Asthma Inhaler Research Articles

Acceptability and preference of three inhalation devices assessed by the Handling Questionnaire in asthma and COPD patients

Background: The patients’ criteria of preference for inhalation devices can affect the extent of their adherence to treatment and outcomes. Aim of this study was to assess and compare the patients’ preference and acceptability (PPA) for Breezhaler and Genuair (both Dry Powder Inhalers), and for Respimat (a Soft Mist Inhaler) in asthma and COPD out-patients by means of the Handling Questionnaire. Methods: The Handling Questionnaire is a validated instrument which allows the investigation of different domains of PPA; it also takes into account the patients’ age and gender, together with their previous experience with the inhalation devices and their previous education approach to them. Differences in terms of preference, acceptance and usability were assessed by linear and logistic regressions in order to evaluate factors influencing the proper actuation. Results and Discussion: Data from 333 patients were collected: Genuair and Respimat were the most liked and perceived as the easiest to use at glance by patients, but also as the least problematic according to the patients’ and nurse’s judgments. Mean number of attempts for achieving the first effective actuation was the highest with Breezhaler (2.6 vs 1.6; p <0.0001). Linear regressions showed that longer the explanation, higher was the number of attempts to the first proper actuation (0.58 additional attempts every 10 s increase in the first explanation, p <0.0001). Devices requiring less manoeuvres for the actuation were used properly after less attempts (0.38 increase in the number of attempts every additional manoeuvres, p <0.0001). Respimat proved to be the most indicated in COPD patients since it was the most liked and its successful rate at first attempt was the highest. Logistic regressions confirmed these data. Previous experience with DPIs and/or MDIs did not affect the patient preference and acceptability, independently whether suffering from asthma or COPD. Conclusions: Substantial differences are existing in patient’s preference and acceptability for inhalation devices, mainly related to the handling and the understanding of the different devices.

Acceptability and preference of three inhalation devices assessed by the Handling Questionnaire in asthma and COPD patients.

BackgroundThe patients’ criteria of preference for inhalation devices can affect the extent of their adherence to treatment and outcomes.Aim of this study was to assess and compare the patients’ preference and acceptability (PPA) for Breezhaler and Genuair (both Dry Powder Inhalers), and for Respimat (a Soft Mist Inhaler) in asthma and COPD out-patients by means of the Handling Questionnaire.MethodsThe Handling Questionnaire is a validated instrument which allows the investigation of different domains of PPA; it also takes into account the patients’ age and gender, together with their previous experience with the inhalation devices and their previous education approach to them. Differences in terms of preference, acceptance and usability were assessed by linear and logistic regressions in order to evaluate factors influencing the proper actuation.Results and DiscussionData from 333 patients were collected: Genuair and Respimat were the most liked and perceived as the easiest to use at glance by patients, but also as the least problematic according to the patients’ and nurse’s judgments. Mean number of attempts for achieving the first effective actuation was the highest with Breezhaler (2.6 vs 1.6; p <0.0001). Linear regressions showed that longer the explanation, higher was the number of attempts to the first proper actuation (0.58 additional attempts every 10 s increase in the first explanation, p <0.0001). Devices requiring less manoeuvres for the actuation were used properly after less attempts (0.38 increase in the number of attempts every additional manoeuvres, p <0.0001). Respimat proved to be the most indicated in COPD patients since it was the most liked and its successful rate at first attempt was the highest. Logistic regressions confirmed these data. Previous experience with DPIs and/or MDIs did not affect the patient preference and acceptability, independently whether suffering from asthma or COPD.ConclusionsSubstantial differences are existing in patient’s preference and acceptability for inhalation devices, mainly related to the handling and the understanding of the different devices.

Medication education program for Indian children with asthma: A feasibility stud

It is postulated that children with asthma who receive an interactive, comprehensive, culturally relevant education program would improve their asthma knowledge (AK), asthma control, and adherence compared with children receiving usual care. The aim of this study was to develop, implement, and evaluate the efficacy of a culturally relevant asthma education intervention for children with asthma and their parents in India. Children with asthma (7-12 years) and their parents were recruited from an outpatient clinic in a Chest Diseases Hospital in New Delhi, and were randomly assigned to either an intervention or usual care group. At baseline, outcome data collected included pediatric asthma caregiver quality of life (PACQL, primary outcome), AK, asthma control, adherence, inhaler technique, action plan ownership, and goal achievement. These data were collected again at 1 and 6 months after baseline. Outcomes were compared within and between groups using ANOVA techniques. Forty parent-child pairs were recruited. Of these, 24 pairs of children with asthma and their parents received the educational intervention. The PACQL significantly improved from baseline to 6 months in the intervention (5.87 ± 0.94-7.00 ± 0.03) versus the usual care group (5.90 ± 0.52-6.34 ± 0.56) (P < 0.001). Other outcomes such as the parents' and child's AK, child's asthma control and inhaler technique were significantly improved in the intervention group across the study. All the participants possessed a written asthma action plan at the end of the intervention. Eighty-five goals were set by children with asthma across all the visits and were achieved by completion. An asthma educator delivered interactive program simultaneously involving children with asthma and their parents, improved quality of life, empowered and promoted better self-management skills.

The combination of fluticasone furoate and vilanterol trifenatate in the management of asthma: clinical trial evidence and experience.

The treatment of persistent asthma has been aided by the recent approval of new medications. The combined inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) powder inhaler fluticasone furoate (FF)/vilanterol trifenatate (VI) is one of these new agents, which was recently approved as a maintenance therapy for persistent asthma. This once-daily ICS/LABA inhaler has previously been approved and used in chronic obstructive pulmonary disease as a maintenance therapy. Both FF and VI individually have been shown to have efficacy in the treatment of persistent asthma; the combination of FF/VI at the dose of 100/25 μg daily improves trough peak expiratory flows and forced expiratory volume in 1 s. It also reduces the frequency of asthma exacerbations in patients with persistent asthma. The once-daily dosing is well tolerated, with limited clinically significant adverse events; the once-daily inhaled dosing regimen should also improve medication adherence. The data supporting the use of the FF/VI inhaler in persistent asthma are reviewed. The dry powder inhaler of FF/VI (100/25 μg) is an effective and well tolerated once-daily maintenance treatment for patients with persistent asthma.

Momentary Assessment of Psychosocial Stressors, Context, and Asthma Symptoms in Hispanic Adolescents

The current study used a novel real-time data capture strategy, ecological momentary assessment (EMA), to examine whether within-day variability in stress and context leads to exacerbations in asthma symptomatology in the everyday lives of ethnic minority adolescents. Low-income Hispanic adolescents (N = 20; 7th-12th grade; 54% male) with chronic asthma completed 7 days of EMA on smartphones, with an average of five assessments per day during non-school time. EMA surveys queried about where (e.g., home, outdoors) and with whom (e.g., alone, with friends) participants were at the time of the prompt. EMA surveys also assessed over the past few hours whether participants had experienced specific stressors (e.g., being teased, arguing with anyone), asthma symptoms (e.g., wheezing, coughing), or used an asthma inhaler. Multilevel models tested the independent relations of specific stressors and context to subsequent asthma symptoms adjusting for age, gender, and chronological day in the study. Being outdoors, experiencing disagreements with parents, teasing, and arguing were associated with more severe self-reported asthma symptoms in the next few hours (ps < .05). Being alone and having too much to do were unrelated to the experience of subsequent self-reported asthma symptoms. Using a novel real-time data capture strategy, results provide preliminary evidence that being outdoors and experiencing social stressors may induce asthma symptoms in low-income Hispanic children and adolescents with chronic asthma. The results of this preliminary study can serve as a basis for larger epidemiological and intervention studies.

ABCs of asthma inhaler and device training.

The impact of poor adherence and medication administration is well documented, as are the difficulties with asthma inhaler and device usage. However, difficulties with these devices and inhalers continue to present significant challenges to many healthcare providers and patients. A systematic review of the published, peer-reviewed international literature was performed to identify likely teaching needs as well as available and recommended resources to address same. Asthma inhaler and device use and educational needs vary as widely as do the types and severity of usage errors committed. Multiple interventions have been studied and found to be effective at improving both patient technique and overall asthma outcomes. Providers must ensure that patient teaching is performed by suitably prepared staff members. Education should be device-specific, patient-centered, and repeated at frequent intervals. Providers must frequently reassess patient understanding and ability with regard to asthma inhalers and devices in order to maximize therapeutic outcomes.

Is acupuncture better than sham acupuncture for attenuated airway inflammation and regulated cytokines produced by diverse Th subtypes in chronic OVA inhalation in asthma induced mice

IntroductionIn China, acupuncture which is part of traditional Chinese medicine is effectively used for the treatment of asthma. This study was designed to evaluate the effect of acupuncture on airway inflammation and the associated cytokines produced by different Th mouse subtypes induced by chronic ovalbumin (OVA) inhalation. MethodsA mouse asthma model was induced by OVA exposure. Mice were divided into 4 groups: normal control, asthma model, acupuncture and sham acupuncture groups, and acupoints GV14, BL12, BL13 and BL23 were selected for acupuncture treatment. Airway hyperresponsiveness (AHR) was analysed using Buxco RC system. Pulmonary histopathology analysis was performed by H&E staining. The inflammatory mediators assay in bronchoalveolar lavage fluid (BALF) and serum were investigated by ELISA and Bio-Plex. ResultsOur results demonstrated that acupuncture reduced AHR to methacholine (Mch) of OVA-induced asthma mice, attenuated inflammatory cells infiltration into lung and mucus secretion. Analysis of cytokines revealed that Th1 cytokine IFN-γ elevated in both BALF and serum by acupuncture treatment. Meanwhile, Th2 cytokines such as IL-4 and IL-5 levels both in BALF and serum reduced significantly compared to mice exposure to OVA. IL-17A was inhibited by acupuncture and IL-10 which is produced by Treg cells increased in BALF both by acupuncture and sham acupuncture. However, TGF-β as another mediator produced by Treg cells did not change markedly by acupuncture treatment. ConclusionThis study indicated that acupuncture treatment appeared to be effective in attenuating inflammation in mice chronically exposed to OVA. This protective effect of acupuncture might be associated with regulation of immune responses by elevating Th1 and Treg cytokines and decreasing Th2 and Th17 cytokines. This may indicate that acupuncture has a regulatory effect with the ability of resetting the Th1/Th2 and Th17/Treg balance. Changes induced resulting from needling requires further investigation.

The impact of expired and empty quick-relief asthma inhalers: The Asthma and Allergy Foundation of America's Asthma Inhaler Design Survey.

Despite the available treatments, asthma remains a serious illness, with a considerable socioeconomic burden associated with a high number of unscheduled visits to the emergency department (ED). Poor adherence and inadequate inhaler technique are contributing factors to poor asthma management and control. The Asthma Inhaler Design Survey assessed the behaviors, attitudes, needs, and preferences of patients with asthma and their caregivers with regard to quick-relief inhaler usage and device design. The Asthma and Allergy Foundation of America invited 19,157 adult patients and parents of children with asthma to take part in an online survey that focused on previous asthma diagnosis, symptom severity, and quick-relief and controller medication use. Opinions were also collected. Data from 590 respondents (366 adults; 224 children) were included in the final analysis. Relief inhalers were needed and found to be past the expiration date by 284 of 561 (50.6%) and relief inhalers were found to be empty by 270 of 560 (48.2%). Of the empty inhaler group, 28 of 270 (10.4%) had to visit the ED for treatment, 18 of 270 (6.7%) missed work or school for an unscheduled physician office visit, and 54 of 270 (20%) went without treatment. Although 78.5% indicated that they had at least two quick-relief inhalers nearby, these were not always easily accessible. Few respondents (194/578 [33.6%]) indicated that they and/or their child were very confident that they were using their inhaler properly, even though the majority had received some instruction. When asked what they would do to improve satisfaction with their quick-relief inhalers, 173 of 558 (31%) responded that they would add a dose counter. Unnecessary health care utilization and avoidable loss of time at work or school were associated with the lack of full availability of properly functioning quick-relief inhalers when needed. Adding a dose counter was the most frequently cited response for improving satisfaction with quick-relief inhalers. Confidence about proper inhaler use was low, despite previous instruction.

The evolution of mobile apps for asthma: an updated systematic assessment of content and tools.

BackgroundInterest in mobile apps that support long-term conditions such as asthma is matched by recognition of the importance of the quality and safety of apps intended for patient use. We assessed how changes over a 2-year period affected the clinical suitability of apps providing self-management information and tools for people with asthma by updating a review first performed in 2011.MethodsSystematic content assessment of all apps for iOS and Android examining the comprehensiveness of asthma information, consistency with the evidence base for asthma self-management and adherence to best practice principles for trustworthy content, comparing the quality of apps available in 2011 to those released since.ResultsBetween 2011 and 2013, numbers of asthma apps more than doubled from 93 to 191, despite withdrawal of 25% (n = 23/93) of existing apps. Newer apps were no more likely than those available in 2011 to include comprehensive information, such as the use of action plans, or offer guidance consistent with evidence; 13% (n = 19/147) of all apps, and 39% (n = 9/23) of those intended to manage acute asthma, recommended self-care procedures unsupported by evidence. Despite increases in the numbers of apps targeting specific skills, such as acute asthma management (n = 12 to 23) and inhaler technique (from n = 2 to 12), the proportion consistent with guidelines (17%, n = 4/23) and inhaler instructions (25%, n = 3/12), respectively, was low, and most apps provided only either basic information about asthma (50%, n = 75/147) or simple diary functions (24%, n = 36/147).ConclusionsIn addition to persisting questions about clinical quality and safety, dynamic aspects of app turnover and feature evolution affect the suitability of asthma apps for use in routine care. The findings underline the need for coordinated quality assurance processes that can adapt to changing clinical and information governance-related risks, ensure compliance with the evidence base and reflect local variations in clinical practice. It is unclear if substantial clinical benefits can be realized from a landscape dominated by low quality generic information apps and tools that do not adhere to accepted medical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0303-x) contains supplementary material, which is available to authorized users.

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

Quality of YouTube videos for patient education on how to use asthma inhalers

Methods The website YouTube.com was queried for the search phrase “how to use asthma inhaler”. The resulting videos were assessed for duration, number of views, number of likes and dislikes, source of video, and content. Content was analyzed for proper inhaler usage. Specifically, videos were assessed whether they discussed the following 9 important steps of inhaler use: removing the cap, priming the inhaler, shaking the inhaler, breathing out before inhaler use, dispensing the medication, taking a deep/slow breath (or several breaths in the pediatric patient using a spacer), holding one’s breath (unless patient took several breaths with a spacer), waiting before taking a repeat dose, and rinsing the mouth after inhaler use.

A review of the value of innovation in inhalers for COPD and asthma

BackgroundAppropriate use of inhaled therapies for asthma and chronic obstructive pulmonary disease (COPD) is critical to ensuring good patient outcomes, efficient use of healthcare resources and limiting the effects of high-morbidity. The appropriate choice of inhaler and active therapy, incorporating patient preferences, can help improve treatment adherence and long-term outcomes. Despite this, many current inhalers are non-intuitive to use, and require extensive training. MethodsIn this review, an expert panel considers the evidence for the use of inhaler devices in management of COPD and asthma. The panel also evaluates the value of innovation in inhaler technologies, which optimise the use of existing molecules from a clinical, economic and societal perspective.ConclusionsThe panel conclusion is that there remains a substantial unmet need in inhaler technology and that innovation in inhaler devices can provide real-world health benefits to patients. Furthermore, we recommend that these innovations should be supported by healthcare systems through appropriate pricing and reimbursement mechanisms.

Perioperative acupuncture in asthma patients under general anesthesia

Background and objective The incidence of asthma has increased in the last few years. Acupuncture was found to have a bronchodilating effect in asthmatic patients. The aim of this study was to evaluate the perioperative bronchodilator effect of acupuncture in comparison with regular inhalation asthma treatment. Patients and methods The study was conducted at Kasr AL Ainy Teaching Hospital. Forty patients of both sexes, aged 20-40 years, classified as ASA 2, with mild partially controlled asthma [determined from forced expiratory volume in the first second (FEV 1 ), forced expiratory volume/forced vital capacity (FEV 1 /FVC), peak expiratory flow rate (PEFR) ranging from 70 to 79%] were allocated to two groups. Group A ( n = 20) received preoperative acupuncture for 30 min, and if there was clinical improvement on the basis of spirometer tests patients were allowed to proceed with their operation, followed by intraoperative acupuncture until fully awake. Group B ( n = 20) received a 30 min preoperative treatment with 10 drops of nebulized salbutamol (1 mg, 1 ml) and 500 mg ipratropium bromide diluted in 2 ml normal saline inhaled through a nebulizer. FEV 1 , FEV 1 /FVC, PEFR, SPO 2 , and hemodynamic data were collected before treatment T(0) and 30 min after the end of treatment T(30). The onset of bronchodilation as marked by the disappearance of wheezing and improvement in patient symptomatology, the success rate of treatment (improved pulmonary function tests >12%, disappearance of wheezing) recorded at T(30), intraoperative hemodynamic changes, peripheral oxygen saturation, end tidal CO 2 levels, peak airway pressure, and any complications related to the different treatments used were also recorded. Results Wheezing disappeared after 9.5 ± 1.67 min, recorded from T(0), in group A compared with 14.4 ± 2.80 min in group B. At T(30), pulmonary function tests improved by more than 12% and wheezing disappeared in 16 (80%) patients in group A and in 18 (90%) patients in group B. This was statistically significant ( P 1 , FEV 1 /FVC, and PEFR peripheral oxygen saturation (SpO 2 ) within each group compared with T(0). Intraoperatively, the peak airway pressure was clinically comparable in both groups, although it was statistically significant ( P = 0.04). In group A there were no complications related to the use of acupuncture. Two (10%) patients in group A and 14 (70%) patients in group B experienced an increase in heart rate by more than 10%. Conclusion Perioperative acupuncture seemed to improve respiratory functions without serious side effects.

Exposure-response relationships for inhalant wheat allergen exposure and asthma

BackgroundA few studies have investigated exposure–response relationships for sensitisation to wheat, work-related symptoms and wheat allergen exposure. IgG4 is suggested to protect against the development of allergic sensitisation. The main...

Study on level of control of bronchial asthma in a peripheral paediatric unit in Sri Lanka

Objectives: To describe the level of control of asthma and the factors associated with poorly controlled asthma in children registered at the Paediatric Clinic at Base Hospital, Kanthale in the Trincomalee District of the Eastern Province of Sri Lanka and to identify co-morbid factors associated with poorly controlled asthma.. Method: It was a prospective cross sectional study conducted in the Paediatric Clinic at Base Hospital Kanthale. Data was collected using an interviewer administered questionnaire from 88 physician diagnosed asthma patients. Asthma Therapy Assessment Questionnaire (ATAQ) was used to assess asthma control. Results: Majority of patients (75%) had poorly controlled asthma. Statistically significant associations were noted between poorly controlled asthma and incorrect inhaler technique (p Conclusions: In our study 75% had poorly controlled bronchial asthma. Poor control of bronchial asthma was significantly associated with incorrect inhaler technique, poor compliance to steroid inhaler, allergic rhinitis, gastro-oesophageal reflux disease and exposure to cigarette smoke at home. (Key words: Bronchial asthma; level of control; ATAQ questionnaire) Sri Lanka Journal of Child Health , 2014; 43 (4): 208-211 DOI: http://dx.doi.org/10.4038/sljch.v43i4.7763

Asthma inhaler adherence determinants in adults: systematic review of observational data.

Nonadherence to inhaled medication leads to poor asthma control and increased healthcare utilisation. Many studies exploring adherence determinants have been conducted, but summaries of the evidence are scarce. We performed a systematic review of observational research on determinants of asthma inhaler adherence among adults. We searched for articles in English reporting quantitative observational studies on inhaler adherence correlates among adults in developed countries, published in EMBASE, Medline, PsychInfo and PsychArticles in 1990-2014. Two coders independently assessed eligibility and extracted data, and assessed study quality. Results were summarised qualitatively into social and economic, and healthcare-, therapy-, condition- and patient-related factors. The 51 studies included mainly examined patient-related factors and found consistent links between adherence and stronger inhaler-necessity beliefs, and possibly older age. There was limited evidence on the relevance of other determinants, partly due to study heterogeneity regarding the types of determinants examined. Methodological quality varied considerably and studies performed generally poorly on their definitions of variables and measures, risk of bias, sample size and data analysis. A broader adoption of common methodological standards and health behaviour theories is needed before cumulative science on the determinants of adherence to asthma inhalers among adults can develop further.

Bronchodilator Response to Salbutamol Delivered by Metered Dose Inhaler with Spacer and Dry Powder Inhaler in Acute Asthma In Children: A Comparative Study

Background: Salbutamol inhalation is the mainstay of treatment for acute exacerbation of asthma. A number of delivery systems for asthma medication have been developed for children, each having its own advantages and disadvantages. This study was done to compare the bronchodilator effect of salbutamol inhalation delivered through metered dose inhaler (MDI) with spacer and dry powder inhaler (DPI) in children presenting with mild and moderate acute asthma. Methodology: Children of 6 to 15 years of age with mild or moderate acute exacerbation of asthma were assessed primarily and randomly distributed into two groups having equal number of patients and received 400micro-gram of salbutamol delivered by either MDI with spacer or DPI device. The primary outcome variable was peak expiratory flow rate (PEFR) and secondary outcome variables were percent predicted PEFR, heart rate, respiratory rate, oxygen saturation, wheezing and accessory muscle scores. Changes in primary and secondary outcome variables, before and after drug intervention were recorded and subjected to statistical tests for significance. Separate analyses were done for mild and moderate asthma patients. Results: The changes in primary outcome variable (PEFR) in both groups before and after intervention was 179.19 ± 33.27 vs. 197.52 ± 57.01 liters/min and 184.81 ± 59.65 vs. 202.83 ± 64.76 liters/min respectively, which was statistically highly significant (P= 0.001). Similar significant changes were also observed in case of secondary outcome variables. Conclusion: Bronchodilator response to salbutamol in mild or moderate acute asthma in children is similar when equal amount of drug is delivered either through an MDI with spacer or a DPI DOI: http://dx.doi.org/10.3329/bjch.v38i2.21138 Bangladesh J Child Health 2014; VOL 38 (2) : 62-67

Epinephrine auto injector administration by parents or patients for anaphylaxis during supervised oral food challenges and assessment of confidence

Background Barriers to administering epinephrine auto injectors include failure to recognize signs and symptoms of anaphylaxis, administering oral antihistamines or asthma inhalers due to lack of education, failing to administer epinephrine correctly, fear of giving a needle, auto injector misplaced, and past experiences with spontaneous recovery. The aim of this study is to assess the impact of supervised auto injector administration by parents/patients on confidence, knowledge and skill for future treatment of severe allergic reactions. Methods

Examining the Utility of Asthma Inhaler Education in Children With Asthma

Examining the Utility of Asthma Inhaler Education in Children With Asthma

Schools to store spare asthma inhalers for children who need them.

YOUNG PEOPLE at risk of asthma attacks will have access to emergency inhalers at school for the first time this month.