Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices.

The patients' inhalation flow pattern is one of the significant determinants for clinical performance of inhalation therapy. However, the development of inhalation flow meters for various inhalation devices has been unable to keep up with the increasing number of newly launched inhalation devices. In the present study, we developed simple attachment orifices for the inhalation flow pattern monitoring system, which are suitable for all commercial inhalers, and investigated the efficacy of the system on the clinical inhalation instruction for patients co-prescribed dry powder inhaler (DPI) and soft mist inhaler (SMI). First, we constructed simple attachment orifices that were adjusted for 13 commercial inhalers, and examined the correlation between orifice and inhalation device. Second, the inhalation flow patterns (peak inspiratory flow rate, PIFR; inhalation duration time, DT) of patients prescribed a combination of DPI and SMI were monitored before and after inhalation instruction. The inhalation resistance of commercial inhalers are listed in the following order; Twincaps® > Handihaler® > Swinghaler® = Clickhaler® > Twisthaler® > Turbuhaler® > Jenuair® > Diskus® = Ellipta® > Diskhaler® > Breezhaler® > Respimat® = pMDI. The pressure drop via orifice was significantly correlated with that via the commercial inhaler. For the confirmation, all participants achieved the DPI criterion of PIFR. On the other hand, 4 participants (6 clinical visits) of 10 experimented participants could not achieve the essential criterion of DT (> 1.5 sec) for SMI, but all participants improved their duration time after inhalation instruction by pharmacists (P<0.05). In the present study, we successfully developed simple attachment orifice suitable for 13 commercial inhalation devices. These data suggested that our simple attachment orifices for the inhalation flow pattern monitoring system can detect patients with inadequate inhalation patterns via SMI.

An evidence-based construction of the models of decline of functioning. Part 1: two major models of decline of functioning.

The purpose of this study is to confirm the working hypothesis on two major models of functioning decline and two corresponding models of rehabilitation program in an older population through detailed interviews with the persons who have functioning declines and on-the-spot observations of key activities on home visits. A total of 542 community-dwelling older persons (65 years and older) in a suburban city, who were qualified for the services of the Insurance for Long-term Care were visited at their home and they gave two types of interviews: a preliminary semistructured one using an International Classification of Functioning, Disability and Health-based questionnaire and the main detailed one combined with observation of performance of key activities both within and around the home. The results confirmed the two major models of functioning decline and corresponding rehabilitation program: 'stroke model' (acute onset type) was observed in 271 (50.0%) persons and 'disuse syndrome model' (chronic progression type) was observed in 226 (41.4%) persons, along with an additional other model (on account of cognitive problems) in 45 (8.3%) persons. This result confirms that disuse syndrome (deconditioning) should be recognized as an important cause of functioning decline in the older population and a corresponding model of the rehabilitation program should be consciously pursued. This recognition of the importance of disuse syndrome will have a strong impact on clinical thinking about the rehabilitation of the older population.