Reconsultas tempranas al servicio de urgencias antes y después de un protocolo para la crisis asmática del adulto: estudio de cohorte retrospectivo / Early revisits to the emergency department before and after a protocol for adult asthma exacerbations: a retrospective cohort study

RESUMEN Objetivo: Comparar las reconsultas por asma al servicio de urgencias (SU) durante la semana posterior al alta y explorar los factores asociados antes y después de la implementación de un protocolo asistencial. Materiales y métodos: Se realizó un estudio de cohorte retrospectivo que incluyó las consultas por crisis asmática de adultos al SU de un hospital universitario en los períodos 2016-2018 (preprotocolo) y 2019-2020 (posprotocolo). Se utilizó un modelo de regresión logística multivariado y se reportaron odds ratios (OR) e intervalo de confianza del 95 % (IC 95 %). Se consideró significativo un valor p < 0,05. Resultados: Las reconsultas fueron 38 (31,40 %) para el período preprotocolo y 33 (26,61 %) para el período posprotocolo. En el modelo de regresión multivariable, no se encontraron diferencias en las reconsultas tempranas al comparar el período posprotocolo con el período preprotocolo (OR 0,68; IC 95 %: 0,26-1,74; p = 0,421). Los factores asociados a las reconsultas tempranas fueron la edad (OR: 1,02; IC 95 %: 1,00-1,04; p = 0,017), el sexo masculino (OR 0,21 IC 95 %: 0,08-0,59; p = 0,003) y el haber tenido más de una consulta al SU en el último año (OR 6,19 IC 95 %: 2,48-15,46; p < 0,001). Conclusión: Aunque las reconsultas tempranas no disminuyeron luego de la aplicación del protocolo, se identificaron la edad y el haber tenido más de una visita al SU por asma dentro del último año como factores de riesgo para las reconsultas dentro de la semana, mientras que el sexo masculino resultó ser un factor protector.

ABSTRACT Objective: To compare revisits for asthma to the emergency department (ED) during the week following discharge and describe associated factors before and after the implementation of an assistance protocol. Materials y methods: A retrospective cohort study was conducted, including visits for asthma exacerbations in adults to the ED of a university hospital during the periods 2016-2018 (pre-protocol) and 2019-2020 (post-protocol). A multivariate logistic regression model was used, and the odds ratios (OR) with their 95% confidence intervals (95 % CI) were reported. A p-value < 0.05 was considered significant. Results: Revisits were 38 (31.40 %) for the pre-protocol period and 33 (26.61%) for the post-protocol period. In the multivariate regression model, no differences were found in early revisits when comparing the post-protocol period with the pre-protocol period (OR 0.68; 95 % CI: 0.26-1.74; p = 0.421). Factors associated with early revisits were age (OR: 1.02; 95 % CI: 1.00-1.04; p = 0.017), male sex (OR: 0.21; 95 % CI: 0.08-0.59: p = 0.003), and having had more than one visit to the ED in the last year (OR: 6.19; 95 % CI: 2.48-15.46; p < 0.001). Conclusion: Although early revisits did not decrease after the protocol implementation, age and having had more than one visit for asthma to the ED in the last year were identified as risk factors for revisits within the week, while male sex was a protective factor.

Cuidando do ambiente ­ Logística reversa e dispositivos inalatórios / Caring for the environment: reverse logistics and inhalation devices

A asma é uma das doenças crônicas mais prevalentes e representa um problema de saúde pública global que afeta mais de 300 milhões de pessoas em todo o mundo, com um aumento adicional estimado de 100 milhões até 2025. A asma é uma doença típica de origem ambiental com exposição a infeções, alérgenos, poluentes e outros fatores estressores implicados na sua patogênese. O impacto ambiental causado pelos dispositivos inalatórios é cada vez mais importante, e pouco abordado ou valorizado. Até 88% dos profissionais de saúde não têm conhecimento que os dispositivos de aerossol dosimetrado contêm gás propelente que afeta a camada de ozônio e causa aquecimento global. São necessárias estratégias alternativas de tratamento se quisermos evitar a piora das alterações climáticas. Portanto, diante desse cenário existem oportunidades de ouro para tornar o tratamento da asma mais eficaz, moderno, seguro e ecológico.

Asthma is one of the most prevalent chronic diseases and represents a global public health problem, affecting more than 300 million people worldwide, with an estimated additional increase of 100 million cases by 2025. Asthma is a textbook disease of environmental origin, with exposure to infections, allergens, pollutants, and other environmental stressors implicated in its pathogenesis. The environmental impact of inhalation devices is increasingly important and has been rarely addressed and undervalued. Up to 88% of healthcare professionals are unaware that metered-dose aerosol devices contain a propellant gas that affects the ozone layer and causes global warming. Alternative treatment strategies are needed if we are to avoid worsening climate change. Given this scenario, there are excellent opportunities to make asthma treatment more effective, modern, safe, and eco-friendly.

Uso de inhaladores para la enfermedad pulmonar obstructiva crónica en un grupo de pacientes colombianos

Introducción: En Colombia son escasos los datos sobre el uso de los inhaladores en pacientes con EPOC. Objetivo: Describir la técnica de uso de inhaladores de dosis medida y polvo seco en pacientes de un hospital colombiano. Materiales y métodos: Estudio descriptivo en pacientes mayores de 40 años con EPOC atendidos en un hospital en La Virginia, Risaralda, Colombia, entre el 1 de septiembre de 2019 al 31 de enero de 2020. La unidad de análisis fueron los pacientes. Se incluyeron variables sociodemográficas, clínicas y lista de chequeo para uso de inhaladores. Se aplicaron frecuencias y proporciones para variables discretas, estadísticas de tendencia central y dispersión para variables continuas. Resultados: Se incluyeron 104 pacientes con edad media de 73,6 ± 10,1 años; 57 eran mujeres (54,8 %). Además, 48 pacientes estaban clasificados como GOLD-D (46,2 %). Igualmente, 89 pacientes manifestaron haber recibido educación sobre el uso de broncodilatadores (85,6 %). Los más frecuentes fueron los inhaladores de dosis medida (DM) en 95 casos (91,3 %), seguido de los de polvo seco unidosis (7,7 %). Así mismo, 37 pacientes que usaron DM sin inhalocámara (35,6 %) no cumplieron los pasos de la lista de chequeo. En el sistema multidosis, el más realizado fue cerrar de manera adecuada el inhalador y el menos ejecutado, expulsar el aire lentamente evitando hacerlo cerca del inhalador (n = 6; 5,7 %). Discusión: Se lograron describir las características de la técnica de uso de los inhaladores en pacientes con EPOC. A pesar de que ningún paciente logró utilizar el inhalador de forma "perfecta", la mayoría han recibido educación por parte de los profesionales de la salud. Conclusión: Un alto porcentaje de pacientes usa inadecuadamente los dispositivos para suministrar los broncodilatadores. Esto puede impactar negativamente en el control de la enfermedad.

Introduction: In Colombia, there is limited data on the use of inhalers in patients with COPD. Objective: The objective was to describe the technique of using metered-dose inhalers and dry powder in patients in a Colombian hospital. Methods: Observational, descriptive study of patients over 40 years of age with COPD, treated in a hospital in La Virginia, Risaralda, Colombia, between September 1st, 2019 and January 31st, 2020. The unit of analysis were patients in consultation. Sociodemographic and clinical variables, and a checklist for use of inhalers were included. Frequencies and proportions were applied for discrete variables, statistics of central tendency and dispersion for continuous variables. Results: A total of 104 patients with an average age of 73.6 ± 10.1 years were included; 57 were women (54.8%). In addition, 48 patients were classified as GOLD-D (46.2%). Similarly, 89 patients reported having received education on the use of bronchodilators (85.6%). The most common were metered-dose (MD) inhalers in 95 cases (91.3%), followed by single-dose dry powder inhalers in eight patients (7.7%). Likewise, 37 patients who used DM without inhalochamber (35.6%) did not comply with the steps of the checklist. In the multidose system, the most performed was to properly close the inhaler and the least performed was to expel the air slowly, avoiding doing so near the inhaler (n=6; 5.7%). Discussion: The characteristics of the technique of using inhalers in patients with COPD were described. Although no patient was able to use the inhaler "perfectly", most have received education from health professionals. Conclusion: A high percentage of patients misuse the devices to deliver bronchodilators. This can negatively impact the control of the disease.

Satisfaction with and Use of Inhalation Devices in Patients with Bronchial Asthma.

Background: Greater patient satisfaction with his or her inhalation device is associated with better adherence to pharmacological therapy and better clinical outcomes, such as improved quality of life, greater asthma control, and fewer exacerbations. The objective of this study was to determine the satisfaction level of a group of patients diagnosed with bronchial asthma concerning their devices for inhalation of bronchodilators and glucocorticoids. Methods: This was a cross-sectional study of patients treated in the Colombian health system. Satisfaction with inhalation devices was evaluated with the Feeling of Satisfaction with Inhaler (FSI)-10 questionnaire. A score of ≥44 points indicated high satisfaction. Results: In total, 362 patients from 59 cities were identified, their median age was 55 years, and 74.6% were women. The FSI-10 average score was 44.6; 68.5% of patients showed high satisfaction, especially with pressurized metered-dose inhalers (pMDIs), and 63.4% did not use them with an inhalation chamber. Users of pMDIs (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.05-3.10) and those who received training by medical specialists (OR: 2.29; 95% CI: 1.33-3.97) had high satisfaction, while patients who were older (40-64 vs. <40 years: OR: 0.38; 95% CI: 0.19-0.78 and ≥65 vs. <40 years: OR: 0.35; 95% CI: 0.15-0.81), resided in the Caribbean region (OR: 0.48; 95% CI: 0.29-0.81), and had a university education (OR: 0.54; 95% CI: 0.32-0.90) had lower satisfaction. Conclusions: The majority of patients with asthma used pMDIs without an inhalation chamber, and their overall satisfaction was higher than that of patients using other inhalation devices. Patients who received special training from medical specialists showed better satisfaction.

Association between beta-2 adrenergic receptor variants and clinical outcomes in children and adolescents with acute asthma

ABSTRACT Objective To investigate whether different genotypes of p.Arg16Gly, p.Gln27Glu, p.Arg19Cys and p.Thr164Ile variants interfere in response to treatment in children and adolescents with moderate to severe acute asthma. Methods This sample comprised patients aged 2 to 17 years with a history of at least two wheezing episodes and current moderate to severe asthma exacerbation. All patients received multiple doses of albuterol and ipratropium bromide delivered via pressurized metered-dose inhaler with holding chamber and systemic corticosteroids. Hospital admission was defined as the primary outcome. Secondary outcomes were changes in forced expiratory volume in the first second after 1 hour of treatment, and for outpatients, length of stay in the emergency room. Variants were genotyped by sequencing. Results A total of 60 patients were evaluated. Hospital admission rates were significantly higher in carriers of the genotype AA relative to those with genotype AG or GG, within the p.Arg16Gly variant (p=0.03, test χ2, alpha=0.05). Secondary outcomes did not differ between genotypes. Conclusion Hospital admission rates were significantly higher among carriers of the genotype AA within the p.Arg16Gly variant. Trial registration: ClinicalTrials.gov: NCT01323010

Avaliação da técnica inalatória em atendimentos de primeira consulta em ambulatório de asma de hospital terciário / Evaluation of the inhalation technique in first care visits in an asthma outpatient clinic at a tertiary hospital

Introdução: Técnica inalatória (TI) correta é fundamental para o controle da asma. Objetivo: Avaliar TI de pacientes em atendimento de primeira consulta em um ambulatório de asma. Métodos: Estudo observacional transversal com amostra de conveniência de asmáticos com idade ≥ 18 anos, em primeira consulta no ambulatório de asma do Hospital Universitário Antonio Pedro (HUAP) da Universidade Federal Fluminense e em uso de medicamentos disponíveis para uso em aerossol dosimetrado (AD), Aerocaps, Aerolizer ou Diskus. Participantes preencheram questionário com dados sociodemográficos, avaliação de controle da doença segundo o documento GINA, existência de orientações médicas para uso dos dispostivos inalatórios (DI), tempo de uso de DI e especialidade do médico encaminhador. A TI era considerada apropriada quando todas as etapas foram realizadas corretamente baseando-se nas bulas das medicações e foram demonstradas com os DI vazios. Resultados: Entre os 51 pacientes incluídos, 43 (84,3%) tinham TI incorretas e 4 (7,8%) apresentavam asma controlada. Trinta e cinco (70%) referiram orientação prévia quanto ao uso do DI. A TI correta associou-se com tempo de uso maior que 2 anos (p=0,006) e uso de DI de pó seco em detrimento de AD (p=0,019). Conclusão: Somente 16% dos pacientes encaminhados ao ambulatório da pneumologia específico de asma, de um hospital terciário, tinham a TI correta em sua primeira consulta e a quase totalidade não tinha a asma controlada. Atenção deve ser dada sempre a supervisão da qualidade da TI, principalmente dos usuários de AD e dos que usam seus DI há menos de 2 anos.

Introduction: Correct inhalation technique (IT) is essential for asthma control. Objective: To evaluate the IT of patients making their first visit to the asthma outpatient clinic. Methods: Cross-sectional observational study with a convenience sample of asthmatics aged ≥ 18 years, in their first visit to the asthma outpatient clinic of the Hospital Universitário Antonio Pedro (HUAP) of the Universidade Federal Fluminense and using medications available in metered-dose aerosol (DA) , Aerocaps, Aerolizer or Diskus. Participants completed a questionnaire with sociodemographic data, assessment of disease control according to the GINA document, existence of medical guidelines for the use of inhalation devices (IDs), length of ID use, and specialty of the refer-ring clinician. IT was considered appropriate when all steps were performed correctly based on medication package inserts and were demonstrated with empty IDs. Results: Among the 51 patients included, 43 (84.3%) had incorrect IT and 4 (7.8%) had controlled asthma. Thirty-five (70%) reported previous guidance regarding the use of ID. Correct IT was associated with time of use greater than 2 years (p=0.006) and use of dry powder ID rather than DA (p=0.019). Conclusion: Only 16% of the patients referred to the asthma-specific pulmonology outpatient clinic of a tertiary hospital had the correct IT at their first appointment and almost all of them did not have controlled asthma. Attention should always be given to the supervision of IT quality, especially for DA users and those who have been using their ID for less than 2 years.

Inhaloterapia: recomendaciones para Argentina 2021 / Inhalotherapy: recommendations for Argentina 2021

Resumen En las últimas décadas ha habido un importante desarrollo de dispositivos inhalados (DI) que permiten aumentar la eficacia de las drogas y disminuir los eventos adversos. Su correcto uso es de fundamental importancia para el control de las enfermedades respiratorias obstructivas. En la Argentina no existen recomendaciones locales sobre el uso de los DI. Se revisó la base biofísica, indicación, ventajas y limitaciones, técnica de correcto uso, errores frecuentes, mantenimiento y limpieza de cada DI. El uso de nebulizaciones ha quedado restringido a la administración de drogas que no están disponibles en otros DI (ejemplo: tratamiento de fibrosis quística), o ante la falla de los otros DI. No deben ser usados durante la pandemia de SARS-CoV2. Los inhaladores de dosis medida (aerosol) deben ser indicados siempre con aerocámaras (AC), las que reducen la incidencia de eventos adversos y aumentan el depósito de la droga en el pulmón. Son los dispositivos de elección junto a los inhaladores de polvo seco. Los aerosoles se deben usar en pacientes que no generan flujos inspiratorios altos. Los inhaladores de polvo seco deben recomendarse en aquellos que pueden realizar flujos inspiratorios enérgicos. Se revisaron los diferentes DI en fibrosis quística y en pacientes con asistencia respiratoria mecánica. La elección del DI dependerá de varios factores: situación clínica, edad, experiencia previa, preferencia del paciente, disponibilidad de la droga y entrenamiento alcanzado con el correcto uso.

Abstract Last decades, a broad spectrum of inhaled devices (ID) had been developed to enhance efficacy and reduce adverse events. The correct use of IDs is a critical issue for controlling obstructive respiratory diseases. There is no recommendation on inhalation therapy in Argentina. This document aims to issue local recommendations about the prescription of IDs. Each device was reviewed regarding biophysical laws, indication, strength, limitations, correct technique of use, frequent mistakes, and device cleaning and maintenance. Nebulization should be restricted to drugs that are not available in other IDs (for example, for treatment of cystic fibrosis) or where other devices fail. Nebulization is not recommended during the SARS-CoV2 pandemic. A metered-dose inhaler must always be used with an aerochamber. Aerochambers reduce the incidence of adverse events and improve lung deposition. Metered-dose inhalers must be prescribed to patients who cannot generate a high inspiratory flow and dry powders to those who can generate an energetic inspiratory flow. We reviewed the use of different IDs in patients with cystic fibrosis and under mechanical ventilation. The individual choice of an ID will be based on several variables like clinical status, age, previous experience, patient preference, drug availability, and correct use of the device.

[Inhalotherapy: Recommendations for Argentina 2021]. / Inhaloterapia: Recomendaciones para Argentina 2021.

Last decades, a broad spectrum of inhaled devices (ID) had been developed to enhance efficacy and reduce adverse events. The correct use of IDs is a critical issue for controlling obstructive respiratory diseases. There is no recommendation on inhalation therapy in Argentina. This document aims to issue local recommendations about the prescription of IDs. Each device was reviewed regarding biophysical laws, indication, strength, limitations, correct technique of use, frequent mistakes, and device cleaning and maintenance. Nebulization should be restricted to drugs that are not available in other IDs (for example, for treatment of cystic fibrosis) or where other devices fail. Nebulization is not recommended during the SARS-CoV2 pandemic. A metered-dose inhaler must always be used with an aerochamber. Aerochambers reduce the incidence of adverse events and improve lung deposition. Metered-dose inhalers must be prescribed to patients who cannot generate a high inspiratory flow and dry powders to those who can generate an energetic inspiratory flow. We reviewed the use of different IDs in patients with cystic fibrosis and under mechanical ventilation. The individual choice of an ID will be based on several variables like clinical status, age, previous experience, patient preference, drug availability, and correct use of the device.

En las últimas décadas ha habido un importante desarrollo de dispositivos inhalados (DI) que permiten aumentar la eficacia de las drogas y disminuir los eventos adversos. Su correcto uso es de fundamental importancia para el control de las enfermedades respiratorias obstructivas. En la Argentina no existen recomendaciones locales sobre el uso de los DI. Se revisó la base biofísica, indicación, ventajas y limitaciones, técnica de correcto uso, errores frecuentes, mantenimiento y limpieza de cada DI. El uso de nebulizaciones ha quedado restringido a la administración de drogas que no están disponibles en otros DI (ejemplo: tratamiento de fibrosis quística), o ante la falla de los otros DI. No deben ser usados durante la pandemia de SARS-CoV2. Los inhaladores de dosis medida (aerosol) deben ser indicados siempre con aerocámaras (AC), las que reducen la incidencia de eventos adversos y aumentan el depósito de la droga en el pulmón. Son los dispositivos de elección junto a los inhaladores de polvo seco. Los aerosoles se deben usar en pacientes que no generan flujos inspiratorios altos. Los inhaladores de polvo seco deben recomendarse en aquellos que pueden realizar flujos inspiratorios enérgicos. Se revisaron los diferentes DI en fibrosis quística y en pacientes con asistencia respiratoria mecánica. La elección del DI dependerá de varios factores: situación clínica, edad, experiencia previa, preferencia del paciente, disponibilidad de la droga y entrenamiento alcanzado con el correcto uso.

Terapia inalatória em ventilação não-invasiva em pacientes com doença pulmonar obstrutiva crônica / Inhalation therapy during noninvasive ventilation in patients with chronic obstructive pulmonary disease

O objetivo deste estudo é descrever os aspectos técnicos e cuidados a serem observados durante a administração de medicamentos inalatórios contidos em inalador pressurizado (pMDI) em pacientes com doença pulmonar obstrutiva crônica em ventilação não-invasiva (VNI). Trata-se de uma revisão integrativa elaborada em quatro fases: (1) busca na literatura; (2) consulta às sociedades médicas; (3) pesquisaem bulas e monografias dos fármacos inalatórios; e (4) contato com empresas de ventiladores, medicamentos e espaçadores. A busca aos estudos foi conduzida a partir de palavras-chaves e restringida a publicações até 31 de dezembro de 2019, nos idiomas português e inglês. Foram selecionados 9 artigos, sendo 1 estudo primário, 6 estudos de revisão e 2 estudos em modelos experimentais de ventilação. Foram incluídas 2 diretrizes a partir da consulta às sociedades médicas e das 8 empresas contatas, quatro fizeram recomendações quanto à técnica inalatória. Não foram encontradas informações sobre a administração dos fármacos em VNI nas bulas e monografias. Recomenda-se atentar para as medidas que podem aumentar a deposição pulmonar dos fármacos inalatórios, como uso de aerocâmara com pMDI, minimização de escape indesejável de ar, sincronia entre paciente-ventilador, disparo do jato na fase inspiratória e inserção de porta de vazamento na máscara ou circuito. (AU)

The aim of this study is to describe the technical aspects and cautions to be observed during the administration of inhaled medications contained in a pressurized inhaler (pMDI) in patients with chronic obstructive pulmonary disease on noninvasive ventilation. This integrative review consisted of 4 phases: (1) search in the literature; (2) consultation with medical societies; (3) research on package inserts and monographs of inhaled drugs; and (4) contact with ventilator, medication and spacer companies. The search for studies was based on keywords and restricted to articles published until December 31, 2019, written in Portuguese and English. Nine articles were selected, including 1 primary study, 6 review studies and 2 studies on experimental ventilation models. Two guidelines were included from the consultation with medical societies, and of the 8 companies contacted, 4 made recommendations regarding the inhalation technique. No information was found on the administration of noninvasive ventilation drugs in package inserts and monographs. Attention should be given to measures that increase the pulmonary deposition of inhaled drugs, such as the use of an air chamber with pMDI, minimization of undesirable air leakage, patient-ventilator synchronization, jet firing in the inspiratory phase and insertion of a leak port in the mask or circuit. (AU)

Técnica de terapia inhalatoria: evaluación de una intervención educativa realizada a estudiantes de Medicina, posgrados de Pediatría y cuidadores de niños y adolescentes internados en un hospital pediátrico de referencia. Período junio-agosto de 2019 / Inhalation therapy: Assessment of a training intervention delivered to Medical students, Postgraduate students of Pediatrics and to caregivers of children and adolescents admitted to a Reference Pediatric Hospital from June to August, 2019 / Terapia por inalação: avaliação de uma intervenção de treinamento com estudantes de medicina, estudantes de pós-graduação em pediatria e cuidadores de crianças e adolescentes internados em um hospital pediátrico de referência de junho a agosto de 2019

Resumen: Introducción: las patologías respiratorias con broncoobstrucción representan una causa frecuente de ingresos hospitalarios, siendo la vía inhalatoria de elección en su tratamiento. Objetivos: conocer la técnica de inhaloterapia realizada por estudiantes de Medicina, posgrados de Pediatría y cuidadores, y de los niños y adolescentes hospitalizados. Metodología: estudio prospectivo, descriptivo, de junio a agosto de 2019. Se elaboró un cuestionario con el procedimiento de la técnica inhalatoria con máscara facial, boquilla e higiene del dispositivo. Se solicitó al cuidador que describiera el procedimiento que realizaba al administrar fármacos inhalados. Se realizó una intervención explicando la correcta técnica y posteriormente se solicitó que describiera nuevamente el procedimiento. Estudiantes de Medicina y posgrados de Pediatría fueron evaluados según recomendaciones internacionales. Resultados: del total de 80 participantes, tres realizaron el procedimiento de forma adecuada. Luego de la intervención, 27 lograron una técnica correcta. En cuanto a la higiene del dispositivo, tres participantes lo realizaron correctamente previo a la intervención. Posteriormente, 44 lo refirieron adecuadamente. Participaron 25 profesionales de la salud, 15 describieron de forma correcta el procedimiento en menores de 5 años y siete en niños mayores. Posteriormente al taller informativo, 24 lograron describir adecuadamente la técnica en menores de 5 años y 15 en mayores. Conclusiones: la mayoría de los cuidadores desconocen la correcta técnica de inhaloterapia. Se debería implementar intervenciones destinadas a evaluar y entrenar a los pacientes de forma regular. Es fundamental capacitar al personal de salud para la mejora en la calidad de utilización del dispositivo.

Summary: Introduction: broncho-obstructive respiratory pathologies are a frequent cause of hospital admissions, and inhalation remains the main choice of treatment. Objectives: learn about the inhalation technique performed by medical students and postgraduate students of pediatrics and by caregivers of hospitalized children and adolescents. Methodology: prospective, descriptive study carried out from June to August 2019. A questionnaire was prepared about the inhalation technique requiring facial mask, and mouthpiece and about the hygiene of the device. Caregivers were asked to describe the procedure performed when administering inhaled drugs. An intervention was performed explaining the correct technique and the caregiver was asked to describe the procedure again. Medical and Pediatrics' students were assessed as per the international recommendations. Results: out of 80 participants, 3 performed the procedure appropriately. After the intervention, 27 they performed the technique correctly. 3 participants performed the device hygiene correctly before the intervention, and after the intervention, 44 did it properly. 25 health professionals participated, 15 correctly described the procedure on children under 5 years of age and 7 described it correctly on older children. After the information workshop, 24 managed to adequately describe the technique on children under 5 years of age and 15 for older patients. Conclusions: Most caregivers are unaware of correct inhalation therapy techniques. Regular interventions aimed at evaluating and training patients should be implemented. It is essential to train health staff to improve the quality of use of the device.

Resumo: Introdução: as patologias respiratórias bronco-obstrutivas são uma causa frequente de internações hospitalares e a inalação é ainda a principal opção de tratamento. Objetivos: aprender sobre a técnica de inalação realizada por estudantes de Medicina e Pediatria e por cuidadores de crianças e adolescentes hospitalizados. Metodologia: estudo prospectivo, descritivo, realizado de junho a agosto de 2019. Elaborou-se um questionário sobre a técnica de inalação que requer máscara facial e bocal e sobre a higiene do dispositivo. Pediu-se ao cuidador que descrevesse o procedimento realizado ao administrar drogas inaladas. Fizemos uma intervenção explicando a técnica correta e pedimos ao cuidador que descrevesse o procedimento novamente. Avaliamos aos estudantes de medicina e aos de pós-graduação em Pediatria de acordo com as recomendações internacionais. Resultados: dos 80 participantes, 3 realizaram o procedimento adequadamente. Após a intervenção, 27 deles realizaram a técnica corretamente. 3 participantes realizaram a higiene do dispositivo corretamente antes da intervenção e, após a intervenção, 44 a realizaram corretamente. Participaram 25 profissionais de saúde, 15 descreveram corretamente o procedimento para crianças menores de 5 anos e 7 descreveram corretamente para crianças maiores. Após o workshop informativo, 24 conseguiram descrever adequadamente a técnica para crianças menores de 5 anos e 15 para pacientes mais maiores. Conclusões: a maioria dos cuidadores desconhecem as técnicas corretas de terapia por inalação. Devem-se implementar intervenções regulares destinadas a avaliar e treinar pacientes. É essencial treinar a equipe de saúde para melhorar a qualidade de uso do dispositivo.

Influencia del uso de inhaladores sobre la caries dental en pacientes pediátricos asmáticos: Estudio de casos y controles / Impact of inhaler use on dental caries in asthma pediatrics patients: A case-control study

Introducción. El asma es una enfermedad inflamatoria crónica con alta prevalencia en pacientes pediátricos. Existen resultados contradictorios respecto al efecto de esta enfermedad en los índices de caries dental. El objetivo del estudio fue determinar la prevalencia de caries dental en pacientes pediátricos asmáticos con medicación inhalatoria. Población y métodos. Estudio de casos y controles cuya muestra estuvo conformada por pacientes pediátricos que acudieron al Centro Médico Naval "Cirujano Mayor Santiago Távara" de diciembre de 2014 a marzo de 2015. Se dividieron en dos grupos: el primero (casos), integrado por pacientes asmáticos que utilizaban inhaladores en su tratamiento; el segundo (controles), por pacientes sanos del mismo nosocomio. Se realizó una evaluación médica para determinar tipo, tiempo y frecuencia del tratamiento y un examen oral para determinar la prevalencia de caries dental y el índice de dientes cariados, perdidos y obturados (CPOD). Resultados. Se encontró que la prevalencia de caries dental en el grupo control fue del 34,2 %, mientras, en el grupo casos, fue del 28,3 % (p = 0,094). Con respecto al índice de caries dental, el grupo control presentó CPOD de 4,73 ± 0,32, y el grupo casos, de 3,98 ± 0,31 (p = 0,08). Sin embargo, se evidenció que, a mayor tiempo de tratamiento con los inhaladores, el índice CPOD aumentaba significativamente (p = 0,04).Conclusiones. La medicación inhalatoria no incrementa la prevalencia de caries dental en pacientes pediátricos asmáticos. Sin embargo, existe una relación directa entre la duración del tratamiento y la prevalencia de caries dental

Introduction. Asthma is a chronic inflammatory disease that is highly prevalent among pediatric patients. The results about the effect of asthma on the rate of dental caries are contradictory. The objective of this study was to determine the prevalence of dental caries in asthma pediatric patients using inhaled drugs. Population and methods. Case-control study in a sample made up of pediatric patients who attended Centro Médico Naval "Cirujano Mayor Santiago Távara" between December 2014 and March 2015. Patients were divided into two groups: group A (cases) included asthma patients using inhalers as part of their treatment; group B (controls), healthy subjects who attended the same facility. A medical examination was done to determine the type, time, and frequency of treatment and an oral exam, to establish the prevalence of dental caries and the decayed, missing, and filled teeth (DMFT) index. Results. The prevalence of dental caries was 34.2 % in the control group and 28.3 % in the case group (p = 0.094). In relation to the rate of dental caries, the DMFT index in the control group was 4.73 ± 0.32, and 3.98 ± 0.31 in the case group (p = 0.08). However, it was evidenced that a longer duration of inhaler use led to a significantly higher DMFT index (p = 0.04).Conclusions. Inhaled drugs do not increase the prevalence of dental caries in asthma pediatric patients. However, there is a direct relationship between treatment duration and the prevalence of dental caries.

Impact of inhaler use on dental caries in asthma pediatrics patients: A case-control study. / Influencia del uso de inhaladores sobre la caries dental en pacientes pediátricos asmáticos: Estudio de casos y controles.

INTRODUCTION: Asthma is a chronic inflammatory disease that is highly prevalent among pediatric patients. The results about the effect of asthma on the rate of dental caries are contradictory. The objective of this study was to determine the prevalence of dental caries in asthma pediatric patients using inhaled drugs. POPULATION AND METHODS: Case-control study in a sample made up of pediatric patients who attended Centro Médico Naval "Cirujano Mayor Santiago Távara" between December 2014 and March 2015. Patients were divided into two groups: group A (cases) included asthma patients using inhalers as part of their treatment; group B (controls), healthy subjects who attended the same facility. A medical examination was done to determine the type, time, and frequency of treatment and an oral exam, to establish the prevalence of dental caries and the decayed, missing, and filled teeth (DMFT) index. RESULTS: The prevalence of dental caries was 34.2 % in the control group and 28.3 % in the case group (p = 0.094). In relation to the rate of dental caries, the DMFT index in the control group was 4.73 ± 0.32, and 3.98 ± 0.31 in the case group (p = 0.08). However, it was evidenced that a longer duration of inhaler use led to a significantly higher DMFT index (p = 0.04). CONCLUSIONS: Inhaled drugs do not increase the prevalence of dental caries in asthma pediatric patients. However, there is a direct relationship between treatment duration and the prevalence of dental caries.

Introducción: El asma es una enfermedad inflamatoria crónica con alta prevalencia en pacientes pediátricos. Existen resultados contradictorios respecto al efecto de esta enfermedad en los índices de caries dental. El objetivo del estudio fue determinar la prevalencia de caries dental en pacientes pediátricos asmáticos con medicación inhalatoria. Población y Métodos: Estudio de casos y controles cuya muestra estuvo conformada por pacientes pediátricos que acudieron al Centro Médico Naval "Cirujano Mayor Santiago Távara" de diciembre de 2014 a marzo de 2015. Se dividieron en dos grupos: el primero (casos), integrado por pacientes asmáticos que utilizaban inhaladores en su tratamiento; el segundo (controles), por pacientes sanos del mismo nosocomio. Se realizó una evaluación médica para determinar tipo, tiempo y frecuencia del tratamiento y un examen oral para determinar la prevalencia de caries dental y el índice de dientes cariados, perdidos y obturados (CPOD). Resultados: Se encontró que la prevalencia de caries dental en el grupo control fue del 34,2 %, mientras, en el grupo casos, fue del 28,3 % (p = 0,094). Con respecto al índice de caries dental, el grupo control presentó CPOD de 4,73 ± 0,32, y el grupo casos, de 3,98 ± 0,31 (p = 0,08). Sin embargo, se evidenció que, a mayor tiempo de tratamiento con los inhaladores, el índice CPOD aumentaba significativamente (p = 0,04). Conclusiones: La medicación inhalatoria no incrementa la prevalencia de caries dental en pacientes pediátricos asmáticos. Sin embargo, existe una relación directa entre la duración del tratamiento y la prevalencia de caries dental.

]Risk of dental caries in pediatric asthmatic patients undergoing treatment with salbutamol and budesonide inhalation therapy, Peru.] / Riesgo de caries dental en pacientes pediátricos asmáticos en tratamiento con la terapia inhalatoria de salbutamol y budesonida, Perú.

Introduction: Asthma is related to caries but the risk factors are not completely determined. Therefore, the objective of the study was to determine the risk of dental caries in pediatric asthmatic patients in inhalation treatment with salbutamol and budesonide who went to the National Hospital Arzobispo Loayza. Methods: Case-control study that consisted of 184 pediatric patients, between 5 and 12 years old, who attended the pneumology and pediatric dentistry service of the National Hospital Arzobispo Loayza during the years 2016-2017. The group of cases (n = 92) was composed of patients with moderate asthma medicated with inhaled salbutamol and budesonide, while the control group (n = 92) was composed of healthy patients. The risk of dental caries was evaluated with the dietary record, oral hygiene index and number of carious lesions. Results: The risk according to the type of cariogenic diet was moderate in both groups (p = 0.768). The oral hygiene index in the control group was regular in 63% (n = 58) and in the case group, bad in 60.9% (n = 56); p=0.001. The number of carious lesions in the control group was moderate in 50% (n = 46) and in the case group, high in 47.8% (n = 44); p = 0.001. Therefore, the risk of dental caries in the case group was high in 50% (n = 46) and in the control group it was moderate in 72.8% (n = 67); p = 0.001. Conclusion: The risk of dental caries in asthmatic patients on inhaled therapy with salbutamol and budesonide is significantly higher than that of healthy patients.

Introducción: El asma está relacionada con la caries pero los factores de riesgo no están determinados completamente. Por ello, el objetivo del estudio fue determinar el riesgo de caries dental en pacientes pediátricos asmáticos en tratamiento inhalatorio con salbutamol y budesonida que acudieron al Hospital Nacional Arzobispo Loayza. Métodos: Estudio de casos y controles que estuvo conformado por 184 pacientes pediátricos, entre 5 a 12 años, que asistían al servicio de neumología y odontopediatría del Hospital Nacional Arzobispo Loayza durante los años 2016-2017. El grupo de casos (n=92) estuvo integrado por pacientes con asma moderado medicados con salbutamol y budesonida inhalatorios, mientras el grupo control (n=92) estuvo integrado por pacientes sanos. El riesgo de caries dental se evaluó con la ficha dietética, índice de higiene oral y número de lesiones cariosas. Resultados: El riesgo según el tipo de dieta cariogénica fue moderado en ambos grupos (p=0,768). El índice de higiene oral en el grupo control fue regular en 63% (n=58) y en el grupo de casos, malo en 60,9% (n=56); p=0,001. El número de lesiones cariosas en el grupo control fue moderado en 50% (n=46) y en el grupo de casos, alto en 47,8% (n=44); p=0,001. Por lo tanto, el riesgo de caries dental en el grupo de casos fue alto en 50% (n=46) y en el grupo control fue moderado en 72,8% (n=67); p=0,001. Conclusión: El riesgo de caries dental en los pacientes asmáticos en tratamiento inhalatorio con salbutamol y budesonida es significativamente superior al de los pacientes sanos.

Metered-dose inhaler therapy with spacers: Are newborns capable of using this system correctly?

INTRODUCTION: Aerosol therapy using a metered-dose inhaler (MDI) coupled to a spacer chamber is the most widely used long-term treatment modality for chronic lung disease of prematurity. However, its use in neonates is based on data obtained from other age groups. Proper use of maintenance treatment is essential for the long-term stability of these patients. OBJECTIVE: To ascertain whether newborns are capable of generating negative pressure during the use of a spacer with face mask for aerosol therapy. PATIENTS AND METHODS: Total of 117 low-risk newborns (age 12-48 hours), with no congenital malformations or any detectable clinical symptoms, were included. Inspiratory pressure was measured with a respiratory pressure meter, at each respiratory cycle, during a 10-second period, for three sequential measurements. The meter was connected to the inner chamber of the spacer through a noncollapsible silicone tube. Suitably sized masks were used. RESULTS: Only 43 participants (36.8%) generated a negative pressure capable of opening the spacer valve, as verified by the respiratory pressure meter. In 25 patients, all three measurements were within the expected range. Weight, gestational age, and mode of delivery were in no way associated with the ability to generate a detectable negative pressure. CONCLUSION: In neonates, the MDI therapy with a spacer chamber and face mask is susceptible to failure due to the inability of most patients in this age range to generate a negative inspiratory pressure sufficient to open the spacer valve.

Asma e a técnica inalatória do inalador pressurizado dosimetrado acoplado ao espaçador: revisão integrativa / Asma y la técnica de inhalación con inhalador presurizado con dosificador acoplado a la cámara espaciadora: revisión integral / Asthma and the inhalation technique for the pressurized metered-dose inhaler with spacer: an integrative review

RESUMO Objetivo: identificar quais técnicas inalatórias do Inalador Pressurizado Dosimetrado, acoplado ao espaçador, têm sido utilizadas em pacientes com asma. Método: trata-se de revisão integrativa, realizada em janeiro de 2018, nas bases de dados US National Library of Medicine e na Literatura Latino-Americana e do Caribe em Ciências de Saúde. Foram selecionados 14 artigos, publicados entre janeiro de 2011 e dezembro de 2017, que continham a descrição da sequência de passos da técnica inalatória. Resultados: os artigos, predominantemente, estudaram indivíduos com idade igual ou superior a 14 anos e justificaram a adoção dos passos da técnica inalatória em referências da literatura. Os passos indicados por cada artigo foram revisados por pares e realizou-se uma quantificação daqueles mais citados, em que 15 passos foram definidos. Conclusão: a síntese do conhecimento gerado pode auxiliar profissionais de saúde no manejo adequado da asma, uma vez que traz evidências relacionadas à eficácia de cada passo.

RESUMEN Objetivo: identificar las técnicas de inhalación del inhalador presurizado con dosificador acoplado al espaciador que se utilizan en pacientes con asma. Método: revisión integral, que se realizó en enero de 2018, en las bases de datos US National Library of Medicine y en Literatura Latinoamericana y del Caribe en Ciencias de Salud. Se eligieron 14 artículos, publicados entre enero de 2011 y diciembre de 2017, con la descripción de la secuencia de procedimientos de la técnica de inhalación. Resultados: los artículos, de modo predominante, abordaron individuos con edad igual o superior a 14 años y justificaron la adopción de los procedimientos de la técnica de inhalación en referencias de la literatura. Se revisaron los procedimientos apuntados por cada artículo por pares y se realizó una cuantificación de aquellos más mencionados, en la cual se definieron 15 procedimientos. Conclusión: la síntesis del conocimiento que se generó puede ayudar a los profesionales de salud en el manejo adecuado del asma, pues trae evidencias asociadas con la eficacia de cada procedimiento.

ABSTRACT Objective: to identify which Pressurized Metered-Dose Inhaler with spacer inhalation techniques have been used in patients with asthma. Method: this was an integrative review, conducted in January 2018, in the US National Library of Medicine and Latin American and Caribbean Health Sciences Literature databases. 14 articles, published between January 2011 and December 2017, which contained the description of the sequence of inhalation technique steps, were selected. Results: the articles predominantly studied individuals aged 14 years or over and justified the adoption of the steps of the inhalation technique from literature references. The steps indicated by each article were reviewed by experts and a quantification of those most cited was performed, with 15 steps being defined. Conclusion: the synthesis of the knowledge generated can help healthcare providers in the proper management of asthma, since it provides evidence related to the efficacy of each step.

Avaliação de vídeos sobre a técnica inalatória na asma infantil: educativos ou midiáticos? / Assessment of videos about the inhalation technique for childhood asthma: educational or mediatic?

Vídeos relacionados à técnica inalatória na asma são populares no YouTube, mas sua qualidade é questão de preocupação. Neste estudo objetivou-se avaliar vídeos que demonstram a técnica inalatória do inalador pressurizado acoplado ao espaçador, para crianças e adolescentes com asma, quanto a conformidade das diretrizes da Global Initiative for Asthma. Estudo exploratório, realizado em 11 de julho de 2017 usando os termos inalador pressurizado e aerossol dosimetrado. Os vídeos foram avaliados por três enfermeiras, independentes e experientes na área, quanto aos critérios de conteúdo, produção e usuários. Dentre os 492 vídeos encontrados, seis preencheram os critérios de elegibilidade. Ponto de destaque foi a demonstração incorreta da técnica inalatória em todos os vídeos e a pontuação inadequada na avaliação técnica e de conteúdo. As descobertas deste estudo mostram que os vídeos não são confiáveis e nem compatíveis com as diretrizes de asma e, portanto, não podem ser recomendados para fins educacionais.

Videos related to asthma inhaling technique are popular on YouTube, but their quality is concerning. In this study, we aimed to assess videos demonstrating the inhaling technique of the pressurized metered dose inhaler, attached to the spacer, for children and adolescents with asthma, according to the guidelines of the Global Initiative for Asthma. We conducted an exploratory study, on 11 July 2017 using the terms "inalador pressurizado" and "aerossol dosimetrado". Three independent nurses experienced in the field assessed the videos regarding content inclusion, production, and users. Within the 492 videos found, six met the eligibility criteria. The highlight point was the incorrect demonstration of the inhalation technique in all videos and the inadequate scoring for technique and content assessments. Our study findings show that videos are not reliable neither compatible with asthma guidelines and, therefore, they should not be recommended for educational purposes.

Evaluación del conocimiento de la técnica de aerosol-terapia con aerocámara por el equipo de salud pediátrico / Pediatric health team's knowledge of the technique of aerosoltherapy with spacer

INTRODUCCIÓN: Los medicamentos inhalados son la base de la terapia para patologías respiratorias. La técnica inhalatoria es un factor condicionante de su éxito terapéutico. El error más frecuente en aerosolterapia es en la técnica y su principal consecuencia es la disminución de medicación que llega a la vía aérea. OBJETIVO: evaluar el conocimiento y el método de instrucción que tiene el equipo de salud pediátrico sobre la técnica de aerosolterapia con aerocámara para niños menores de 6 años. MATERIAL Y MÉTODO: estudio transversal, analítico. Se realizó una encuesta. Incluyó a profesionales de la salud que ejercen en el área pediátrica. Se realizó estadística descriptiva y comparativa. Se consideró significancia estadística p<0,05. RESULTADOS: Se incluyeron 71 profesionales. La técnica de aerosolterapia con aerocámara fue MUY BUENA en 15,49% (IC95% 8,8-25,65), BUENA en 70,42% (IC95% 58,98-79,77) y REGULAR en 14,08% (IC95% 7,83-24,02) profesionales. La mediana de pasos realizados correctamente fue de 5 de 7 pasos. La herramienta más utilizada para instruir sobre la técnica de aerosolterapia con aerocámara fue la "demostración". El 39,44% y el 21,13% de los profesionales utilizaron la combinación de 2 y 3 metodologías para la instrucción de la técnica, respectivamente. CONCLUSIONES: El conocimiento de la técnica de aerosolterapia del equipo de salud es bueno. La mayoría de los profesionales de la salud utilizó la demostración como herramienta de transmisión de la técnica de aerosolterapia. Más de la mitad de los profesionales combinaron herramientas para instruir sobre aerosolterapia. (AU)

INTRODUCTION: the basis treatment of respiratory diseases are inhaled medications. The inhalation technique is a conditioning factor of its therapeutic success. The most frequent error in aerosol therapy is in the technique and its main consequence is the decrease of medication that reaches the airway. OBJECTIVE: Evaluate the knowledge and method of instruction that the pediatric health team has on the aerosol therapy technique with spacer for children under 6 years. MATERIAL AND METHOD: cross-sectional, analytical study. A survey was conducted. It included health professionals who practice in the pediatric area. Descriptive and comparative statistics were performed. Statistical significance was set at p <0.05. RESULTS: We included 71 professionals. The aerosol therapy technique was very good in 15.49% (IC95% 8.8-25.65), good in 70.42% (IC95% 58.98-79.77) and regular in 14.08% (IC95% 7.83-24.02) professionals. The median of steps performed correctly was 5 of 7 steps. The most used tool to instruct the aerosol therapy technique was the "demonstration". The 39.44% and 21.13% of the professionals used the combination of 2 and 3 methodologies for the instruction of the technique, respectively. CONCLUSIONS: health team´s knowledge of the aerosol therapy technique is good. The most of health professionals used the demonstration as a transmission tool for the aerosol therapy technique. More than half of the professionals combined tools to instruct on aerosol therapy. (AU)

Validation of scores of use of inhalation devices: valoration of errors / Validação de escores de uso de dispositivos para inalação: valoração dos erros cometidos

AbstractObjective: To validate two scores quantifying the ability of patients to use metered dose inhalers (MDIs) or dry powder inhalers (DPIs); to identify the most common errors made during their use; and to identify the patients in need of an educational program for the use of these devices.Methods: This study was conducted in three phases: validation of the reliability of the inhaler technique scores; validation of the contents of the two scores using a convenience sample; and testing for criterion validation and discriminant validation of these instruments in patients who met the inclusion criteria.Results: The convenience sample comprised 16 patients. Interobserver disagreement was found in 19% and 25% of the DPI and MDI scores, respectively. After expert analysis on the subject, the scores were modified and were applied in 72 patients. The most relevant difficulty encountered during the use of both types of devices was the maintenance of total lung capacity after a deep inhalation. The degree of correlation of the scores by observer was 0.97 (p < 0.0001). There was good interobserver agreement in the classification of patients as able/not able to use a DPI (50%/50% and 52%/58%; p < 0.01) and an MDI (49%/51% and 54%/46%; p < 0.05).Conclusions: The validated scores allow the identification and correction of inhaler technique errors during consultations and, as a result, improvement in the management of inhalation devices.

ResumoObjetivo: Validar dois escores para medir a habilidade de pacientes em utilizar inaladores pressurizados (IPs) ou inaladores de pó (IPos), verificar os erros mais comuns na sua utilização e identificar os pacientes que necessitam de um programa educacional para o uso desses dispositivos.Métodos: Este estudo foi realizado em três etapas: validação da confiabilidade dos escores de uso dos dispositivos inalatórios; validação do conteúdo dos escores utilizando-se uma amostra de conveniência; e realização de testes para a validação de critério e a validação discriminante desses instrumentos em pacientes que preenchiam os critérios de inclusão do estudo.Resultados: A amostra de conveniência foi composta por 16 pacientes, e houve discordância interobservador em 19% e 25% para os escores de IPo e IP, respectivamente. Após a análise de expertos no assunto, os escores sofreram modificações e foram aplicados em 72 pacientes. A dificuldade mais relevante no uso de ambos os dispositivos foi a manutenção da capacidade pulmonar total após inspiração profunda. O grau de correlação dos escores por observador foi de 0,97 (p < 0,0001). Houve boa concordância interobservador na classificação dos pacientes como aptos/não aptos para uso de IPo (50%/50% e 52%/58%; p < 0,01) e de IP (49%/51% e 54%/46%; p < 0,05).Conclusões: Os escores validados permitem identificar e corrigir os erros da técnica inalatória ao longo das consultas e, em consequência, melhorar o manejo dos dispositivos para inalação.

Assessment of inhaler techniques employed by patients with respiratory diseases in southern Brazil: a population-based study / Avaliação da técnica de utilização de dispositivos inalatórios no tratamento de doenças respiratórias no sul do Brasil: estudo de base populacional

OBJECTIVE: To identify incorrect inhaler techniques employed by patients with respiratory diseases in southern Brazil and to profile the individuals who make such errors. METHODS: This was a population-based, cross-sectional study involving subjects ≥ 10 years of age using metered dose inhalers (MDIs) or dry powder inhalers (DPIs) in 1,722 households in the city of Pelotas, Brazil. RESULTS: We included 110 subjects, who collectively used 94 MDIs and 49 DPIs. The most common errors in the use of MDIs and DPIs were not exhaling prior to inhalation (66% and 47%, respectively), not performing a breath-hold after inhalation (29% and 25%), and not shaking the MDI prior to use (21%). Individuals ≥ 60 years of age more often made such errors. Among the demonstrations of the use of MDIs and DPIs, at least one error was made in 72% and 51%, respectively. Overall, there were errors made in all steps in 11% of the demonstrations, whereas there were no errors made in 13%.Among the individuals who made at least one error, the proportion of those with a low level of education was significantly greater than was that of those with a higher level of education, for MDIs (85% vs. 60%; p = 0.018) and for DPIs (81% vs. 35%; p = 0.010). CONCLUSIONS: In this sample, the most common errors in the use of inhalers were not exhaling prior to inhalation, not performing a breath-hold after inhalation, and not shaking the MDI prior to use. Special attention should be given to education regarding inhaler techniques for patients of lower socioeconomic status and with less formal education, as well as for those of advanced age, because those populations are at a greater risk of committing errors in their use of inhalers. .

OBJETIVO: Conhecer os erros na técnica de uso de dispositivos inalatórios empregada por pacientes com doenças respiratórias no sul do Brasil e o perfil daqueles que possuem dificuldades em realizá-la. MÉTODOS: Estudo transversal, de base populacional, com indivíduos com idade ≥ 10 anos e em uso de inaladores pressurizados (IPrs) ou inaladores de pó (IP) em 1.722 domicílios de Pelotas (RS). RESULTADOS: Foram incluídos 110 indivíduos que utilizavam 94 IPrs e 49 IP. Os principais erros no uso dos IPrs e IP foram não expirar antes da inalação (66% e 47%, respectivamente), não fazer uma pausa inspiratória após a inalação (29% e 25%) e não agitar o IPr antes do uso (21%). Os indivíduos com idade ≥ 60 anos mais frequentemente cometeram erros. Das demonstrações de uso do IPr e IP, respectivamente, 72% e 51% apresentaram ao menos um erro, enquanto 13% das demonstrações foram plenamente corretas e 11% apresentaram erros em todas as fases. A proporção de indivíduos com menor nível de escolaridade que cometeram ao menos um erro foi significativamente maior do que a daqueles com maior nível de escolaridade tanto no uso de IPrs (85% vs. 60%; p = 0,018) quanto no de IPs (81% vs. 35%; p = 0,010). CONCLUSÕES: Nesta amostra, os principais erros cometidos no uso dos inaladores foram não realizar a expiração antes da inalação, não fazer a pausa inspiratória após a inalação e não agitar o IPr. Pacientes com menor nível socioeconômico e educacional, assim como aqueles com idade avançada, merecem especial atenção na educação sobre a realização da técnica inalatória, pois apresentam um maior risco de cometer erros durante o uso dos inaladores. .

Uso de inhaladores de dosis medida en pacientes adultos: Necesidad de educación dirigida por enfermería / Handling of Metered Dose inhaler in adult patients: a need of education directed by Professional Nursing

Objetivo: Describir el uso de inhaladores de dosis medida en pacientes adultos de consulta de neumología en dos instituciones de salud de Atlántico (Colombia), 2013. Materiales y métodos: Estudio descriptivo transversal que evaluó 131 pacientes adultos que utilizaban inhaladores de dosis medida (de cartucho presurizado) con inhalocámara o sin esta, asistentes a dos instituciones de salud del departamento del Atlántico. Se diseñó y aplicó un cuestionario que incluía lista de chequeo que permitió evaluar la técnica. Resultados: De 131 pacientes participantes, la media de edad fue de 44,75 años (DE+/-: 17.77). La tasa de éxito en el uso de la técnica fue baja, menos de 1.52% (2) fue perfecto, mientras que un 24.43% (32) tuvo una técnica adecuada y el 74.05% (97) inadecuada. 105 utilizaban inhaladores sin inhalocámara y 26 con inhalocámara. Conclusiones: Existen debilidades en el uso de los inhaladores. El 74.05% de los pacientes los usó inadecuadamente. Los pasos de la técnica de utilización de inhaladores que fallaron mayormente fueron: no exhalar el volumen residual, no comenzar a respirar cuando se activa el canister, no inhalar lento y profundo, no retener el medicamento por 10 segundos no esperar 30 segundos antes del segundo disparo y no agitar nuevamente el dispositivo antes del mismo. Es necesario implementar programas de educación en los que participen profesionales en enfermería.

Objective: To describe the handling of Metered-Dose inhaler (MDI) in adults of the pneu-mology medical consultation located in Atlántico country (Colombia), 2013. Materials and Methods: We conducted a cross-sectional descriptive study which es-timated 131 adults patients that were using MDIs (pressurized inhaler) with or without a holding chamber and were attending into two health institutions located in Atlántico County, Colombia. We designed and applied a questionnaire that contained a checklist that was allowed for the evaluation of the technique. Results: Mean age was 44.75 years (SD +/-: 17.77). The success rate in the use of the technique was low, 1.52% (2) was perfect, 24.43% (32) was adequate and 74.05% (97) inadequate. Out of 131 patients, 105 used inhalers without holding chamber and 26 with holding chamber. Conclusions: There are weaknesses in the Handling of Metered-Dose inhaler (MDI). 74.05% of patients misused the MDI. The technique steps that are often wrongly executed by patients were: not exhale the residual volume, not start breathing when activating the canister, not inhale slowly and deeply, not retain the medication for 10 seconds and not hold the breath, not wait 30 seconds in between puffs and not shake again the inhaler be-fore shooting it for a second time. It needs to implement education programs that involve professional nursing staff.