Handling of inhaler devices in actual pulmonary practice: metered-dose inhaler versus dry powder inhalers.

BACKGROUND: Handling of inhaler devices such as pressurized metered-dose inhalers (MDIs) and dry-powder inhalers (DPIs) in actual pulmonary practice is not well studied. OBJECTIVE: The aim of this study was to evaluate patients' proper handling of inhaler devices during actual pulmonary practice. METHODS: Prospective observational evaluations were conducted at 3 pulmonary clinics in Jordan, from February 2006 until August 2006. MDI (without spacer), Turbuhaler, Diskus, and Aerolizer devices were studied. Incorrect handling was defined as improper technique in any of the predefined essential steps. RESULTS: Patients (n = 300) were recruited and 525 inhaler-device handling technique evaluations were completed. Diskus inhaler had the lowest rate of incorrect handling (7/103, 6.8%) and MDI had the highest rate of incorrect handling (144/193, 74.6%). Turbuhaler and Aerolizer were handled incorrectly by 63/146 (43.2%) and 14/83 (16.9%) patients, respectively. DPI had a lower rate of incorrect handling, when compared with the MDI (p < 0.001). Among the DPI devices, the Diskus had the lowest rate of incorrect handling (p < 0.031). CONCLUSIONS: In actual pulmonary clinical practice the majority of patients were unable to use MDI correctly, whereas correct handling of DPI devices was variable. Regular checking of inhalation technique and proper teaching by health care providers is crucial for optimum use of most inhaler devices.

Etiology of community-acquired pneumonia in hospitalized patients in Jordan.

OBJECTIVE: To ascertain the causative organisms of community acquired pneumonia (CAP) in Jordanian patients requiring hospital admission. METHODS: A prospective study of both adults and children admitted to Princess Basma and Princess Rahma Teaching Hospitals in Irbid, Jordan with a diagnosis of CAP over a 6-month period from April to October 2002. RESULTS: A total of 35 adult patients were admitted with a mean age of 47 years, and 63 children with a mean age of 3 years. A pathogen was isolated from 25 (71%) adults, and from 17 (27%) children, and sputum cultures gave the best diagnostic yield. In adults Streptococcus pneumoniae was the most common isolate (26%), followed by Chlamydia pneumoniae (23%), Haemophilus influenzae (17%), Mycoplasma pneumoniae (9%), and Legionella pneumophila and Klebsiella pneumoniae (6%) each. Seven of the 9 gram negative isolates were from patients with some co morbid illness. While in children, Chlamydia pneumoniae was the most common (14%), followed by Mycoplasma pneumoniae (6%), and Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa (3%) each. CONCLUSION: Streptococcus pneumoniae and atypical microorganisms are the most common cause of CAP in previously healthy adults; while in those with associated co morbid illness, gram negative organisms are the likely cause. In children, the overall detection rate of causative organisms was low with atypical microorganisms being the most common.