Administration Of Inhalers Research Articles

Predictors of proper inhaler technique and asthma control in pediatric patients with asthma.

Improper use of asthma inhalers is one of the potential factors of poor asthma control among children. This study aimed to assess the proper handling of asthma inhalers and asthma control in addition to factors influencing them among pediatric patients who self-administer their inhalers. A cross-sectional study was conducted in Jordan from February 2019 to February 2020. All eligible pediatric patients with asthma attending outpatient settings were approached. The inhalation technique was assessed according to a standard checklist, and asthma control was assessed using the Asthma Control Test. A total of 150 patients were included in this study. A metered dose inhaler (MDI) was the most commonly used inhaler device (89.4%) which was used appropriately by only 13.4% of participants. Whereas, appropriate use of Turbohaler and Diskus was reported by 38.5% and 28.9%, respectively. The higher level of parental knowledge was associated with higher number of correct MDI steps (OR = 1.066; 95% CI = 1.010-1.125; p = .020) and less reported errors in critical steps (OR = 0.949; 95% CI = 0.900-0.999; p = .047). Higher level of both parental education and pediatric average stigma score (less stigmatized) were associated with better asthma control ([OR = 5.181; 95% CI = 1.238-21.677; p = .024], [OR = 2.825; 95% CI = 1.420-5.619; p = .003], respectively). Continuous education on appropriate inhaler self-administration for asthmatic children is highly recommended. Clinical pharmacists play a major role toward improving the administration of inhalers through patient training and counseling.

Hospital staff practical skills and theoretical knowledge in inhaled aerosol therapy: a single centre cross-sectional observational study.

Inhaled therapy is widely used for treatment of many respiratory disorders. Drug delivery in lungs is dependent on the correct use of aerosol devices and patients' training is vital for a correct therapy administration. Therefore, is very important to assess the skills of professionals involved in training patients to the correct use of inhaler devices. The aim of this study was to check the practical skills and the theoretical knowledge of health care personnel in our University Hospital in using aerosol therapy and to determine differences among professional figures in the management of inhaler devices. Three hundred and fifteen (315) volunteers including physicians, residents, nurses and respiratory physiotherapists were enrolled; an independent professional, not working in our University Hospital, assessed their theoretical knowledge related to aerosol throughout a questionnaire. Practical skills were assessed through placebo simulation with the devices that participants declared to use frequently with patients. None of the respondents correctly answered all questions evaluating theoretical knowledge on the proper use of aerosol therapy. Respiratory physiotherapists obtained significantly better results with 17.2 (1.3) average points compared to 10.3 (3.7) obtained by doctors, 9.0 (3.0) by nurses and 9.1 (4.5) by residents. Analysing in detail physicians' results, pneumologists showed better theoretical knowledge than other specialists. Concerning the practical skills, about 80% of those stating they knew how to use metered dose inhalers, made mistakes in the basic steps for proper inhalation technique and over 50% of respondents were unable to properly simulate placebo administration of dry powder inhalers. Also here, respiratory physiotherapists and pneumologists had significant better performances, when compared to other health professionals. Our data are in line with those published in the literature in other international clinical settings, noting inadequate practical and theoretical knowledge of the available devices for aerosol therapy.

Pathways for Improving Inpatient Pediatric Asthma Care (PIPA): A Multicenter, National Study.

Pathways guide clinicians through evidence-based care of specific conditions. Pathways have been demonstrated to improve inpatient asthma care but mainly in studies at large, tertiary children's hospitals. It remains unclear if these effects are generalizable across diverse hospital settings. Our objective was to improve inpatient asthma care by implementing pathways in a diverse, national sample of hospitals. We used a learning collaborative model. Pathway implementation strategies included local champions, external facilitators and/or mentors, educational seminars, quality improvement methods, and audit and feedback. Outcomes included length of stay (LOS) (primary), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits (balancing). Hospitals reviewed a sample of up to 20 charts per month of children ages 2 to 17 years who were admitted with a primary diagnosis of asthma (12 months before and 15 months after implementation). Analyses were done by using multilevel regression models with an interrupted time series approach, adjusting for patient characteristics. Eighty-five hospitals enrolled (40 children's and 45 community); 68 (80%) completed the study (n = 12 013 admissions). Pathways were associated with increases in early administration of metered-dose inhalers (odds ratio: 1.18; 95% confidence interval [CI]: 1.14-1.22) and referral to smoking cessation resources (odds ratio: 1.93; 95% CI: 1.27-2.91) but no statistically significant changes in other outcomes, including LOS (rate ratio: 1.00; 95% CI: 0.96-1.06). Most hospitals (65%) improved in at least 1 outcome. Pathways did not significantly impact LOS but did improve quality of asthma care for children in a diverse, national group of hospitals.

“At a loss of what to do”: a qualitative analysis of parents’ online discussion forums about their administration of asthma inhalers to their young children

Objective: The difficulties adults have using inhaler devices is well documented but much less is known about how parents administer inhaler devices to young children and the difficulties experienced. The purpose of this article is to explore the underlying concepts and practical issues that parents encounter in administering inhaled asthma medications to their young children.Methods: This is a qualitative study using applied thematic analysis on parental written discourses from asynchronous online discussion forums on the topic of administration and use of asthma inhaler devices to young children.Results: “At a loss of what to do” summarizes the experiences parents described when administering inhaler devices to their young children. Parents describe the problems, the situations, the emotions, the decisions, and the confusion they face. They struggle with their child’s resistance and the associated conflict, describing their own and their child’s distress. Results highlight the coping strategies used in administration, how parents decide whether to use coercive measures or not, their help-seeking endeavors, together with the assurance they give to themselves and others after administration.Conclusion: The online discussions highlight parents’ distress, lack of preparedness, and understanding of administering inhaler devices to young children. While the prevalence of the problem cannot be estimated from our data, it illustrates a need for some healthcare professionals to review their own knowledge and skills in administration of inhaled medication to younger patients, and their provision of patient and family centered care.

National Analysis of State Health Policies onStudents' Right to Self-Carry and Self-Administer Asthma Inhalers at School.

Asthma has no known cure, and though manageable, it disrupts the everyday lives of over 6 million US children. Because children spend more than half of their waking hours in school, students must be able to carry and administer their inhaler at school to manage their asthma. This policy paper is a comprehensive review of all 50 states and the District of Columbia's laws and policies for the self-carry and administration of quick-relief asthma inhalers among children in prekindergarten through 12th grade. All states permit students to carry and administer their inhalers at school, although each state differs in their development and implementation of policies for asthma self-management at school. This review examines how states regulate self-carry policies by looking at policy development, regulated school systems, relevant stakeholders, required medical records, and school liability. Each state's laws have nuances that create gray areas, increasing the potential of misinterpreted or incorrectly implemented policies for asthma self-management at school. As a result, children may not have immediate access to their inhaler for symptom management or in an emergency. State policymakers should reform current laws to remove barriers for students to carry and use inhalers at school.

PAST AND PRESENT TRENDS OF DRY POWDER INHALER DEVICES: A REVIEW

Administration of dry powder inhalers (DPIs) for to the management of respiratory diseases has improved significantly in modern lifetime. Currently there is a vast margin of available DPIs that differ not only in the design-plan, effective operational techniques that are requisite, output features and the delivery of drug across an assortment of inhalation pattern. Diverse patient population possibly make choice of individual types of DPI as it is precisely easier to use when in comparison to the other types and preferring the right DPI which shall fulfil a particular requirement for patient will certainly enhance the patient compliance along with the therapy. For instance some DPIs are found to put forth a greater resistance against inspirational flow rate contrast to others which undoubtedly affects the total emitted dose (TED) and also the fine particle fraction (FPF) of aerosol that has been released. As a consequence an individual patient may receive different doses of drug while inhaling from the different DPIs. For that reason, it is essential that the prescriber should be in complete knowledge of the characteristics of different types of DPI, in order to prescribe the device which is most appropriate to the individual patient’s needs. The present study sights the features of currently accessible DPIs, evaluates their effectiveness, usage, patient acceptability, drugs administered by that inhaler. The variation in output characteristics, availability and patient’s selection between the available devices has revealed to have an effect on treatment efficacy and patient compliance through therapy. Altering the DPI that has been prescribed to the patient to a cost effective or a generic device may consequently affect disease control and thereby amplify the cost of treatment.

The effects of acute doses of nicotine on video lottery terminal gambling in daily smokers

A growing body of evidence suggests that gambling frequently co-occurs with smoking, yet little is known about the degree to which nicotine and/or tobacco use influences gambling behavior. Nonetheless, an increasing number of studies suggest that acute administration of nicotine may alter other reinforcing behaviors in both animal and human models, raising the possibility that nicotine may also influence gambling behavior and craving. The purpose of this study was to examine the acute effects of nicotine on subjective and behavioral gambling responses. Twenty-eight (15 male) regular gamblers who smoke daily completed two double-blind laboratory sessions where their subjective and behavioral responses to video lottery terminal (VLT) gambling were assessed, following the administration of nicotine inhalers (NI; 4 mg deliverable) or placebo inhalers. NI significantly decreased tobacco-related cravings (p < 0.05) but did not affect gambling-related cravings, VLT betting patterns, or subjective responses (ps > 0.1). NI were found to acutely suppress tobacco-related cravings without influencing gambling. These results suggest that use of nicotine replacement therapies may be a safe option for gamblers who are attempting to quit smoking.

An Evaluation of Patients' Willingness to Trade Symptom-Free Days for Asthma-Related Treatment Risks: A Discrete Choice Experiment

Background. Not taking treatment preferences into account may lead to patients' inappropriate use of asthma treatments. The objective of this study was to quantify these preferences, in terms of risk-benefits trade-offs, for six asthma treatment attributes using a discrete choice experiment (DCE). Methods. Adult asthma patients (n = 157) participated in the study. The custom-designed DCE measured preferences for treatment effectiveness (symptom-free days), potential risk (oral thrush and tremor/heart palpitation), ease of use (frequency of daily administration and number of inhalers required), and cost. A nested logit model was used to determine the relative preferences of each attribute, from which the marginal rates of substitution were calculated. Segmented models were used to test for interactions between cost and treatment benefit with socioeconomic status and medication use. Results. Relationships between preferences and all attributes were in the hypothesized direction. On average, patients were willing to pay an additional $14 per month to receive one additional symptom-free day, and $26, $79, and $112 monthly to avoid one, two, and three annual episodes of oral thrush, respectively. Income and the magnitude of short-acting β -agonist use also affected treatment preferences. Conclusions. Overall, asthma patients desired treatments that offered more symptom-free days, but they were willing to trade days without symptoms in exchange for a reduction in adverse events and greater convenience.