The knowledge and considerations of the physicians regarding the inhaler devices in asthma and COPD: the INTEDA-1 study.

INTRODUCTION: The present paper was aimed at indicating and discussing the possible problems related to inhaler devices by considering the knowledge and practices of the physicians regarding the inhalation therapies. MATERIALS AND METHODS: The present study is a prospective, cross-sectional survey carried out by Turkish Respiratory Society Inhalation Therapy Group between February 2010 and February 2011 with a participation of ten individual centres. Seven inhaler devices that were available on the market in the country were assessed. The data on the problems that 684 clinicians actively attending patients with respiratory disorders experienced in daily clinical practice or their evaluations of their patients were obtained through the questionnaire. RESULTS: The respondents, most of whom were pulmonologist (37.5%), and pediatrist (38.1%), had been,on average, 11.6 years in profession. The source of information on inhalers and administration techniques were reported to be mainly the internet and patient leaflets. Of the participants only 18.5% reported to have had adequate knowledge of inhaler devices and proper administration techniques. Most of the participants stated that they themselves provided the instructions of administration and that the method was often verbal explanation. The physicians believed that although approximately 60% of the patients used the drug correctly, 40.7% made critical mistakes to have adverse effects on the therapeutic outcome. The most important criteria on which the physians lay greater emphasis in choosing the inhaler devices were the physical capability, skills and age of the patients. CONCLUSION: The awareness of proper use of inhaler devices is a fundamental prerequisite for effective inhalation therapy has been improved in physicians. The results of the present study have shown that more effort is required for professional training. Assisting the physicans with medical personnel for training of the patients and educational motivation are required.

Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis.

The objective of this study is to test the reliability and validity of WHODAS-II (Turkish version) for the assessment of disability in patients with osteoarthritis. This study is designed as follows: the internal construct validity of WHODAS-II in patients with knee osteoarthritis was assessed by Rasch analysis, and external construct validity by association with the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) and the Nottingham Health Profile (NHP); reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and test-retest ICC. Our study presents the results of 225 outpatients assessed with mean age 58.4 years (SD 11.1) of whom 80.9% were female. Cronbach's α, ICC, and test-retest ICC values for the six subscales of WHODAS-II varied between 0.71 and 0.94, 0.71 and 0.94, and 0.87 and 0.97, respectively. Rasch analysis of WHODAS-II indicated that after adjustment for local dependency, satisfactory fit was achieved. Two separate 'activities' and 'participation' components could also be identified. External construct validity of the scale was confirmed with expected correlations with WOMAC and NHP. This study concludes that WHODAS-II provides a reliable and valid health status instrument for measuring disability and components of 'activities' and 'participation' in patients with osteoarthritis. Thus, it provides the opportunity to model the consequences of disease according to the International Classification of Functioning, Disability and Health framework.

The role of FEV6 in the detection of airway obstruction.

OBJECTIVES: There are recent reports regarding the use of forced expiratory volume in 6 s (FEV6) in place of forced expiratory vital capacity (FVC) in the detection of airway obstruction. We aimed to investigate the role of FEV6 in comparison with FVC in the evaluation of airway obstruction. METHODS: The pulmonary function tests (PFT) results of all 5114 patients, who had been tested in the pulmonary function laboratory between 1998 and 2003, were retrospectively analyzed to investigate the relationship between FEV6 and FVC. RESULTS: We have found a mean difference of 95.35+/-121.7 (min=0, max=1050) ml (3.37%) when FVC and FEV6 values (FVC-FEV6) of all cases were compared. This difference was found to be higher (180 ml, 7.3%) in patients with airway obstruction. When FEV1/FVC is taken as the gold standard, FEV1/FEV6 had negative predictive value of 92.24% and a sensitivity of 86.09% in the detection of airway obstruction. CONCLUSIONS: Although it is easier to use FEV6 in place of FVC, relatively low sensitivity in that setting may result in the underestimation of airway obstruction. This drawback should be kept in mind when FEV6 is utilized to detect airway obstruction.

[One-year follow up results of Smoking Cessation Outpatient Clinic]. / Sigara Birakma Poliklinigimizin bir yillik izlem sonuçlari.

In this study we investigated the five-year-results of our smoking cessation outpatient clinic retrospectively. Out of 839 subjects admitted to our clinic during this time period 634 of them completed the one-year follow up period. 318 (50.2%) of these subjects were male and 316 (49.8%) of them were female. Subjects were divided into two groups. While one group received nicotine patch therapy, education and motivation the other group received just education and motivation. Mean age was 43.5 +/- 12 years. Nicotine patch therapy administered to 297 subjects and smoking cessation rates in this group were 46.8% at 15th day and 33.6% at the end of first year. The other group had smoking cessation rates of 11.8% at 15th day and 10.9% at the end of one year. Out of 185 subjects who did not smoke at the end of 15th day 98 of them were also not smoking at the end of one year. 449 subjects were smoking at the end of 15th day and just 26 (5.7%) of them gave up smoking at the end of first year. Therapy compliance was 82.2% at the 15th day and 23.2% at 12th week. Most frequent side effects were local skin reactions (13.8%) due to nicotine patches, irritability and nervousness (8.5%) and concentration difficulties (7.4%). In this retrospective analysis we concluded that nicotine replacement therapy in conjunction with education and motivation may be an effective method for helping individuals in giving up smoking. We also observed that smoking situation in first 15 days is a good predictor of long-term success.