Real-world observational study of the evaluation of inhaler techniques in asthma patients.

BACKGROUND: Inhaler devices are a keystone in the management of asthma during the maintenance phase of treatment. OBJECTIVE: To evaluate techniques for using inhaler devices in asthma patients. METHODS: A prospective cross-sectional study was conducted to assess patient compliance with correct techniques for using inhaler devices across three regimens: pressurized metered-dose inhaler (pMDI), Accuhaler®, and Turbuhaler®. The compliance of patients with essential steps for correct device usage in the case of each regimen was recorded. These were recorded when patients presented for a routine visit and one month after receiving face-to-face training. The percentage of compliance between the use of the devices and the risk factors related to incorrect techniques were analyzed by logistic regression analysis. The percentages of incorrect techniques were compared between the two visits using a Chi-squared test. RESULTS: A total of 108 asthma patients (35.2% male), with a mean age of 57.5 ± 12.3 years were evaluated. Percentages of incorrect use of Accuhaler®, pMDI, and Turbuhaler® were 50%, 48%, and 55.6%, respectively. The most common incorrectness's is breath out gently to residual volume (approximately one-third). Previous treatment by a pulmonologist for less than 2 years was the single factor related to incorrect technique [Adjusted OR = 2.8 (95%CI, 1.2-6.3), p = 0.02]. Formal training resulted in a statistically significant decrease in percentage of incorrect techniques (52.8% vs. 32.1%, p = 0.02). CONCLUSIONS: Inhalation technique in asthma patients was mostly unsatisfactory, especially in patients who had been treated by a pulmonologist for less than 2 years. Face-to-face training significantly improved good technique in all devices.

Major affective disorders in chronic obstructive pulmonary disease compared with other chronic respiratory diseases.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and other chronic respiratory diseases (CRDs) have significant impacts on quality of life including psychomotor domain. PURPOSE: To evaluate three major affective disorders in subjects with COPD compared with other CRDs and nonill population. MATERIALS AND METHODS: The Thai version of Mini International Neuropsychiatric Interview (MINI) was used as a diagnostic instrument for three major affective disorders (generalized anxiety disorder, major depressive disorder, and panic disorder) by face-to-face interview in assessing patients with CRDs [COPD, asthma, rhinasthma, all asthma (asthma and rhinasthma), and chronic rhinitis], and nonill subjects. Logistic regression analyses were used to determine the relation between major affective disorders and CRDs adjusting for age, sex, and disease severity. RESULTS: Major affective disorders were more prevalent in CRDs than nonill groups (adjusted OR =2.6 [95% CI, 1.8-3.9], P<0.001). COPD patients had significantly more generalized anxiety and panic disorder (adjusted OR =4.0 [95% CI, 1.4-11.9], P=0.011, and 4.4 [95% CI, 1.1-18.1], P=0.038, respectively) but not major depressive disorder (adjusted OR =2.7 [95% CI, 0.8-9.0, P=0.105]) than nonill group. Comparing with all asthma, COPD patients had lower occurrence of major depressive and panic disorders (adjusted OR =0.1 [95% CI, 0.0-0.4], P=0.002, and 0.1 [95% CI, 0.0-0.9], P=0.043, respectively). There was no difference in major mood disorders in COPD, rhinasthma, and chronic rhinitis patients. Major affective disorders were not increased by disease severity in COPD. CONCLUSION: Major affective disorders were significantly higher in CRDs than nonill population. Generalized anxiety and panic disorders were significantly high in COPD patients. Moreover, major depressive and panic disorders in COPD were significantly lower than all asthma. The prevalence of major affective disorders may not be related to severity of COPD.

Evaluating inhaler use technique in COPD patients.

BACKGROUND: Poor inhalation techniques are associated with decreased medication delivery and poor disease control in chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate techniques for using inhaler devices in COPD patients. METHODS: A prospective cross-sectional study was conducted to assess patient compliance with correct techniques for using inhaler devices across four regimens, ie, the pressurized metered-dose inhaler (pMDI), the pMDI with a spacer, the Accuhaler, and the Handihaler. The percentage of compliance with essential steps of correct device usage for each regimen was recorded without prior notification when COPD patients presented for a routine visit, and 1 month after receiving face-to-face training. We compared the percentage of compliance between the devices and risk factors related to incorrect techniques using logistic regression analysis. Percentage of patient compliance with correct techniques was compared between the two visits using the chi-square test. Statistical significance was set at P<0.05. RESULTS: A total of 103 COPD patients (mean age 71.2±9.2 years, males 64.1%, low education level 82.5%, and percent predicted forced expiratory volume in 1 second 51.9±22.5) were evaluated. Seventy-seven patients (74.8%) performed at least one step incorrectly. Patients using the Handihaler had the lowest compliance failure (42.5%), and the odds ratio for failure with the other devices compared with the Handihaler were 4.6 (95% confidence interval [CI] 1.8-11.8) for the pMDI, 3.1 (95% CI 1.2-8.2) for the pMDI with a spacer, and 2.4 (95% CI 1.1-5.2) for the Accuhaler. Low education level was the single most important factor related to incorrect technique (adjusted odds ratio 4.1, 95% CI 1.2-13.4, P=0.022). Formal training resulted in a statistically significant decrease in percentage of incorrect techniques for all devices and for the pMDI (59.4% vs 48.6%, P<0.001; 72.4% vs 48.3%, P=0.039, respectively). CONCLUSION: Inhalation technique in COPD patients without face-to-face training was mostly unsatisfactory, especially in patients with low education levels. The Handihaler was the inhaler device associated with the lowest technique failure. Face-to-face inhalation technique training significantly increased technique compliance for the pMDI.

A comparative study of COPD burden between urban vs rural communities in northern Thailand.

BACKGROUND: COPD prevalence and consequent burden are expected to rapidly increase worldwide. Until now, there has been no community-based study of COPD in Thailand. PURPOSE: We aimed to compare the prevalence, clinical characteristics, disease severity, previous diagnosis, and management of COPD between urban and rural communities. MATERIALS AND METHODS: A population-based cross-sectional study was designed to compare COPD prevalence and burden in rural and urban communities in Chiang Mai Province, Thailand. The COPD subjects were diagnosed and severity categories assigned using Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The prevalence between the groups was compared using risk regression analysis. Unpaired t-test and chi-square were used to compare differences between the groups. RESULTS: There were 574 and 293 enrolled subjects with acceptable spirometry, in rural and urban communities respectively. The prevalence of COPD in general and COPD in females was higher in the rural group (6.8% vs 3.7% and 4.4% vs 0.9%, respectively) across all independent variables. However, after adjustment for age, sex, and smoking status, no significant differences were demonstrated. Although the pulmonary function and disease severity between the two groups were not significantly different, the tendency was more pronounced in the rural group (COPD stage III-IV: 65.0% vs 33.3%). Most of the COPD patients in both groups were underdiagnosed (80.0% vs 77.2%) and undertreated (85.0% vs 81.9%). None of the patients in the study had participated in exercise training programs. CONCLUSION: The prevalence of COPD in general and particularly COPD in females tended to be higher, with more severe disease in the rural community. However, both groups were similarly underdiagnosed and undertreated.