Asthma Inhaler Use Research Articles

Impact of a Five Minute Counseling Session of Proper Inhaler Technique on Control of Asthma in Patients Presenting to Tertiary Care Hospital

Objectives: To determine the effectiveness of counseling session of inhaler technique in improving control of symptoms in asthma patients, the factors affecting the improper inhaler technique and association of inhaler use with control of asthma. It has been observed that patients coming to tertiary care hospitals have poor asthma control and patients does not know exactly how to use inhaler in asthma symptoms. Study design: A facility based Observational, Prospective, Cross-sectional study conducted on patient with asthma symptoms and signs. Settings: This study was done in Department of Medicine, Sir Ganga Ram hospital Lahore. Timings: From 24-1-2023 to 23-5-2023. Methods: A facility based Observational, Prospective, Cross-sectional study was conducted on patient with asthma symptoms and signs. This study described the improvement in asthma symptoms by counseling sessions of using inhaler techniques in asthma patients. This study was done in Department of Medicine, Sir Ganga Ram hospital, Lahore. Patients who come to Out patient department of the hospital were selected who had asthma symptoms and signs. Sample size: A total of eighty Patients were selected with asthma symptoms and signs. Patients history were recorded and they were asked to use inhaler and there inhaler use technique were scored. Sample Selection: Inclusion Criteria: Patients age 16 years above, Both male and female patients, new onset asthma symptoms and signs, previously uncontrolled asthma on corticosteroid inhalers and meter dose inhaler devices. Exclusion criteria: Patients with history of chronic bronchitis and Patient with history of emphysema, Patients age less than 16 years. Data Collection procedure: A questionnaire was given to doctors who filled the data and record of patients with asthma symptoms and signs. A proper five minutes counseling of inhaler technique was done in asthma patients who came to Out Patient department of hospital. A questionnaire was filled and used for interpretation of results. We separated patients in two groups. One group of patients did not know how to use inhaler and other group knew how to use inhalers. Improper technique for use of inhaler defined as less than 75 percent of corrected steps done for use of inhaler device. Then we scored patient about the level of effective use of inhaler in asthma patients. We did a five minute counseling session to teach them how to use inhalers properly. We followed these patients in out patients department of tertiary care of hospital and see the improvement in control of asthma symptoms. We observed that patients asthma were controlled, if symptoms and signs improved, reduce nocturnal awakening of patients with cough and shortness of breath, improved quality of life and daily activities. We did the comparison of both group of patients coming to tertiary care hospital and see the impact of five minute counseling of proper inhaler techniques in improving asthma control in these patients. Results: A total of eighty patients were enrolled in the study. Mean age of Patients were 38.12 years and among them 40 percent were male 60 percent were female. 85.12 percent patients asthma symptoms were not controlled, 14.17 percent patients asthma symptoms were controlled. 11 percent patients were diabetics, 26 percent patients had hypertension, 11 percents were smokers, 3.7 percent patients had ischemic heart disease. Among total 80 patients, 48.12 percent patients were using inhalers. 70 percent patients did not know how to use inhaler devices correctly , 30 percent knew how to use inhalers. All patients who were well controlled with asthma were those who knew how to use asthma inhaler correctly. After counseling of proper inhaler techniques, patients were followed and questionnaire were interpreted and inhaler technique was scored, 78 percent patients have better control of asthma symptoms who scored well on use of inhaler technique of asthma devices. Practical Implication: Patients asthma are well controlled, if patients know there technique to use inhaler properly and if patients are well compliant to their inhaler medications for asthma. Conclusion: Patients who were counseled about proper use of inhaler techniques in asthma patients have better asthma symptoms control as compare to patients who did not know how to use asthma inhaler devices. These findings emphasis the need for patient education about asthma inhaler use for good control of asthma symptoms. Keywords: Asthma, Inhaler Technique, Allergens, Control of symptoms.

Retrospective assessment of a collaborative digital asthma program for Medicaid-enrolled children in southwest Detroit: reductions in short-acting beta-agonist (SABA) medication use

BackgroundReal-world evidence for digitally-supported asthma programs among Medicaid-enrolled children remains limited. Using data from a collaborative quality improvement program, we evaluated the impact of a digital intervention on asthma inhaler use among children in southwest Detroit.MethodsChildren (6–13 years) enrolled with Kids Health Connection (KHC), a program involving home visits with an asthma educator, were invited to participate in a digital self-management asthma program (Propeller Health). Patients were provided with a sensor to capture short-acting beta-agonist (SABA) medication use, and given access to a paired mobile app to track usage. Patients’ healthcare providers and caregivers (“followers”) were invited to view data as well. Retrospective paired t-tests assessed change in mean SABA use and SABA-free days (SFD) over time, and regressions explored the relationship between followers and medication use.ResultsFifty-one patients were assessed. Mean program participation was nine months, and patients had on average 3 followers. From the first to last participation month, mean SABA use decreased from 0.68 to 0.25 puffs/day (p < 0.001), and mean SFD increased from 25.2 to 28.1 days/month (p < 0.001). 76% of patients had an increase in the number of SFD. There was a positive, but non-significant, relationship between the number of followers and reductions in SABA inhaler use.ConclusionsWe observed a significant reduction in SABA inhaler use and an increase in the number of SABA-free days among Medicaid-enrolled children enrolled in a multi-modal digital asthma program.

250 Tracking Asthma Medication Use in Children After an Emergency Department Visit With a Smart Inhaler and Connected Mobile Application

Asthma is the most common chronic childhood illness and the third leading cause of hospitalization among pediatric patients in the US. It is responsible for more than 1.8 million emergency department (ED) visits per year and represents significant health care burden and costs. The primary objective of this study is to determine the feasibility of employing a “smart” inhaler connected to a mobile application to track asthma inhaler use after an ED visit. Future goals are to determine if regular daily use of a steroid inhaler results in less rescue medication use, and to connect this usage with real time environmental data to build a risk profile to alert patients of conditions that increase risk of asthma exacerbation.

Impact of choice of inhalers for asthma care on global carbon footprint and societal costs: a long-term economic evaluation

Background While effective asthma control medications reduce the burden of asthma, a significant subgroup of these treatments, namely metered-dose inhalers (MDIs), produce substantial greenhouse gas (GHG) emissions, thus contributing to climate change. This study quantified the global climate impact (i.e. carbon dioxide equivalent [CO2e] emissions) and costs of long-term status quo asthma inhaler use versus alternative scenarios substituting MDIs with propellant-free dry powder inhalers (DPIs). Methods Three scenarios were evaluated across 10-year (2020–2030) and 50-year (2020–2070) time horizons: A (status quo inhaler use), B and C (2% and 5% year-over-year substitution of MDIs with DPIs, respectively). Global inhaler volumes and costs at baseline were sourced from IQVIA, then projected using UN and WHO trends in per capita GDP, urbanization, and asthma population growth. Inhaler spending was assumed to fall by 90% following generic entry in 2030. The carbon footprint per inhaler and health damage factors for disability-adjusted life years (DALYs) were derived from literature. The US government’s central and high-impact estimates for the social cost of carbon (SCC) were used to calculate emissions costs. Results Over 50 years, scenario A resulted in 826 million tonnes of CO2e emissions globally, with an associated SCC between 21% and 65% of the projected global spending on asthma inhalers. In comparison, CO2e emissions were reduced by 38% and 58% in Scenarios B and C, respectively, and DALYs improved by 33 and 51%. Depending on SCC estimates, Scenarios B and C increased global costs by 7.3% and 16.5%, respectively (central SCC), or decreased costs by 4.2% and 2.6% (high-impact SCC) versus Scenario A. Over 10 years, Scenario A resulted in 97 million tonnes of CO2e emissions globally, with an associated SCC between 4.4% and 12.2% of projected spending. In comparison, Scenarios B and C were associated with 12% and 24% reductions in CO2e emissions and improvements in DALYs by 11.5% and 22.7%, respectively. Conclusions Global efforts by environmental and health-policy decision-makers to substitute currently available MDIs with DPIs for asthma control would result in substantial reductions in GHG emissions with manageable costs, or potential cost savings, depending on the SCC. Policies that decrease use of MDIs warrant global attention.

Assisting Students With Asthma Inhaler Technique and Knowledge.

Proper inhaler use is critical to asthma management, but many children and youth do not use their inhalers correctly. School nurses are ideally positioned and have an important role in assessing the inhaler technique and knowledge regarding its use among students. This article discusses common student errors with inhaler technique, along with knowledge deficits surrounding use of asthma inhalers. A tool for assessing inhaler use is provided, in addition to suggestions for how to assist students with improved inhaler technique. By assessing inhaler technique and knowledge early in the school year, school nurses proactively assist in improved student management of their asthma.

POSB94 Impact of Choice of Inhalers for Asthma Care on Global Carbon Footprint and Societal Costs: A Long-Term Economic Evaluation

As guideline-recommended care for asthma increases globally, there is an opportunity to reduce asthma burden while minimizing greenhouse gas (GHG) emissions from inhalers. This analysis quantified the long-term global climate impact and economic impact of status quo asthma inhaler use compared to substituting metered-dose inhalers (MDIs), which use propellants with 1,300-3,350 times carbon dioxide’s (CO2’s) global warming potential, with propellant-free dry-powder inhalers (DPIs).

Examining the Efficacy of a Novel Augmented Reality Mobile Delivery Platform for the Enhancement of Asthma Care Education for Children

&lt;p align="center"&gt; &lt;/p&gt;&lt;p align="center"&gt;MySpira is the world first augmented reality (AR) asthma inhaler training app; it enables children to learn asthma keywords, types of inhalers, the preparation of the inhaler and spacer, asthma triggers, and develop skills on how to use an asthma inhaler effectively. All of these are compiled into an enjoyable 20-minute experience, introducing likable characters and tactile interactions, which incentivise the child to progress all the way through the learning experience. This study aimed to compare the efficacy of the MySpira application to traditional educational material (e.g. leaflets and videos) to improve asthma treatment compliance, technique and user engagement amongst 110 schoolchildren, aged 6 to 13. The findings indicate that MySpira surpasses the traditional educational materials, specifically in terms of enjoyment rating, the use of different inhalers’ techniques, particularly in the younger group (aged 6-9 years). Therefore, MySpira may enhance the level of available asthma care in an attempt to resolve one of the major problems facing asthma suffers and their carers, notably effective use of asthma inhalers.&lt;/p&gt;

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.

Respiratory and atopic conditions in children two to four years after the 2014 Hazelwood coalmine fire.

To evaluate associations between exposure during early life to mine fire smoke and parent-reported indicators of respiratory and atopic illness 2-4 years later. The Hazelwood coalmine fire exposed a regional Australian community to markedly increased air pollution during February - March 2014. During June 2016 - October 2018 we conducted a prospective cohort study of children from the Latrobe Valley. Seventy-nine children exposed to smoke in utero, 81 exposed during early childhood (0-2 years of age), and 129 children conceived after the fire (ie, unexposed). Individualised mean daily and peak 24-hour fire-attributable fine particulate matter (PM2.5 ) exposure during the fire period, based on modelled air quality and time-activity data. Parent-reported symptoms, medications use, and contacts with medical professionals, collected in monthly online diaries for 29 months, 2-4 years after the fire. In the in utero exposure analysis (2678 monthly diaries for 160 children exposed in utero or unexposed), each 10μg/m3 increase in mean daily PM2.5 exposure was associated with increased reports of runny nose/cough (relative risk [RR], 1.09; 95% CI, 1.02-1.17), wheeze (RR, 1.56; 95% CI, 1.18-2.07), seeking health professional advice (RR, 1.17; 95% CI 1.06-1.29), and doctor diagnoses of upper respiratory tract infections, cold or flu (RR, 1.35; 95% CI, 1.14-1.60). Associations with peak 24-hour PM2.5 exposure were similar. In the early childhood exposure analysis (3290 diaries for 210 children exposed during early childhood, or unexposed), each 100μg/m3 increase in peak 24-hour PM2.5 exposure was associated with increased use of asthma inhalers (RR, 1.26; 95% CI, 1.01-1.58). Exposure to mine fire smoke in utero was associated with increased reports by parents of respiratory infections and wheeze in their children 2-4 years later.

Children and parents overestimate correct use of asthma inhalers by youngsters, study finds

Children and parents overestimate correct use of asthma inhalers by youngsters, study finds

Inhaler Syncope

Syncope can result from certain activities that trigger an exaggerated physiological response in susceptible individuals; examples include cough, laugh, and micturition syncope. We report a novel cause for syncope, that due to reflex bradycardia and asystole produced by the use of asthma inhalers. We discuss the possible mechanisms for this effect and briefly review other breathing-related causes of bradycardia.

Design of a smartphone application to monitor stress, asthma symptoms, and asthma inhaler use

Design of a smartphone application to monitor stress, asthma symptoms, and asthma inhaler use

A statistical model for under- or overdispersed clustered and longitudinal count data

We propose a likelihood-based model for correlated count data that display under- or overdispersion within units (e.g. subjects). The model is capable of handling correlation due to clustering and/or serial correlation, in the presence of unbalanced, missing or unequally spaced data. A family of distributions based on birth-event processes is used to model within-subject underdispersion. A computational approach is given to overcome a parameterization difficulty with this family, and this allows use of common Markov Chain Monte Carlo software (e.g. WinBUGS) for estimation. Application of the model to daily counts of asthma inhaler use by children shows substantial within-subject underdispersion, between-subject heterogeneity and correlation due to both clustering of measurements within subjects and serial correlation of longitudinal measurements. The model provides a major improvement over Poisson longitudinal models, and diagnostics show that the model fits well.

Endemic asthma inhaler abuse among antisocial adolescents

Background Approximately 40 million prescriptions were dispensed in the U.S. for asthma inhalers in 2006. Although the pervasive distribution of asthma inhalers warrants greater attention to possible misuse of these products, few investigations have examined asthma inhaler misuse. The purpose of this study was to describe the prevalence, correlates and consequences of asthma inhaler misuse among antisocial youth. Method A cross-sectional survey with face-to-face interviews assessing substance use, psychiatric symptoms, and antisocial behaviors among adolescents ( N = 723) in residential treatment. Results More than 26% ( N = 193) of youth were diagnosed with asthma; 91.2% of asthmatic youth had received a prescription for an inhaler. Of the 373 youth who had used a prescribed or non-prescribed asthma inhaler, 23.6% ( N = 88) reported using an inhaler to get high (i.e., were inhaler misusers). Asthma inhaler misusers had an earlier onset of antisocial conduct, significantly greater levels of current psychiatric distress and lifetime suicidality, higher rates of lifetime substance use problems and volatile solvent abuse, and significantly higher levels of temperamental impulsivity and fearlessness than did inhaler non-users or users. Caucasian racial status, current level of psychiatric distress, and lifetime volatile solvent abuse significantly distinguished lifetime asthma inhaler users and misusers in multivariate logistic regression analyses. Asthma inhaler misusers were significantly more likely to report euphoria, memory problems, slurred speech, blurred vision, confusion, dizziness, and a variety of other acute reactions to asthma inhaler use than were asthma inhaler users. Conclusions Asthma inhaler misuse for the purposes of getting high was prevalent among antisocial youth, co-occurred with other psychiatric and substance use problems, and was associated with adverse consequences.

Emergency asthma inhaler use in schools

A school asthma policy could help to reduce asthma-related morbidity and death, says Julie Hall

Pulmonary outcome in adolescents of extreme preterm birth: a regional cohort study

Aims: The pulmonary outcome of extreme prematurity remains to be established in adults. We determined respiratory health and lung function status in a population-based, complete cohort of young preterms approaching adulthood. Methods. Forty-six preterms with gestational age ±28 wk or birthweight ±1000g, born between 1982 and 1985, were compared to the temporally nearest term-born subject of equal gender. Spirometry, plethysmography, reversibility test to salbutamol and methacholine bronchial provocation test were performed. Neonatal data were obtained from hospital records and current symptoms from validated questionnaires. Results: When entering the study at a mean age of 17.7 (SD: 1.2) y, a doctor's diagnosis of asthma and use of asthma inhalers were significantly more prevalent among preterms than controls (one asthmatic control compared to nine preterms, all but one using asthma inhalers). Peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1) were decreased and the discrepancies relative to controls increased parallel to increased severity of neonatal lung disease. Parameters of increased neonatal oxygen exposure significantly predicted FEV1. Adjusted for height, gender and age, FEV1 was reduced by a mean of 580 ml/s in subjects with a history of bronchopulmonary dysplasia. Fifty-six percent of preterms had a positive methacholine provocation test compared to 26% of controls. Conclusion: A substantially decreased FEV1, increased bronchial hyperresponsiveness and a number of established risk factors for steeper age-related decline in lung function were observed in preterms. A potential for early onset chronic obstructive pulmonary disease is present in subsets of this group.

Pulmonary outcome in adolescents of extreme preterm birth: a regional cohort study

The pulmonary outcome of extreme prematurity remains to be established in adults. We determined respiratory health and lung function status in a population-based, complete cohort of young preterms approaching adulthood. Forty-six preterms with gestational age < or = 28 wk or birthweight < or = 1000 g, born between 1982 and 1985, were compared to the temporally nearest term-born subject of equal gender. Spirometry, plethysmography, reversibility test to salbutamol and methacholine bronchial provocation test were performed. Neonatal data were obtained from hospital records and current symptoms from validated questionnaires. When entering the study at a mean age of 17.7 (SD: 1.2) y, a doctor's diagnosis of asthma and use of asthma inhalers were significantly more prevalent among preterms than controls (one asthmatic control compared to nine preterms, all but one using asthma inhalers). Peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1) were decreased and the discrepancies relative to controls increased parallel to increased severity of neonatal lung disease. Parameters of increased neonatal oxygen exposure significantly predicted FEV1. Adjusted for height, gender and age, FEV1 was reduced by a mean of 580 ml/s in subjects with a history of bronchopulmonary dysplasia. Fifty-six percent of preterms had a positive methacholine provocation test compared to 26% of controls. A substantially decreased FEV1, increased bronchial hyperresponsiveness and a number of established risk factors for steeper age-related decline in lung function were observed in preterms. A potential for early onset chronic obstructive pulmonary disease is present in subsets of this group.

Pilot study of abuse of asthma inhalers by middle and high school students

During a school-based survey, middle and high school students (n = 1536) reported on their nonprescribed, lifetime use of asthma inhalers. Approximately 15% of 8th and 9th graders reported using nonprescribed asthma inhalers; the odds for this behavior were significantly higher for these students (2.25 and 2.30, respectively) and the nonprescribed use of asthma inhalers was significantly associated with higher rates of other drug use.

Asthma inhaler use and barriers in a population-based sample of African-American and white adolescents.

There is little information on inhaler medication and barriers to use among a population-based sample of adolescents and whether possible variations in asthma treatment by ethnic group exist. We describe the prevalence of inhaler use and identify barriers for proper use of asthma medication in a population-based sample of adolescents of which 34% are African-American. A cross-sectional survey using the ISAAC (International Survey of Asthma and Allergies in Children) questionnaire was conducted in a school population-based sample (n = 2056) of 13 to 14-year-old eight grade students in the Charlotte-Mecklenburg, North Carolina public school system. Questions were asked about symptom prevalence, asthma diagnosis, inhaler use, and barriers to care. Fourteen percent of the children (296/2056) reported using an inhaler in the last 12 months with no differences among African-American children and white children. Twenty-six percent of inhaler users were not allowed to carry their medication on their person while at school. Girls were more likely to be allowed to carry their inhalers at school and diagnosed asthmatic girls had a higher prevalence of wheezing in the last year (47%) compared with diagnosed asthmatic boys (35%). Smoking prevalence was higher in inhaler users (26%) compared to the study population (19%). Inhaler use is high in this population. Adolescents using inhalers need to reduce their smoking levels. Schools need to reevaluate their policies on the use of inhalers at school.