ABSTRACT
OBJECTIVE: Inhalation therapy is one of the key pillars in the treatment of chronic obstructive diseases, such as asthma and COPD (Chronic obstructive pulmonary disease); however, wide number of errors occur with high frequency in the inhalation manoeuvres among these patient. This review discuss the main errors made with inhalation devices, factors associated with poor IT (inhalation technique), their consequences and possible solutions. DATA SOURCES: To do this, we performed a search of any publications available in PubMed between the years 2000 and 2019, using the key words: asthma, COPD, obstructive lung disease, inhalers, misuse and errors. STUDY SELECTIONS: After a review of the titles and abstracts by the working group, the articles chosen were considered the most relevant in providing evidence of the problems and establishing solutions in the inhalation treatment of asthma and COPD. RESULTS: There are several publications that associated the errors in the inhalation technique with a poor prognosis both of asthma and COPD. Most authors generally agree in that a poor IT is associated with poor control of the symptoms. CONCLUSIONS: It is essential to review the IT in all our patients with asthma and COPD due to the high socio-economic impact that it involves; an effort must be made to homogenise the evaluation of IT, so that it helps to transmit a clear message to the patients, as well as to the health professionals on what is and what is not a correct manoeuvre.
Subject(s)
Asthma , Pulmonary Disease, Chronic Obstructive , Administration, Inhalation , Asthma/diagnosis , Asthma/drug therapy , Humans , Metered Dose Inhalers , Nebulizers and Vaporizers , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Respiratory TherapyABSTRACT
Objetivo: Con el objetivo de comparar el entrenamiento muscular respiratorio (EMR) con dispositivos de umbral de presión (U) y de carga resistiva (CR) en pacientes con enfermedad pulmonar obstructiva crónica (EPOC), se ha diseñado un estudio prospectivo y aleatorizado que incluyó ambas modalidades y un grupo control (C). Pacientes y métodos: Los 33 pacientes con EPOC grave-moderada incluidos se asignaron aleatoriamente a realizar entrenamiento en el domicilio con un dispositivo de U, de CR o un nivel mínimo de ambos durante 6 semanas, a razón de 2 sesiones diarias de 15 min. En los grupos U (n = 12) y CR (n = 11) se ajustó semanalmente la carga hasta la máxima tolerada como estrategia más equitativa para no favorecer a ningún grupo. Se exploraron medidas de función respiratoria, musculares y de calidad de vida antes y después del EMR y se compararon los patrones de presión en el entrenamiento. Resultados: Mejoraron las presiones inspiratorias máximas y las puntuaciones del cuestionario para enfermedad respiratoria crónica (CRQ) en U y CR respecto a C: la presión inspiratoria estática máxima pasó de 86 a 104,25 cmH2O (p < 0,01)en el grupo U, y de 91,36 a 105,7 cmH2O (p < 0,01) en CR, que fue el grupo que presentó mayores incrementos en áreas de calidad de vida del CRQ. La diferencia respecto a la disnea fue de 3 puntos en CR, de 2,58 en U y de 2,5 en C. Se observaron diferencias significativas entre grupos en el ciclo respiratorio durante el EMR (de 0,31 en U, frente a 0,557 de CR), si bien las mayores presiones pico y media en U rindieron índices presión-tiempo finales equivalentes: de 0,11 en U y de 0,11 en CR. Conclusiones: Mediante el reajuste de carga se consiguieron intensidades de entrenamiento equivalentes con patrones de presión diferentes. Nuestro planteamiento demostró la eficacia de un EMR no controlado, pero no la superioridad de una modalidad de entrenamiento sobre otra
Objective: The aim of this study was to compare the use of threshold and resistive load devices for inspiratory muscle training in patients with chronic obstructive pulmonary disease (COPD). A randomized prospective trial was designed to compare use of the 2 devices under training or control conditions. Patients and methods: Thirty-three patients with moderate or severe COPD were randomly assigned to home treatment with a threshold device, a resistive load device, or a control situation in which either of those devices was maintained at a minimum load throughout the study. Training was performed daily in 2 sessions of 15 minutes each for 6 weeks. In the patients who underwent training with threshold (n=12) and resistive load (n=11) devices, the loads used were adjusted weekly until the maximum tolerated load was reached to ensure that the interventions were as equivalent as possible. Respiratory function, respiratory muscle function, and quality of life were assessed before and after training and the different inspiratory pressure profiles were compared between training groups. Results: Both peak inspiratory pressure and scores on the Chronic Respiratory Questionnaire (CRQ) improved in the groups that received inspiratory muscle training compared with control subjects: maximal static inspiratory pressure increased from 86 cmH2O to 104.25 cmH2O (P<.01) in the threshold device group and from 91.36 cm H2O to 105.7 cmH2O (P<.01) in the resistive load device group. The resistive load group showed the largest increase in CRQ quality-of-life scores. Differences between the dyspnea score on the CRQ at the beginning and end of the training period were as follows: 3 points in the resistive load group, 2.58 in the threshold group, and 2.5 in the control group. Significant differences in duty cycle measured during training sessions were observed between groups at the end of training (0.31 in the threshold group and 0.557 in the resistive load group), but the mean pressuretime index was similar (0.11) in both groups because of the greater peak and mean inspiratory pressures in the threshold device group. Conclusions: Load readjustment allowed equivalent training intensities to be achieved with different inspiratory pressure profiles. Our study demonstrated the effectiveness of inspiratory muscle training without control of breathing pattern but showed no superiority of one training method over another
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/rehabilitation , Breathing Exercises , Quality of Life , Case-Control Studies , Prospective Studies , Time Factors , Severity of Illness IndexABSTRACT
La estimulación supramáxima o twitch magnético isométrico del cuádriceps es una técnica reproducible y objetiva que nos informa sobre la función muscular, que se encuentra comprometida en las enfermedades respiratorias. Hemos validado la técnica estándar y comparado un equipo utilizado en nuestro laboratorio con otro electroimán de referencia. También evaluamos el potencial de la técnica para entrenamiento muscular mediante estimulación repetitiva. Los equipos Magstim 200 con pala en mariposa (MAG, equipo de referencia) y Medtronic Magpro con pala circular (MED) se aplicaron sobre el nervio femoral de 6 voluntarios, a diferentes porcentajes del estímulo máximo. El MED se aplicó también sobre el músculo cuádriceps (MED-Q). Se realizaron medidas voluntarias y comparaciones entre equipos y días diferentes. El MED alcanzó valores menores que el MAG, con mayor variabilidad entre días y sin clara supramaximalidad. La estimulación MED-Q fue equivalente al 80,7% del MAG. En conclusión, no puede garantizarse un estímulo supramáximo del cuádriceps con el MED y pala redonda, aunque ésta, aplicada sobre el músculo, genera una contracción que avala este abordaje para la estimulación repetitiva
Compromised muscle function can be evaluated in respiratory disease patients by supramaximal magnetic stimulation (isometric twitch) of the quadriceps, a technique that is reproducible and objective. We validated the technique, comparing a device used in our laboratory with another reference electromagnet. We also assessed whether the technique could potentially be used to train the muscle by repetitive stimulation. The Medtronic Magpro (MED) device with a circular coil and the Magstim 200 device (MAG) with a figure-of-eight coil (reference device) were used to stimulate the femoral nerve of 6 volunteers at different percentages of maximal output. MED stimulation was also applied on the quadriceps muscle. We measured voluntary contractions, comparing measurements from the 2 devices and on different days. The stimulation achieved with MED was lower than with MAG, showed greater day-to-day variability, and was not clearly supramaximal. MED quadriceps stimulation was 80.7% of MAG stimulation. In conclusion, supramaximal stimulation of the quadriceps cannot be guaranteed with MED and the circular coil. However, this device generates sufficient contraction when applied to the muscle to be used for repetitive stimulation
