Practice and exploration of physician-pharmacist joint outpatient service mode of chronic obstructive pulmonary disease (COPD) and asthma / 药学实践杂志

Objective To explore the physician-pharmacist joint outpatient service mode of chronic obstructive pulmonary disease ( COPD) and asthma. Methods Cases of COPD or asthma patients who visited the joint outpatient department from June 2021 to December 2021 were collected in our hospital, the inhaler usage score，compliance ( MMAS-8) score，clinical control efficacy，incidence of adverse reactions and patient satisfaction were evaluated before and after pharmaceutical care intervention and statistically analyzed．Results The inhaler usage score，MMAS-8 score，and the Asthma Control Test（ACT）/COPD Assessment Test（CAT） score had been changed significantly after the intervention (P<0.05). Patient satisfaction with pharmaceutical care was basically above 94.75%．Conclusion Pharmaceutical care provided by joint outpatient department in our hospital could help COPD and asthma patients to use inhaler device correctly，resulting in improving compliance of inhaler usage, better disease control，and reducing the occurrence of adverse drug reactions, which could be a positive attempt and exploration of standardized pharmaceutical care model for patients with COPD and asthma．

Progress in inhaler devices of asthmatic children using inhaled corticosteroids / 国际儿科学杂志

Asthma is a common,chronic respiratory disease in childhood.Inhaled corticosteroids are the key anti-inflammatory treatment of asthma.Delivery of respiratory medications by inhalation achieves a higher concentration in the airways,more rapid onset of action,and fewer systemic adverse effects.Inhaler devices include pressurized metered-dose inhaler,dry powder inhaler and nebulizer.Effective use of inhalers requires proper inhaler techniques,which is an important part of education and self-management of asthmatic children.However,the majority of children cannot master proper inhaler techniques,which leads to poor asthma control and increased risk of exacerbations and hospital visits,and seriously affects their quality of life.Therefore,health care professionals should choose the most appropriate inhaler device for children,show how to use the device correctly with a physical demonstration,and inform them of the do's and don'ts and recheck and correct their inhaler technique at every follow-up.

Application of QCC in Improving the Compliance of Asthma/COPD Outpatients Handling Inhaler Devices / 中国药房

OBJECTIVE:To evaluate the effects of quality control circle(QCC)in improving the compliance of asthma/COPD outpatients handling inhaler devices. METHODS:By simple random sampling method,90 asthma/COPD outpatients receiving Tiotropium bromide powder for inhalantion,Salmeterol xinafoate and fluticasone propionate powder for inhalantion and Budesonide and formoterol fumarate powder for inhalantion were selected from our hospital during Apr. to Nov. 2015. The reasons for poor com-pliance of handling inhaler devices were analyzed by QCC. The countermeasures were formulated to improve the compliance,in-cluding clinical pharmacist education,follow-up,issuing education manuals,developing WeChat consulting. Operation step score of inhaler devices,compliance score and activity ability score of QCC members were analyzed statistically before and after QCC. RESULTS:After the development of QCC,operation step score of inhaler devices and compliance score in 90 asthma/COPD outpa-tients increased from 7.7 and 7.7 before activity to 8.8 and 9.3 after activity,the achievable rate of compliance was 114.3%,and the improvement rate was 20.8%. The sense of honor,responsibility,self-confidence,QCC techniques,communication and coordi-nation,team cohesion of all members were all improved obviously. CONCLUSIONS:QCC activity improves the compliance of asthma/COPD outpatients handling inhaler devices and shows the professional service level of clinical pharmacists,which is of sig-nificance to the improvement of pharmaceutical care.

Effectiveness of Same Versus Mixed Asthma Inhaler Devices: A Retrospective Observational Study in Primary Care

PURPOSE: Correct use of inhaler devices is fundamental to effective asthma management but represents an important challenge for patients. The correct inhalation manoeuvre differs markedly for different inhaler types. The objective of this study was to compare outcomes for patients prescribed the same inhaler device versus mixed device types for asthma controller and reliever therapy. METHODS: This retrospective observational study identified patients with asthma (ages 4-80 years) in a large primary care database who were prescribed an inhaled corticosteroid (ICS) for the first time. We compared outcomes for patients prescribed the same breath-actuated inhaler (BAI) for ICS controller and salbutamol reliever versus mixed devices (BAI for controller and pressurised metered-dose inhaler [pMDI] for reliever). The 2-year study included 1 baseline year before the ICS prescription (to identify and correct for confounding factors) and 1 outcome year. Endpoints were asthma control (defined as no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection) and severe exacerbations (hospitalisation or oral corticosteroids for asthma). RESULTS: Patients prescribed the same device (n=3,428) were significantly more likely to achieve asthma control (adjusted odds ratio, 1.15; 95% confidence interval [CI], 1.02-1.28) and recorded significantly lower severe exacerbation rates (adjusted rate ratio, 0.79; 95% CI, 0.68-0.93) than those prescribed mixed devices (n=5,452). CONCLUSIONS: These findings suggest that, when possible, the same device should be prescribed for both ICS and reliever therapy when patients are initiating ICS.

Impacto da exibição de filme educativo, de modificações no inalador de pó e na bula sobre a capacidade de manuseio do dispositivo por indivíduos sadios / Impact that display an educational film, changes in powder inhaler device and in the instructions given to the patient have on the inhaler handling skill

Objetivo: Determinar o impacto que a exibição de um filme educativo, demonstrando a utilização de dispositivo inalatório de pó, mudanças no dispositivo e na bula fornecida ao paciente, teria sobre a capacidade de manuseio do inalador.Métodos: Em estudo observacional e cruzado, 88 entrevistados que nunca utilizaram nenhum dispositivo inalatório avaliaram dois dispositivos e suas respectivas bulas: um dispositivo e bula já comercializados (Formare® Atual) em comparação com um dispositivo e bula modificados com base em pesquisa de opinião prévia (Formare® Novo). Ao final, um vídeo demonstrando a utilização do dispositivo de Formare® Novo foi exibido e uma nova avaliação era realizada.Resultados: A modificação no dispositivo (maior facilidade para abrir a tampa e perfurar a cápsula) reduziu o número de pacientes com dificuldade para manipular o inalador de 35,2 para 15,9% (p = 0,003). O uso de linguagem mais objetiva e a introdução de mais figuras ilustrativas na bula aumentaram a porcentagem de pacientes que consideraram muito fácil manipular o inalador com base na bula de 50,0% para 80,7% (p < 0,001). A utilização de filme demonstrando o uso do inalador reduziu ainda mais a porcentagem de entrevistados com dificuldade para manipulá-lo (de 15,9% para 5,7%, p = 0,029).Conclusões: Dispositivos mais convenientes aos pacientes, bulas mais ilustradas e objetivas e vídeos educativos demonstrando a utilização dos inaladores são formas de facilitar o uso de dispositivos inalatórios pelos pacientes.

A descriptive study on usage of inhaled steroids in children.

Objective To determine the use of inhaled corticosteroids in a cohort of children at Lady Ridgeway Hospital (LRH), Colombo. Method A cross-sectional descriptive study was carried out on all clinic and in-ward patients of ward 4 LRH receiving inhaled corticosteroids for more than 6 months. A pre-tested, structured interviewer administered questionnaire was used to collect data on the demography, type of drug and device, adherence and response to therapy. Results The study population comprised 185 children, 55% of whom were males and 35% in the 2-5 year age group. In 90% the inhaled steroid was beclomethasone. Metered dose inhaler was used by 64% and dry powder inhaler by 36% for steroid delivery. Ninety six percent of the study population used the correct inhaler device for their age group. The commonest indication for inhaled steroid was moderate persistent bronchial asthma. The technique was demonstrated at initiation to 99.5% of the users by the prescriber. Eighty four percent of the study population practised a ‘good’ technique. Nearly 80% of the patients adhered to the therapy daily and attended the clinic regularly. Around 15% needed hospitalisation. About 96% showed restricted lifestyles, mainly consumption of iced food. Inhaler technique of the patient had a significant effect on the clinical response to therapy (p<0.05). Conclusions Beclomethasone was the most commonly used inhaled corticosteroid in the study. Ninety six percent used the correct inhaler device for their age group. Inhaler technique had a significant effect on the clinical response. About 96% had restricted lifestyle despite optimal control.