the study. The diagnosis of asthma and the severity was recorded according to Global Initiative for Asthma guidelines. The sample size was calculated to be 40. Type, dose, and frequency of administration of ICS and other coprescribed drugs were recorded on an asthma diary and entered into the study proforma. HbA1c levels were measured in children before they were started on ICS, on the same day of visit using high perfusion liquid chromatography technique and repeated after 6 months. Student’s t-test was used to compare mean values between two groups. Results: Mean age of patients is 5.75. About 62.5% of patients were males. About 72.5% of the patients had a diagnosis of moderate persistent asthma. The mean HbA1c before the treatment with ICS was 5.36 and after the treatment is 5.37 and the difference was not significant. Conclusions: There was no significant change in HbA1c levels with the use of ICS.

Association between beta-2 adrenergic receptor variants and clinical outcomes in children and adolescents with acute asthma

ABSTRACT Objective To investigate whether different genotypes of p.Arg16Gly, p.Gln27Glu, p.Arg19Cys and p.Thr164Ile variants interfere in response to treatment in children and adolescents with moderate to severe acute asthma. Methods This sample comprised patients aged 2 to 17 years with a history of at least two wheezing episodes and current moderate to severe asthma exacerbation. All patients received multiple doses of albuterol and ipratropium bromide delivered via pressurized metered-dose inhaler with holding chamber and systemic corticosteroids. Hospital admission was defined as the primary outcome. Secondary outcomes were changes in forced expiratory volume in the first second after 1 hour of treatment, and for outpatients, length of stay in the emergency room. Variants were genotyped by sequencing. Results A total of 60 patients were evaluated. Hospital admission rates were significantly higher in carriers of the genotype AA relative to those with genotype AG or GG, within the p.Arg16Gly variant (p=0.03, test χ2, alpha=0.05). Secondary outcomes did not differ between genotypes. Conclusion Hospital admission rates were significantly higher among carriers of the genotype AA within the p.Arg16Gly variant. Trial registration: ClinicalTrials.gov: NCT01323010

Avaliação da técnica inalatória em atendimentos de primeira consulta em ambulatório de asma de hospital terciário / Evaluation of the inhalation technique in first care visits in an asthma outpatient clinic at a tertiary hospital

Introdução: Técnica inalatória (TI) correta é fundamental para o controle da asma. Objetivo: Avaliar TI de pacientes em atendimento de primeira consulta em um ambulatório de asma. Métodos: Estudo observacional transversal com amostra de conveniência de asmáticos com idade ≥ 18 anos, em primeira consulta no ambulatório de asma do Hospital Universitário Antonio Pedro (HUAP) da Universidade Federal Fluminense e em uso de medicamentos disponíveis para uso em aerossol dosimetrado (AD), Aerocaps, Aerolizer ou Diskus. Participantes preencheram questionário com dados sociodemográficos, avaliação de controle da doença segundo o documento GINA, existência de orientações médicas para uso dos dispostivos inalatórios (DI), tempo de uso de DI e especialidade do médico encaminhador. A TI era considerada apropriada quando todas as etapas foram realizadas corretamente baseando-se nas bulas das medicações e foram demonstradas com os DI vazios. Resultados: Entre os 51 pacientes incluídos, 43 (84,3%) tinham TI incorretas e 4 (7,8%) apresentavam asma controlada. Trinta e cinco (70%) referiram orientação prévia quanto ao uso do DI. A TI correta associou-se com tempo de uso maior que 2 anos (p=0,006) e uso de DI de pó seco em detrimento de AD (p=0,019). Conclusão: Somente 16% dos pacientes encaminhados ao ambulatório da pneumologia específico de asma, de um hospital terciário, tinham a TI correta em sua primeira consulta e a quase totalidade não tinha a asma controlada. Atenção deve ser dada sempre a supervisão da qualidade da TI, principalmente dos usuários de AD e dos que usam seus DI há menos de 2 anos.

Introduction: Correct inhalation technique (IT) is essential for asthma control. Objective: To evaluate the IT of patients making their first visit to the asthma outpatient clinic. Methods: Cross-sectional observational study with a convenience sample of asthmatics aged ≥ 18 years, in their first visit to the asthma outpatient clinic of the Hospital Universitário Antonio Pedro (HUAP) of the Universidade Federal Fluminense and using medications available in metered-dose aerosol (DA) , Aerocaps, Aerolizer or Diskus. Participants completed a questionnaire with sociodemographic data, assessment of disease control according to the GINA document, existence of medical guidelines for the use of inhalation devices (IDs), length of ID use, and specialty of the refer-ring clinician. IT was considered appropriate when all steps were performed correctly based on medication package inserts and were demonstrated with empty IDs. Results: Among the 51 patients included, 43 (84.3%) had incorrect IT and 4 (7.8%) had controlled asthma. Thirty-five (70%) reported previous guidance regarding the use of ID. Correct IT was associated with time of use greater than 2 years (p=0.006) and use of dry powder ID rather than DA (p=0.019). Conclusion: Only 16% of the patients referred to the asthma-specific pulmonology outpatient clinic of a tertiary hospital had the correct IT at their first appointment and almost all of them did not have controlled asthma. Attention should always be given to the supervision of IT quality, especially for DA users and those who have been using their ID for less than 2 years.

Inhaloterapia: recomendaciones para Argentina 2021 / Inhalotherapy: recommendations for Argentina 2021

Resumen En las últimas décadas ha habido un importante desarrollo de dispositivos inhalados (DI) que permiten aumentar la eficacia de las drogas y disminuir los eventos adversos. Su correcto uso es de fundamental importancia para el control de las enfermedades respiratorias obstructivas. En la Argentina no existen recomendaciones locales sobre el uso de los DI. Se revisó la base biofísica, indicación, ventajas y limitaciones, técnica de correcto uso, errores frecuentes, mantenimiento y limpieza de cada DI. El uso de nebulizaciones ha quedado restringido a la administración de drogas que no están disponibles en otros DI (ejemplo: tratamiento de fibrosis quística), o ante la falla de los otros DI. No deben ser usados durante la pandemia de SARS-CoV2. Los inhaladores de dosis medida (aerosol) deben ser indicados siempre con aerocámaras (AC), las que reducen la incidencia de eventos adversos y aumentan el depósito de la droga en el pulmón. Son los dispositivos de elección junto a los inhaladores de polvo seco. Los aerosoles se deben usar en pacientes que no generan flujos inspiratorios altos. Los inhaladores de polvo seco deben recomendarse en aquellos que pueden realizar flujos inspiratorios enérgicos. Se revisaron los diferentes DI en fibrosis quística y en pacientes con asistencia respiratoria mecánica. La elección del DI dependerá de varios factores: situación clínica, edad, experiencia previa, preferencia del paciente, disponibilidad de la droga y entrenamiento alcanzado con el correcto uso.

Abstract Last decades, a broad spectrum of inhaled devices (ID) had been developed to enhance efficacy and reduce adverse events. The correct use of IDs is a critical issue for controlling obstructive respiratory diseases. There is no recommendation on inhalation therapy in Argentina. This document aims to issue local recommendations about the prescription of IDs. Each device was reviewed regarding biophysical laws, indication, strength, limitations, correct technique of use, frequent mistakes, and device cleaning and maintenance. Nebulization should be restricted to drugs that are not available in other IDs (for example, for treatment of cystic fibrosis) or where other devices fail. Nebulization is not recommended during the SARS-CoV2 pandemic. A metered-dose inhaler must always be used with an aerochamber. Aerochambers reduce the incidence of adverse events and improve lung deposition. Metered-dose inhalers must be prescribed to patients who cannot generate a high inspiratory flow and dry powders to those who can generate an energetic inspiratory flow. We reviewed the use of different IDs in patients with cystic fibrosis and under mechanical ventilation. The individual choice of an ID will be based on several variables like clinical status, age, previous experience, patient preference, drug availability, and correct use of the device.

Terapia inalatória em ventilação não-invasiva em pacientes com doença pulmonar obstrutiva crônica / Inhalation therapy during noninvasive ventilation in patients with chronic obstructive pulmonary disease

O objetivo deste estudo é descrever os aspectos técnicos e cuidados a serem observados durante a administração de medicamentos inalatórios contidos em inalador pressurizado (pMDI) em pacientes com doença pulmonar obstrutiva crônica em ventilação não-invasiva (VNI). Trata-se de uma revisão integrativa elaborada em quatro fases: (1) busca na literatura; (2) consulta às sociedades médicas; (3) pesquisaem bulas e monografias dos fármacos inalatórios; e (4) contato com empresas de ventiladores, medicamentos e espaçadores. A busca aos estudos foi conduzida a partir de palavras-chaves e restringida a publicações até 31 de dezembro de 2019, nos idiomas português e inglês. Foram selecionados 9 artigos, sendo 1 estudo primário, 6 estudos de revisão e 2 estudos em modelos experimentais de ventilação. Foram incluídas 2 diretrizes a partir da consulta às sociedades médicas e das 8 empresas contatas, quatro fizeram recomendações quanto à técnica inalatória. Não foram encontradas informações sobre a administração dos fármacos em VNI nas bulas e monografias. Recomenda-se atentar para as medidas que podem aumentar a deposição pulmonar dos fármacos inalatórios, como uso de aerocâmara com pMDI, minimização de escape indesejável de ar, sincronia entre paciente-ventilador, disparo do jato na fase inspiratória e inserção de porta de vazamento na máscara ou circuito. (AU)

The aim of this study is to describe the technical aspects and cautions to be observed during the administration of inhaled medications contained in a pressurized inhaler (pMDI) in patients with chronic obstructive pulmonary disease on noninvasive ventilation. This integrative review consisted of 4 phases: (1) search in the literature; (2) consultation with medical societies; (3) research on package inserts and monographs of inhaled drugs; and (4) contact with ventilator, medication and spacer companies. The search for studies was based on keywords and restricted to articles published until December 31, 2019, written in Portuguese and English. Nine articles were selected, including 1 primary study, 6 review studies and 2 studies on experimental ventilation models. Two guidelines were included from the consultation with medical societies, and of the 8 companies contacted, 4 made recommendations regarding the inhalation technique. No information was found on the administration of noninvasive ventilation drugs in package inserts and monographs. Attention should be given to measures that increase the pulmonary deposition of inhaled drugs, such as the use of an air chamber with pMDI, minimization of undesirable air leakage, patient-ventilator synchronization, jet firing in the inspiratory phase and insertion of a leak port in the mask or circuit. (AU)

Técnica de terapia inhalatoria: evaluación de una intervención educativa realizada a estudiantes de Medicina, posgrados de Pediatría y cuidadores de niños y adolescentes internados en un hospital pediátrico de referencia. Período junio-agosto de 2019 / Inhalation therapy: Assessment of a training intervention delivered to Medical students, Postgraduate students of Pediatrics and to caregivers of children and adolescents admitted to a Reference Pediatric Hospital from June to August, 2019 / Terapia por inalação: avaliação de uma intervenção de treinamento com estudantes de medicina, estudantes de pós-graduação em pediatria e cuidadores de crianças e adolescentes internados em um hospital pediátrico de referência de junho a agosto de 2019

Resumen: Introducción: las patologías respiratorias con broncoobstrucción representan una causa frecuente de ingresos hospitalarios, siendo la vía inhalatoria de elección en su tratamiento. Objetivos: conocer la técnica de inhaloterapia realizada por estudiantes de Medicina, posgrados de Pediatría y cuidadores, y de los niños y adolescentes hospitalizados. Metodología: estudio prospectivo, descriptivo, de junio a agosto de 2019. Se elaboró un cuestionario con el procedimiento de la técnica inhalatoria con máscara facial, boquilla e higiene del dispositivo. Se solicitó al cuidador que describiera el procedimiento que realizaba al administrar fármacos inhalados. Se realizó una intervención explicando la correcta técnica y posteriormente se solicitó que describiera nuevamente el procedimiento. Estudiantes de Medicina y posgrados de Pediatría fueron evaluados según recomendaciones internacionales. Resultados: del total de 80 participantes, tres realizaron el procedimiento de forma adecuada. Luego de la intervención, 27 lograron una técnica correcta. En cuanto a la higiene del dispositivo, tres participantes lo realizaron correctamente previo a la intervención. Posteriormente, 44 lo refirieron adecuadamente. Participaron 25 profesionales de la salud, 15 describieron de forma correcta el procedimiento en menores de 5 años y siete en niños mayores. Posteriormente al taller informativo, 24 lograron describir adecuadamente la técnica en menores de 5 años y 15 en mayores. Conclusiones: la mayoría de los cuidadores desconocen la correcta técnica de inhaloterapia. Se debería implementar intervenciones destinadas a evaluar y entrenar a los pacientes de forma regular. Es fundamental capacitar al personal de salud para la mejora en la calidad de utilización del dispositivo.

Summary: Introduction: broncho-obstructive respiratory pathologies are a frequent cause of hospital admissions, and inhalation remains the main choice of treatment. Objectives: learn about the inhalation technique performed by medical students and postgraduate students of pediatrics and by caregivers of hospitalized children and adolescents. Methodology: prospective, descriptive study carried out from June to August 2019. A questionnaire was prepared about the inhalation technique requiring facial mask, and mouthpiece and about the hygiene of the device. Caregivers were asked to describe the procedure performed when administering inhaled drugs. An intervention was performed explaining the correct technique and the caregiver was asked to describe the procedure again. Medical and Pediatrics' students were assessed as per the international recommendations. Results: out of 80 participants, 3 performed the procedure appropriately. After the intervention, 27 they performed the technique correctly. 3 participants performed the device hygiene correctly before the intervention, and after the intervention, 44 did it properly. 25 health professionals participated, 15 correctly described the procedure on children under 5 years of age and 7 described it correctly on older children. After the information workshop, 24 managed to adequately describe the technique on children under 5 years of age and 15 for older patients. Conclusions: Most caregivers are unaware of correct inhalation therapy techniques. Regular interventions aimed at evaluating and training patients should be implemented. It is essential to train health staff to improve the quality of use of the device.

Resumo: Introdução: as patologias respiratórias bronco-obstrutivas são uma causa frequente de internações hospitalares e a inalação é ainda a principal opção de tratamento. Objetivos: aprender sobre a técnica de inalação realizada por estudantes de Medicina e Pediatria e por cuidadores de crianças e adolescentes hospitalizados. Metodologia: estudo prospectivo, descritivo, realizado de junho a agosto de 2019. Elaborou-se um questionário sobre a técnica de inalação que requer máscara facial e bocal e sobre a higiene do dispositivo. Pediu-se ao cuidador que descrevesse o procedimento realizado ao administrar drogas inaladas. Fizemos uma intervenção explicando a técnica correta e pedimos ao cuidador que descrevesse o procedimento novamente. Avaliamos aos estudantes de medicina e aos de pós-graduação em Pediatria de acordo com as recomendações internacionais. Resultados: dos 80 participantes, 3 realizaram o procedimento adequadamente. Após a intervenção, 27 deles realizaram a técnica corretamente. 3 participantes realizaram a higiene do dispositivo corretamente antes da intervenção e, após a intervenção, 44 a realizaram corretamente. Participaram 25 profissionais de saúde, 15 descreveram corretamente o procedimento para crianças menores de 5 anos e 7 descreveram corretamente para crianças maiores. Após o workshop informativo, 24 conseguiram descrever adequadamente a técnica para crianças menores de 5 anos e 15 para pacientes mais maiores. Conclusões: a maioria dos cuidadores desconhecem as técnicas corretas de terapia por inalação. Devem-se implementar intervenções regulares destinadas a avaliar e treinar pacientes. É essencial treinar a equipe de saúde para melhorar a qualidade de uso do dispositivo.

Influencia del uso de inhaladores sobre la caries dental en pacientes pediátricos asmáticos: Estudio de casos y controles / Impact of inhaler use on dental caries in asthma pediatrics patients: A case-control study

Introducción. El asma es una enfermedad inflamatoria crónica con alta prevalencia en pacientes pediátricos. Existen resultados contradictorios respecto al efecto de esta enfermedad en los índices de caries dental. El objetivo del estudio fue determinar la prevalencia de caries dental en pacientes pediátricos asmáticos con medicación inhalatoria. Población y métodos. Estudio de casos y controles cuya muestra estuvo conformada por pacientes pediátricos que acudieron al Centro Médico Naval "Cirujano Mayor Santiago Távara" de diciembre de 2014 a marzo de 2015. Se dividieron en dos grupos: el primero (casos), integrado por pacientes asmáticos que utilizaban inhaladores en su tratamiento; el segundo (controles), por pacientes sanos del mismo nosocomio. Se realizó una evaluación médica para determinar tipo, tiempo y frecuencia del tratamiento y un examen oral para determinar la prevalencia de caries dental y el índice de dientes cariados, perdidos y obturados (CPOD). Resultados. Se encontró que la prevalencia de caries dental en el grupo control fue del 34,2 %, mientras, en el grupo casos, fue del 28,3 % (p = 0,094). Con respecto al índice de caries dental, el grupo control presentó CPOD de 4,73 ± 0,32, y el grupo casos, de 3,98 ± 0,31 (p = 0,08). Sin embargo, se evidenció que, a mayor tiempo de tratamiento con los inhaladores, el índice CPOD aumentaba significativamente (p = 0,04).Conclusiones. La medicación inhalatoria no incrementa la prevalencia de caries dental en pacientes pediátricos asmáticos. Sin embargo, existe una relación directa entre la duración del tratamiento y la prevalencia de caries dental

Introduction. Asthma is a chronic inflammatory disease that is highly prevalent among pediatric patients. The results about the effect of asthma on the rate of dental caries are contradictory. The objective of this study was to determine the prevalence of dental caries in asthma pediatric patients using inhaled drugs. Population and methods. Case-control study in a sample made up of pediatric patients who attended Centro Médico Naval "Cirujano Mayor Santiago Távara" between December 2014 and March 2015. Patients were divided into two groups: group A (cases) included asthma patients using inhalers as part of their treatment; group B (controls), healthy subjects who attended the same facility. A medical examination was done to determine the type, time, and frequency of treatment and an oral exam, to establish the prevalence of dental caries and the decayed, missing, and filled teeth (DMFT) index. Results. The prevalence of dental caries was 34.2 % in the control group and 28.3 % in the case group (p = 0.094). In relation to the rate of dental caries, the DMFT index in the control group was 4.73 ± 0.32, and 3.98 ± 0.31 in the case group (p = 0.08). However, it was evidenced that a longer duration of inhaler use led to a significantly higher DMFT index (p = 0.04).Conclusions. Inhaled drugs do not increase the prevalence of dental caries in asthma pediatric patients. However, there is a direct relationship between treatment duration and the prevalence of dental caries.

Efficacy and Safety of a Pressurized Metered-Dose Inhaler in Older Asthmatics: Comparison to a Dry Powder Inhaler in a 12-Week Randomized Trial

PURPOSE: Asthma control in older asthmatics is often less effective, which may be attributed to small airway dysfunction and poor inhalation technique. We compared the efficacy of 2 inhalers (fluticasone propionate/formoterol treatment using a pressurized metered-dose inhaler [p-MDI group] vs. fluticasone propionate/salmeterol treatment using a dry powder inhaler [DPI group]) in older asthmatics.METHODS: We conducted a 12-week, randomized, open-label, parallel-designed trial in older patients (over 55 years old) with moderate-to-severe asthma, and compared the efficacy and safety for asthma control between the 2 groups. Subgroup analyses on disease duration and air trapping were performed. Clinical parameters, including changes in lung function parameters, inhaler technique and adherence, were compared with monitoring adverse reactions between the 2 groups.RESULTS: A total of 68 patients underwent randomization, and 63 (30 in the p-MDI group and 33 in the DPI group) completed this study. The p-MDI group was non-inferior to the DPI group with regard to the rate of well-controlled asthma (53.3% vs. 45.5%, P < 0.001; a predefined non-inferiority limit of 17%). In subgroup analyses, the proportion of patients who did not reach well-controlled asthma in the p-MDI group was non-inferior to that in the DPI group; the difference was 12.7% among those with a longer disease duration (≥ 15 years) and 17.5% among those with higher air-trapping (RV/TLC ≥ 45%), respectively (a predefined non-inferiority limit of 17%, P < 0.001). No significant differences were observed in lung function parameters, inhalation techniques, adherence and adverse reactions between the 2 groups.CONCLUSION: These results suggest that the p-MDI group may be comparable to the DPI group in the management of older asthmatics in aspects of efficacy and safety.

Patients’ sensory perception and satisfaction with use of metered dose inhalers and dry powder inhalers in moderate persistent asthma

Background: Inhalers containing corticosteroid and a long acting ?2 agonist (LABA) are widely used in asthma treatment. This study assessed the patient sensory perception and satisfaction of budesonide/formoterol fixed dose combination by pressurized metered dose inhalers (pMDI) with spacer and dry powder inhalers (DPI) in patients of moderate persistent asthma.Methods: This was a 6 week prospective, randomized, open label, comparative, parallel group clinical study. All patients had a forced expiratory volume in 1 second (FEV1) of 60-80% predicted normal. The patients were assessed for sensory perception and satisfaction in group I (pMDIs with spacers) and group II (DPIs) using patient evaluation questionnaire (PEQ) and patient satisfaction and preference questionnaire (PASAPQ) at the end of 6th week.Results: In PEQ, statistical analysis of the mean attribute ratings showed that both the devices were easy to use by patients. More medication was felt reaching throat using DPIs. Patients on DPI liked the taste and felt it to be less strong than patients on pMDIs. The overall liking was statistically comparable in two groups. In PASAPQ, the patients on DPI group were very satisfied with the treatment than pMDI (p<0.05).Conclusion: Overall liking of both DPIs and pMDIs was comparable and patients on DPI were satisfied more with the treatment device. Patient sensory perception and satisfaction may be taken into account in selecting device to improve compliance to treatment.

Asma e a técnica inalatória do inalador pressurizado dosimetrado acoplado ao espaçador: revisão integrativa / Asma y la técnica de inhalación con inhalador presurizado con dosificador acoplado a la cámara espaciadora: revisión integral / Asthma and the inhalation technique for the pressurized metered-dose inhaler with spacer: an integrative review

RESUMO Objetivo: identificar quais técnicas inalatórias do Inalador Pressurizado Dosimetrado, acoplado ao espaçador, têm sido utilizadas em pacientes com asma. Método: trata-se de revisão integrativa, realizada em janeiro de 2018, nas bases de dados US National Library of Medicine e na Literatura Latino-Americana e do Caribe em Ciências de Saúde. Foram selecionados 14 artigos, publicados entre janeiro de 2011 e dezembro de 2017, que continham a descrição da sequência de passos da técnica inalatória. Resultados: os artigos, predominantemente, estudaram indivíduos com idade igual ou superior a 14 anos e justificaram a adoção dos passos da técnica inalatória em referências da literatura. Os passos indicados por cada artigo foram revisados por pares e realizou-se uma quantificação daqueles mais citados, em que 15 passos foram definidos. Conclusão: a síntese do conhecimento gerado pode auxiliar profissionais de saúde no manejo adequado da asma, uma vez que traz evidências relacionadas à eficácia de cada passo.

RESUMEN Objetivo: identificar las técnicas de inhalación del inhalador presurizado con dosificador acoplado al espaciador que se utilizan en pacientes con asma. Método: revisión integral, que se realizó en enero de 2018, en las bases de datos US National Library of Medicine y en Literatura Latinoamericana y del Caribe en Ciencias de Salud. Se eligieron 14 artículos, publicados entre enero de 2011 y diciembre de 2017, con la descripción de la secuencia de procedimientos de la técnica de inhalación. Resultados: los artículos, de modo predominante, abordaron individuos con edad igual o superior a 14 años y justificaron la adopción de los procedimientos de la técnica de inhalación en referencias de la literatura. Se revisaron los procedimientos apuntados por cada artículo por pares y se realizó una cuantificación de aquellos más mencionados, en la cual se definieron 15 procedimientos. Conclusión: la síntesis del conocimiento que se generó puede ayudar a los profesionales de salud en el manejo adecuado del asma, pues trae evidencias asociadas con la eficacia de cada procedimiento.

ABSTRACT Objective: to identify which Pressurized Metered-Dose Inhaler with spacer inhalation techniques have been used in patients with asthma. Method: this was an integrative review, conducted in January 2018, in the US National Library of Medicine and Latin American and Caribbean Health Sciences Literature databases. 14 articles, published between January 2011 and December 2017, which contained the description of the sequence of inhalation technique steps, were selected. Results: the articles predominantly studied individuals aged 14 years or over and justified the adoption of the steps of the inhalation technique from literature references. The steps indicated by each article were reviewed by experts and a quantification of those most cited was performed, with 15 steps being defined. Conclusion: the synthesis of the knowledge generated can help healthcare providers in the proper management of asthma, since it provides evidence related to the efficacy of each step.

Avaliação de vídeos sobre a técnica inalatória na asma infantil: educativos ou midiáticos? / Assessment of videos about the inhalation technique for childhood asthma: educational or mediatic?

Vídeos relacionados à técnica inalatória na asma são populares no YouTube, mas sua qualidade é questão de preocupação. Neste estudo objetivou-se avaliar vídeos que demonstram a técnica inalatória do inalador pressurizado acoplado ao espaçador, para crianças e adolescentes com asma, quanto a conformidade das diretrizes da Global Initiative for Asthma. Estudo exploratório, realizado em 11 de julho de 2017 usando os termos inalador pressurizado e aerossol dosimetrado. Os vídeos foram avaliados por três enfermeiras, independentes e experientes na área, quanto aos critérios de conteúdo, produção e usuários. Dentre os 492 vídeos encontrados, seis preencheram os critérios de elegibilidade. Ponto de destaque foi a demonstração incorreta da técnica inalatória em todos os vídeos e a pontuação inadequada na avaliação técnica e de conteúdo. As descobertas deste estudo mostram que os vídeos não são confiáveis e nem compatíveis com as diretrizes de asma e, portanto, não podem ser recomendados para fins educacionais.

Videos related to asthma inhaling technique are popular on YouTube, but their quality is concerning. In this study, we aimed to assess videos demonstrating the inhaling technique of the pressurized metered dose inhaler, attached to the spacer, for children and adolescents with asthma, according to the guidelines of the Global Initiative for Asthma. We conducted an exploratory study, on 11 July 2017 using the terms "inalador pressurizado" and "aerossol dosimetrado". Three independent nurses experienced in the field assessed the videos regarding content inclusion, production, and users. Within the 492 videos found, six met the eligibility criteria. The highlight point was the incorrect demonstration of the inhalation technique in all videos and the inadequate scoring for technique and content assessments. Our study findings show that videos are not reliable neither compatible with asthma guidelines and, therefore, they should not be recommended for educational purposes.

Short-term Evaluation of a Comprehensive Education Program Including Inhaler Training and Disease Management on Chronic Obstructive Pulmonary Disease / 결핵및호흡기질환

BACKGROUND: Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management. METHODS: We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit. RESULTS: The outcomes of 127 COPD patients were analyzed. CAT scores (19.6±12.5 vs. 15.1±12.3) improved significantly after this program (p<0.05). Patients with improved CAT scores of 4 points or more had a better understanding of COPD management and the correct technique for using inhalers than those who did not have improved CAT scores (p<0.05). CONCLUSION: A comprehensive education program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management.

Pharmacoeconomical analysis of inhaled glucocorticosteroids in the treatment of children with cough variant asthma / 中国基层医药

Objective To discuss the clinical curative effect and pharmacoeconomics of inhaled glucocortico-steroids(ICS)in the treatment of children with cough variant asthma(CVA),in order to provide the reference for reasonable and economic drug -use of clinic treating children with CVA.Methods 128 children with CVA were divided into A,B,C three groups according to random number table method in our hospital from March 2013 to May 2014.The children with CVA of A,B,C groups were respectively given budesonide aerosol(200 -800μg/day,twice per day),fluticasone propionate aerosol(50 -100μg/time,twice per day),beclometasone dipropionate aerosol(50 -100μg/time,three times per day)on the basis of bronchodilator,smooth wheezing and expectorant.The clinical effica-cy and cost -effectiveness was evaluated after 12 weeks of treatment.Results The clinical total effective rates of A, B,C group were 90.0%,93.4%,90.7% respectively,and there were no statistically significant difference(χ2 =25.215,22.878,21.336,all P >0.05 ).The per capita cost of A,B,C group were 498.68yuan,671.20yuan, 541.14yuan respectively,and A group had the lowest cost -effectiveness ratio(C /E =5.54).Conclusion Budes-onide aerosol has better economy in treating of children with CVA.

Validation of scores of use of inhalation devices: valoration of errors / Validação de escores de uso de dispositivos para inalação: valoração dos erros cometidos

AbstractObjective: To validate two scores quantifying the ability of patients to use metered dose inhalers (MDIs) or dry powder inhalers (DPIs); to identify the most common errors made during their use; and to identify the patients in need of an educational program for the use of these devices.Methods: This study was conducted in three phases: validation of the reliability of the inhaler technique scores; validation of the contents of the two scores using a convenience sample; and testing for criterion validation and discriminant validation of these instruments in patients who met the inclusion criteria.Results: The convenience sample comprised 16 patients. Interobserver disagreement was found in 19% and 25% of the DPI and MDI scores, respectively. After expert analysis on the subject, the scores were modified and were applied in 72 patients. The most relevant difficulty encountered during the use of both types of devices was the maintenance of total lung capacity after a deep inhalation. The degree of correlation of the scores by observer was 0.97 (p < 0.0001). There was good interobserver agreement in the classification of patients as able/not able to use a DPI (50%/50% and 52%/58%; p < 0.01) and an MDI (49%/51% and 54%/46%; p < 0.05).Conclusions: The validated scores allow the identification and correction of inhaler technique errors during consultations and, as a result, improvement in the management of inhalation devices.

ResumoObjetivo: Validar dois escores para medir a habilidade de pacientes em utilizar inaladores pressurizados (IPs) ou inaladores de pó (IPos), verificar os erros mais comuns na sua utilização e identificar os pacientes que necessitam de um programa educacional para o uso desses dispositivos.Métodos: Este estudo foi realizado em três etapas: validação da confiabilidade dos escores de uso dos dispositivos inalatórios; validação do conteúdo dos escores utilizando-se uma amostra de conveniência; e realização de testes para a validação de critério e a validação discriminante desses instrumentos em pacientes que preenchiam os critérios de inclusão do estudo.Resultados: A amostra de conveniência foi composta por 16 pacientes, e houve discordância interobservador em 19% e 25% para os escores de IPo e IP, respectivamente. Após a análise de expertos no assunto, os escores sofreram modificações e foram aplicados em 72 pacientes. A dificuldade mais relevante no uso de ambos os dispositivos foi a manutenção da capacidade pulmonar total após inspiração profunda. O grau de correlação dos escores por observador foi de 0,97 (p < 0,0001). Houve boa concordância interobservador na classificação dos pacientes como aptos/não aptos para uso de IPo (50%/50% e 52%/58%; p < 0,01) e de IP (49%/51% e 54%/46%; p < 0,05).Conclusões: Os escores validados permitem identificar e corrigir os erros da técnica inalatória ao longo das consultas e, em consequência, melhorar o manejo dos dispositivos para inalação.

Effect of nebulized corticosteroids on long-term poorly controlled asthma in elderly patients / 中华老年医学杂志

Objective To evaluate the efficacy and safety of long-term nebulized corticosteroids and inhaled bronchodilators therapy on asthma in long term poor controlled elderly patients.Methods Prospective,randomized control study was conducted.63 elderly asthma patients,who received inhaled corticosteroids or combined with other long-term medication treatment for asthma control for more than 3 months but were still in moderate to severe persistent asthma state,were randomly divided into nebulizer treatment group (n=31) and dry powder inhalation group (n=32),and they were treated correspondingly with Budesonide inhalation suspension 1 mg and Salbutamol 2.5 mg BidorBudesonide/Formoterol powder 320/9 μg inhalation Bid.Patients in the two groups were evaluated for the differences in lung function,acute exacerbations of asthma,asthma control test (ACT) and adverse effects after 12-week treatment.Results The improvement in morning peak expiratory flow (PEF) and ACT score were better in the test group than in the control group [(29.2 ±14.4) ml vs.(15.8±13.5)ml,(4.8±2.2) vs.(3.0±2.7),t=3.715 and 2.897,P=0.000 and 0.005],but there were no statistical differences in average daily use of relievers and severe acute exacerbations between the test and control groups (t=1.512,P=0.136;x2=2.238,P=0.135).The local adverse effects caused by inhaled corticosteroids had no significant difference between the two groups.Conclusions Compared with the powder inhalation,the nebulizer inhalation administration of corticosteroids and bronchodilators could improve the asthma symptoms and lung function better in elderly patients with serious asthma condition and shows a good safety in tbe12 weeks of continuous treatment.

Assessment of inhaler techniques employed by patients with respiratory diseases in southern Brazil: a population-based study / Avaliação da técnica de utilização de dispositivos inalatórios no tratamento de doenças respiratórias no sul do Brasil: estudo de base populacional

OBJECTIVE: To identify incorrect inhaler techniques employed by patients with respiratory diseases in southern Brazil and to profile the individuals who make such errors. METHODS: This was a population-based, cross-sectional study involving subjects ≥ 10 years of age using metered dose inhalers (MDIs) or dry powder inhalers (DPIs) in 1,722 households in the city of Pelotas, Brazil. RESULTS: We included 110 subjects, who collectively used 94 MDIs and 49 DPIs. The most common errors in the use of MDIs and DPIs were not exhaling prior to inhalation (66% and 47%, respectively), not performing a breath-hold after inhalation (29% and 25%), and not shaking the MDI prior to use (21%). Individuals ≥ 60 years of age more often made such errors. Among the demonstrations of the use of MDIs and DPIs, at least one error was made in 72% and 51%, respectively. Overall, there were errors made in all steps in 11% of the demonstrations, whereas there were no errors made in 13%.Among the individuals who made at least one error, the proportion of those with a low level of education was significantly greater than was that of those with a higher level of education, for MDIs (85% vs. 60%; p = 0.018) and for DPIs (81% vs. 35%; p = 0.010). CONCLUSIONS: In this sample, the most common errors in the use of inhalers were not exhaling prior to inhalation, not performing a breath-hold after inhalation, and not shaking the MDI prior to use. Special attention should be given to education regarding inhaler techniques for patients of lower socioeconomic status and with less formal education, as well as for those of advanced age, because those populations are at a greater risk of committing errors in their use of inhalers. .

OBJETIVO: Conhecer os erros na técnica de uso de dispositivos inalatórios empregada por pacientes com doenças respiratórias no sul do Brasil e o perfil daqueles que possuem dificuldades em realizá-la. MÉTODOS: Estudo transversal, de base populacional, com indivíduos com idade ≥ 10 anos e em uso de inaladores pressurizados (IPrs) ou inaladores de pó (IP) em 1.722 domicílios de Pelotas (RS). RESULTADOS: Foram incluídos 110 indivíduos que utilizavam 94 IPrs e 49 IP. Os principais erros no uso dos IPrs e IP foram não expirar antes da inalação (66% e 47%, respectivamente), não fazer uma pausa inspiratória após a inalação (29% e 25%) e não agitar o IPr antes do uso (21%). Os indivíduos com idade ≥ 60 anos mais frequentemente cometeram erros. Das demonstrações de uso do IPr e IP, respectivamente, 72% e 51% apresentaram ao menos um erro, enquanto 13% das demonstrações foram plenamente corretas e 11% apresentaram erros em todas as fases. A proporção de indivíduos com menor nível de escolaridade que cometeram ao menos um erro foi significativamente maior do que a daqueles com maior nível de escolaridade tanto no uso de IPrs (85% vs. 60%; p = 0,018) quanto no de IPs (81% vs. 35%; p = 0,010). CONCLUSÕES: Nesta amostra, os principais erros cometidos no uso dos inaladores foram não realizar a expiração antes da inalação, não fazer a pausa inspiratória após a inalação e não agitar o IPr. Pacientes com menor nível socioeconômico e educacional, assim como aqueles com idade avançada, merecem especial atenção na educação sobre a realização da técnica inalatória, pois apresentam um maior risco de cometer erros durante o uso dos inaladores. .

Uso de inhaladores de dosis medida en pacientes adultos: Necesidad de educación dirigida por enfermería / Handling of Metered Dose inhaler in adult patients: a need of education directed by Professional Nursing

Objetivo: Describir el uso de inhaladores de dosis medida en pacientes adultos de consulta de neumología en dos instituciones de salud de Atlántico (Colombia), 2013. Materiales y métodos: Estudio descriptivo transversal que evaluó 131 pacientes adultos que utilizaban inhaladores de dosis medida (de cartucho presurizado) con inhalocámara o sin esta, asistentes a dos instituciones de salud del departamento del Atlántico. Se diseñó y aplicó un cuestionario que incluía lista de chequeo que permitió evaluar la técnica. Resultados: De 131 pacientes participantes, la media de edad fue de 44,75 años (DE+/-: 17.77). La tasa de éxito en el uso de la técnica fue baja, menos de 1.52% (2) fue perfecto, mientras que un 24.43% (32) tuvo una técnica adecuada y el 74.05% (97) inadecuada. 105 utilizaban inhaladores sin inhalocámara y 26 con inhalocámara. Conclusiones: Existen debilidades en el uso de los inhaladores. El 74.05% de los pacientes los usó inadecuadamente. Los pasos de la técnica de utilización de inhaladores que fallaron mayormente fueron: no exhalar el volumen residual, no comenzar a respirar cuando se activa el canister, no inhalar lento y profundo, no retener el medicamento por 10 segundos no esperar 30 segundos antes del segundo disparo y no agitar nuevamente el dispositivo antes del mismo. Es necesario implementar programas de educación en los que participen profesionales en enfermería.

Objective: To describe the handling of Metered-Dose inhaler (MDI) in adults of the pneu-mology medical consultation located in Atlántico country (Colombia), 2013. Materials and Methods: We conducted a cross-sectional descriptive study which es-timated 131 adults patients that were using MDIs (pressurized inhaler) with or without a holding chamber and were attending into two health institutions located in Atlántico County, Colombia. We designed and applied a questionnaire that contained a checklist that was allowed for the evaluation of the technique. Results: Mean age was 44.75 years (SD +/-: 17.77). The success rate in the use of the technique was low, 1.52% (2) was perfect, 24.43% (32) was adequate and 74.05% (97) inadequate. Out of 131 patients, 105 used inhalers without holding chamber and 26 with holding chamber. Conclusions: There are weaknesses in the Handling of Metered-Dose inhaler (MDI). 74.05% of patients misused the MDI. The technique steps that are often wrongly executed by patients were: not exhale the residual volume, not start breathing when activating the canister, not inhale slowly and deeply, not retain the medication for 10 seconds and not hold the breath, not wait 30 seconds in between puffs and not shake again the inhaler be-fore shooting it for a second time. It needs to implement education programs that involve professional nursing staff.

Factors related to the incorrect use of inhalers by asthma patients / Fatores relacionados ao uso incorreto dos dispositivos inalatórios em pacientes asmáticos

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

OBJETIVO: Avaliar a técnica inalatória em pacientes com asma atendidos ambulatorialmente, estabelecendo associações dessa com o grau de controle da doença. MÉTODOS: Estudo transversal envolvendo pacientes com idade > 14 anos e diagnóstico médico de asma, recrutados no Ambulatório de Asma do Hospital de Clínicas de Porto Alegre, na cidade de Porto Alegre (RS). Os pacientes completaram dois questionários (um geral e um questionário de controle da asma baseado nas diretrizes da Global Initiative for Asthma de 2011). Os pacientes demonstraram a técnica inalatória e realizaram testes de função pulmonar. A técnica inalatória incorreta foi definida como a execução incorreta de pelo menos duas etapas da avaliação. RESULTADOS: Foram incluídos 268 pacientes. Desses, 81 (30,2%) apresentaram técnica inalatória incorreta, que foi associada com falta de controle da asma (p = 0,002). A regressão logística identificou os seguintes fatores associados com a técnica inalatória incorreta: ser viúvo (OR = 5,01; IC95%, 1,74-14,41; p = 0,003); utilizar inalador pressurizado (OR = 1,58; IC95%, 1,35-1,85; p < 0,001); ter renda familiar mensal < 3 salários mínimos (OR = 2,67; IC95%, 1,35-1,85; p = 0,008); e ter > 2 comorbidades (OR = 3,80; IC95%, 1,03-14,02; p = 0,045). CONCLUSÕES: Na amostra estudada, a técnica inalatória incorreta se associou com a falta de controle da asma. Viuvez, uso de inalador pressurizado, baixo nível socioeconômico e presença de > 2 comorbidades se associaram à técnica inalatória incorreta. .

Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil / Uso de inaladores na população de adolescentes e adultos com diagnóstico médico autorreferido de asma, bronquite ou enfisema em Pelotas, RS

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. .

OBJETIVO: Avaliar as características dos usuários de dispositivos inalatórios e a prevalência de uso desses em adolescentes e adultos com diagnóstico médico autorreferido de asma, bronquite ou enfisema. MÉTODOS: Estudo de base populacional realizado em Pelotas, RS, incluindo 3.670 indivíduos com idade ≥ 10 anos, avaliados com um questionário. RESULTADOS: Aproximadamente 10% da amostra referiram pelo menos uma das doenças respiratórias investigadas. Entre esses, 59% apresentaram sintomas respiratórios no último ano, e, desses, apenas metade usou inaladores. O uso de inaladores diferiu significativamente de acordo com o nível socioeconômico (39% e 61% entre mais pobres e mais ricos, respectivamente; p = 0,01). Não houve diferença na frequência de uso de inaladores por sexo ou idade. Entre indivíduos com enfisema, o uso da combinação broncodilatador + corticoide inalatório foi mais frequente que o uso isolado de broncodilatador. Somente entre os indivíduos que referiram diagnóstico médico de asma e sintomas atuais, a proporção de uso de inaladores foi maior que 50%. CONCLUSÕES: Em nossa amostra, os inaladores foram subutilizados, e o tipo de medicamento usado por aqueles que referiram enfisema parece não estar de acordo com o preconizado em consensos sobre essa doença. .