Correct Inhaler Research Articles

Clinical profile, inhaler technique, and predictors of inhaler adherence among asthma and COPD patients who attended the outpatient emergency department for acute exacerbation.

Understanding the patients' clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients (n = 85, 70.8%). Most were on regular follow-up (n = 72, 60.0%) and adhered to their inhaler(s) (n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly (n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers' mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.

MISCONCEPTIONS ABOUT ASTHMA AMONG PATIENTS VISITING THE TERTIARY CARE HOSPITAL OF KARACHI

Asthma is a common respiratory condition that significantly impacts patient quality of life, with many individuals lacking adequate knowledge about triggers and proper inhalation therapy. Understanding patient awareness of asthma management is crucial in designing interventions that enhance their ability to prevent and manage symptoms effectively. Objective: This study aimed to assess the awareness of asthma triggers, perceptions of inhalation therapy, and the effect of a teaching intervention among patients visiting a tertiary healthcare facility in Karachi, Pakistan. Methods: A cross-sectional descriptive survey was conducted in the Department of Pulmonary Medicine at Aga Khan University Hospital, Karachi, from January to June 2024. A total of 200 asthma patients were included through convenience sampling. Data were collected using a standardized questionnaire that assessed participants' knowledge of primary asthma triggers, correct inhaler usage, and relevant socio-demographic factors. The statistical analysis was performed using SPSS Version 25, and frequencies, percentages, and chi-square tests were used to examine associations between patient knowledge and other variables. Results: The study revealed that asthma awareness among participants was limited. Only 45% of respondents could identify common asthma triggers accurately, while 30% believed that asthma was solely caused by smoking or pollution. Additionally, 35% of patients expressed concerns about frequent reliance on inhalers, and 40% indicated that they were unsure of the correct way to use their inhalers. The teaching intervention demonstrated an improvement in inhaler usage knowledge and reduced anxiety related to inhalation therapy. Conclusion: This study highlights a significant gap in patient awareness regarding asthma triggers and the proper use of inhalers. These findings emphasize the importance of developing targeted educational interventions to improve asthma management, particularly in low-resource settings. Future efforts should focus on enhancing patient education to prevent asthma-related complications and improve overall disease control.

Demographic and Asthma-Related Characteristics of Asthmatics Using Pressurized Metered Dose Inhalers and Dry Powder Inhalers.

Background: Asthma controller medications can be delivered via pressurized metered dose inhaler (pMDI) or dry powder inhaler (DPI) devices. Objective: This study aimed to evaluate the frequency of exacerbations and satisfaction rate with device use in asthmatics using pMDIs or DPIs. Methods: A multicenter, cross-sectional study was conducted in adults who used pMDIs or DPIs with correct inhaler technique and good adherence for asthma treatment. Demographic and asthma-related characteristics of the subjects and data regarding device satisfaction were collected through a face-to-face interview in the outpatient clinic. Rates of pMDI and DPI users and the data were compared between the two groups. Results: The study included 338 patients (mean age: 48.6 ± 14.5 years, 253 [74.9%] women). Among participants, 96 (28.4%) were using pMDI and 242 (71.6%) were using DPI. The age of patients using pMDI were significantly lower compared with DPI users. No significant difference was observed in terms of device satisfaction and clinical outcomes of asthma between pMDI and DPI users with good inhaler technique and good adherence. Conclusion: More asthmatics use DPIs, however, pMDIs are used in younger asthmatic patients. No significant difference in terms of device satisfaction and clinical outcomes of asthma was observed between pMDI and DPI users.

Evaluation of impact of adherence to inhaled therapy and critical mistakes in inhalation technique on clinical outcomes in patients with obstructive airway diseases in India

Adherence to inhaled therapy is more relevant in respiratory diseases because, to achieve therapeutic efficacy, it is necessary that the patient adhere to the recommended therapy as well as use their inhalers correctly with appropriate inhalation technique.This was a prospective, observational study that included 126 patients >18 years of age of all genders, diagnosed with an obstructive airway disease, and prescribed inhaler medication. Adherence was assessed using the Test of Adherence to Inhalers (TAI) questionnaire, and inhaler device technique was assessed every 3 months. At the end of one year, outcome data like the number of exacerbations, the number of admissions, including critical-care admissions, the number of days of hospitalization, adverse events, and their associations were analyzed.Poor adherence to inhaled therapy was found in 40.48% of patients, with the majority of patients (69.05%) having an unwitting or ignorant pattern of non- adherence. Out of 75 patients using MDI (Metered Dose Inhaler), 34.67% had critical mistakes in technique, and out of 51 patients using Rotahaler, 23.53% had critical mistakes in technique. There was no significant relationship between level of adherence and critical mistakes with gender, BMI category, or past history of smoking. Patients with poor adherence and those with critical mistakes in inhalation technique had poor health outcomes.This study highlights the role of adherence and identifies barriers responsible for non-adherence to inhaled therapy. Identifying the behaviors responsible for non-adherence and counseling the patients on the correct inhalation technique can improve the health outcomes of chronic respiratory diseases.

Impact of Pharmacist-Led Intervention on Adherence to Inhalers, Inhalation Technique, and Disease Control Among Asthma/COPD Patients in a Resource Limited Center: An Interventional Study.

Asthma and Chronic obstructive pulmonary disease (COPD) are chronic respiratory conditions characterized by airflow obstruction and respiratory symptoms. Adherence to prescribed inhaler therapy and correct inhalation technique are essential for effective disease management and optimal disease control. However, non-adherence and incorrect inhalation technique are common challenges faced by patients with asthma and COPD, leading to suboptimal treatment outcomes and increased healthcare burden. To study the impact of a pharmacist-led intervention on inhaler adherence, inhalation technique, and disease control among patients with asthma and COPD. A pre-post interventional design assessed the effects of pharmacist-led intervention on inhaler adherence, inhalation techniques, and disease control in asthma and COPD patients at Dhulikhel Hospital in Nepal. Inclusion criteria: adult patient clinically diagnosed with asthma or COPD patients of all genders. The intervention comprised counseling patients with aids like videos, and informational leaflets. Impact was measured using checklist method for inhalation technique, the Test of Adherence to Inhaler (TAI) questionnaire for adherence to inhaler, and "Asthma Control Test (ACT)" or "COPD Assessment Test (CAT)" for disease control. The pharmacist-led intervention significantly increased adherence to inhalers, evidenced by a notable rise in the proportion of patients with good adherence (P<0.001). Sporadic, deliberate, and unwitting noncompliance pattern also improved significantly after the intervention (P<0.001, P<0.001 and P=0.001). Inhalation technique exhibited substantial improvement after intervention (P<0.001). The analysis indicated significant moderate negative correlations between "TIA" and "CAT" [ρ=-0.31; P=0.01], and between "inhalation technique score" and "CAT score" [ρ=-0.31; P=0.01] suggesting that as adherence to inhaler usage and inhalation technique improve, CAT scores tend to decrease, indicating reduced disease impact on the patient. This study shows the potential efficacy of pharmacist-led intervention in enhancing adherence to inhaler, inhalation technique, and disease control in respiratory conditions such as asthma and COPD.

Service development project to pilot a digital technology innovation for video direct observation of therapy in adult patients with asthma

BackgroundAdherence to pharmacotherapy and use of the correct inhaler technique are important basic principles of asthma management. Video- or remote-direct observation of therapy (v-DOT) could be a feasible approach to...

Age-related features of the choice of inhalers in chilren and adolescents with bronchial asthma and other respiratory diseases

The inhalation way of drug delivery seems to be the most logical for respiratory diseases. However, the most important condition for the effectiveness of inhalation therapy in children and adolescents along with the correct choice of the active substance is the selection of the optimal device and adequate execution of the inspiratory maneuver. When prescribing therapy attention should be paid to the inhalation technique of a particular patient and also take into account the likelihood of side effects when using certain devices. The article provides data on factors affecting the pulmonary deposit of the drug, the internal resistance of various inhalers which have the greatest informativeness for choosing a device along with the assessment of the inspiratory flow rate developed by the patient. The most problematic aspects of drug delivery to the respiratory tract in children under 5 years of age and in patients with inadequate inhalation rate are analyzed. The principles of correct inhalation are discussed which are necessary to obtain an optimal respiratory fraction. It is known that the problem of synchronizing inhalation with the moment of receipt of the drug is the most important when using metered – dose aerosol inhalers. In children this problem can be solved by using a spacer or using nebulizers that convert the liquid form of the drug into an aerosol using compressor air. Individual selection of an inhaler depending on the abilities and preferences of the patient in some groups of patients can significantly increase the effectiveness of therapy without increasing the dose of medications. The article presents up-to-date data on digital inhaler systems and the possibilities of using electronic devices for monitoring and using the inhaler.

Rate of Correct Inhaler Usage and Related Factors in Elderly Patients With Chronic Obstructive Pulmonary Disease

Poor disease control in patients with chronic obstructive pulmonary disease (COPD) is associated with suboptimal inhaler use. This study was designed to explore the accuracy of inhaler use and related factors in elderly patients with COPD. A cross-sectional survey design was used to recruit patients with COPD from a medical centre in southern Taiwan who were over 65 years old and used inhalers regularly. All of the data as well as information on inhaler use accuracy were collected using a self-designed questionnaire and inhaler operation checklist. Multivariable logistic regression was used to analyse significant correlates of correct inhaler operation. The average age of the 150 participants was 75.0 years (SD = 7.5) years. Most used one type of inhaler only (86.0%). The rate of accurate inhaler operation was 40.7% (n = 61) for the sample, with dry powder inhalers associated with the highest accuracy (64%) and pressurized metered-dose inhalers associated with the lowest accuracy (1.6%). Multivariate logistic regression analysis showed that using a soft mist inhaler (adjusted odds ratio, AOR = 23.29; 95% confidence interval, 95% CI [2.84, 191.07]), using a dry powder inhaler (AOR =15.60, 95% CI [1.99, 122.26]), and higher satisfaction with the inhaler were positively and independently associated with accurate inhaler use (AOR = 1.94, 95% CI [1.09, 3.44]). Important factors related to inhaler use accuracy include inhaler type and level of patient satisfaction with their inhaler. Healthcare professionals should regularly confirm that older patients are able to use their inhalers correctly and are satisfied with their inhalers.

Impact of pollen season and viral disease COVID-19 on respiratory function of the adult population in Eastern Slovakia: analysis of spirometric data and results of a questionnaire survey

Introduction Asthma is a chronic heterogeneous disease with characteristic symptoms, but with proper treatment the patient can lead a full life. In patients with allergic asthma, symptoms appear after irritation with an allergen, most often in the pollen season. In 2019, the viral disease COVID-19 appeared, which, especially in people with asthma, led not only to an asthma attack, but also to other serious diseases. Methods The main aim was to investigate differences in patients’ health status by comparing spirometric values in and out of pollen season (A), spirometric values before and after COVID-19 viral illness (B) and an anonymous questionnaire (C). Spirometric values were recorded in each patient (control group - patients diagnosed with asthma, research group - patients after overcoming COVID-19 disease) in 3 cycles, namely (in the pollen period, in the non-pollen period and after overcoming COVID-19 disease - at an interval of 2 months after a negative PCR test). Results We observed significant results during the individual spirometry performed (A) during the pollen season and non-pollen season. We observed the same in patients after they received COVID-19 treatment (B). Patients were also asked questions regarding family history, symptoms and their variability, worsening of the condition or correct inhalation technique (C). Conclusion Our research shows that the PEF parameter is most affected by the pollen and non-pollen season in asthmatic patients. Significant differences in PEF parameter were observed between genders, where we observed highly significant statistical significance of PEF parameter in pollen and non-pollen season in females.

Successful Use of Easyhaler® Dry Powder Inhaler in Patients with Chronic Obstructive Pulmonary Disease; Analysis of Peak Inspiratory Flow from Three Clinical Trials.

There is increasing pressure to use environmentally friendly dry powder inhalers (DPI) instead of pressurized metered-dose inhalers (pMDI). However, correct inhalation technique is needed for effective inhaler therapy, and there is persistent concern whether patients with chronic obstructive pulmonary disease (COPD) can generate sufficient inspiratory effort to use DPIs successfully. The aims of this study were to find clinical predictors for peak inspiratory flow rate (PIF) and to assess whether patients with COPD had difficulties in generating sufficient PIF with a high resistance DPI. Pooled data of 246 patients with COPD from previous clinical trials was analyzed to find possible predictors of PIF via the DPI Easyhaler (PIFEH) and to assess the proportion of patients able to achieve an inhalation flow rate of 30 l/min, which is needed to use the Easyhaler successfully. The mean PIF was 56.9l/min and 99% (243/246) of the study patients achieved a PIF ≥ 30l/min. A low PIF was associated with female gender and lower forced expiratory volume in 1s (FEV1), but the association was weak and a statistical model including both only accounted for 18% of the variation seen in PIFEH. Based on our results, impaired expiratory lung function or patient characteristics do not predict patients' ability to use DPIs in COPD; 99% of the patients generated sufficient PIFEH for successful dose delivery. Considering the targets for sustainability in health care, this should be addressed as DPIs are a potential option for most patients when choosing the right inhaler for the patient. Two of three included trials were registered under numbers NCT04147572 and NCT01424137. Third trial preceded registration platforms and therefore, was not registered.

Asthma and Sport

Asthma is a chronic inflammatory disease of the airways affecting approximately 300 million people worldwide. Asthma causes recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing, typically occurring at night or early in the morning. The article discusses the pathophysiology of asthma, characterized by episodic, reversible airway constriction, airway hyperreactivity, and underlying inflammation. Diagnosis and management of asthma require precise methods and adjustments in lifestyle and medication to minimize exposure to known triggers and prevent severe exacerbations. Additionally, the relationships between asthma and COPD, as well as asthma and physical activity, particularly exercise-induced asthma, are explored. Recent developments in asthma treatment, such as the use of combined inhalation medications and the treatment of upper respiratory tract diseases to improve asthma symptoms, are also highlighted. Furthermore, the importance of spirometry as a diagnostic tool and correct inhalation techniques to maximize therapy efficiency are emphasized.

Understanding Knowledge, Practices, and Barriers in Metered Dose Inhaler Use Among Sri Lankan Patients with Bronchial Asthma and Chronic Obstructive Pulmonary Disease

Background and Aims: Despite declining mortality rates, asthma and chronic obstructive pulmonary disease (COPD) continue to pose significant public health challenges with persistently high morbidity rates. One prominent con¬tributing factor is the inadequate use of prescription metered dose inhalers (MDIs) by patients, leading to insufficient dosing and suboptimal disease control. Thus, it is crucial to assess patients’ knowledge, practices, and barriers concerning MDI usage. Methods: This descriptive convenience sampling, conducted at Polonnaruwa District General Hospital in Sri Lanka, enrolled 250 participants to investigate MDI-related behaviors. Questionnaire was used as data collection tool and sampling technique is conveniet sampling. Microsoft Excel spreadsheet and SPSS version 20 (IBM Corporation, New York, USA) software were used for statistical analysis. Results: The majority of participants were aged over 40, with a higher proportion of females (59%) than males (39%). Over half of them had been managing bronchial asthma and COPD for more than five years. Notably, all participants were MDI users, but 59% reported disease exacerbations occurring more than four weeks ago, with dust being the primary trigger (45%). Healthcare professionals, especially nurses and doctors, were common sources of MDI education. However, none of the participants demonstrated correct inhalation technique both before and after receiving education, raising significant concerns. Conclusions: This study highlights the inadequacies in MDI utilization among participants, emphasizing the urgent need for improved patient education by healthcare professionals. Addressing these knowledge and skills gaps related to MDI usage is essential for enhancing asthma and COPD management, ultimately leading to improved patient outcomes and a reduced disease burden.

Practice of Metered Dose Inhaler Technique and Health Impacts of COPD Patients in Bangladesh

Objective: This study aimed to identify the practice of the Metered Dose Inhaler (MDI) technique and the health impact of disease and investigate their relationship among COPD patients in Bangladesh. Methods: This was a descriptive correlational study. 102 COPD patients were recruited conveniently from Dhaka's National Institute of Diseases of the Chest and Hospital (NIDCH). The data was collected from September to October 2023. Data was collected using an observation checklist and a face-to-face interview using a structured questionnaire. A 12-point checklist was used to assess the practice of the MDI technique, and the COPD Assessment Test (CAT) questionnaire was used to measure the health impact. Both descriptive and inferential statistics were used to analyze data. Result: Only 5.9% of COPD patients correctly performed the MDI using the technique, and more than half of the patients had a high health impact on COPD. A significant relationship was found between the practice of the MDI technique and the health impact of COPD patients (p=0.001)). The practice of the MDI technique was also associated with the patient's age, smoking, employment status and duration of using MDI. In contrast, the health impact of COPD was associated with the patient's age, education status, marital status, smoking, employment status, monthly family income and duration of using MDI. Conclusion: It is concluded that the majority of COPD patients incorrectly practice their MDI technique, and the health impact on COPD is high. Inhaler teaching and training are highly recommended for COPD patients to minimize errors and promote correct inhaler techniques.

The Effect of Simulation-Based Education on Patient Training Correct Inhaler Technique of Nursing Students: A Randomized Controlled Trial.

Teaching inhaler techniques to nursing students is crucial. This study aimed to investigate the effect of simulation-based education on patient training correct inhaler technique in nursing students. This is a single-blind, randomized controlled trial in which nursing students are randomly allocated into two groups of control (n = 41) and intervention (n = 40). The students' mean score of correct inhaler technique was measured before and one week after intervention, using checklists of inhaler techniques. The mean score of control group was significantly lower than the intervention group (p < .001). The results also revealed that there was no significant difference in students' level of confidence regarding the ability to educate patients on inhaler techniques before the intervention, while all students were shown to have higher levels of confidence in this term after the intervention. Simulation is an effective way to train nursing students in the correct inhaler techniques.

Telepharmacy versus Face-to-Face Approach in Providing Inhaler Technique Training Service: A Non-Inferiority Assessment Among German Pharmacy Students.

The use of telepharmacy in delivering pharmaceutical care services has grown in the past few years; however, there are perceptions of its inappropriateness for providing medical device training among pharmacy students and practicing pharmacists. The primary objective of this study was to determine if the telepharmacy approach for providing inhaler technique training service was non-inferior to the face-to-face approach regarding pharmacy students' performance in simulated patient encounters. Secondary objectives were to determine students' self-assessment of their ability to demonstrate and practice inhaler technique between the two modes of communication and their perceptions of telepharmacy. A randomized crossover non-inferiority trial was conducted among undergraduate pharmacy students. Outcomes were measured by comparing Objective Structured Clinical Examination (OSCE) scores of participants' performance between two modes of communication while providing inhaler technique training service. Moreover, the participants also completed self-assessment and perception questionnaires. The telepharmacy approach was non-inferior to the face-to-face approach for demonstrating and practicing the correct inhaler technique based on OSCE scores and a predefined non-inferiority margin of -10%. The results also revealed no significant differences in student self-confidence between the two modes of communication. Moreover, participants had a largely positive perception of telepharmacy and its use in providing inhaler technique training service. Considering our findings, telepharmacy is a viable alternative to traditional face-to-face consultations for providing inhaler technique training service. However, to address perceived difficulties and differences between virtual and face-to-face consultations, the pharmacy curriculum should include more telepharmacy-related didactic content with experiential learning and simulations.

Optimization of Inhalation Technique Knowledge in the Pharmacies of Matosinhos Municipality, Portugal: An Intervention Project.

The therapeutic approach to the most common respiratory diseases, asthma and chronic obstructive pulmonary disease (COPD), involves the use of inhalation devices. Its use is essential, but incorrect use is frequent, and learning and reviewing the technique is necessary for the adequate management of these diseases. This study aims to increase the knowledge of health professionals from pharmacies in the municipality of Matosinhos, Portugal, about the correct inhalation technique. The project developed from May 2022 to June 2023 was based on a training session for pharmacy professionals that took place after professionals completed a questionnaire and after evaluating each participant's inhalation technique by the authorsusing a checklist. Both were reapplied three months after the first evaluation. Fifteen pharmacies in Matosinhos, Portugal, were invited, of which eight agreed to participate, with a total of 16 health professionals (30.8% of professionals in these pharmacies). We found that professionals questioned and taught users more times about the inhalation technique and that a greater number of professionals considered they knew how to correctly perform the inhalation technique in the second assessment. It was also possible to verify statistically significant differences (p<0.001) between the mean of correct steps in the inhalation technique between the first and second assessments. There was also an improvement in the qualitative analysis of errors in the inhalation technique. In the first assessment, the inhalation devices with the lowest percentage of correct steps were Forspiro® and Respimat®. In the second evaluation, the Diskus® and Ellipta® devices obtained 100% correct steps, with the K-haler® being the device with the lowest percentage. This study confirms the effectiveness of continuous training for health professionals and the importance of multidisciplinary cooperation in teaching inhalation techniques. Other studies are needed to complement these results, particularly with representative samples of the general population, or assessing the impact of this intervention in patients with respiratory diseases.

Achieving mastery in inhaler technique: An evaluation of training provided to general practice healthcare professionals

Abstract Introduction A local scoping questionnaire on previous training and confidence demonstrating inhaler technique in general practice (GP) healthcare professionals (HCP), identified that despite frequent consultations with patients with respiratory disease, 43% reported being self-taught on inhalers. In addition, the proportion of HCPs who reported confidence for demonstrating inhaler technique was low, approximately 60% for pressurised metered dose inhalers (pMDI), and 35-50% for the dry powder inhalers (DPIs) Ellipta, Easyhaler, and NEXThaler. Aim To evaluate the impact of an expert-led face-to-face inhaler technique workshop on HCP confidence and skills. Methods GP HCPs at seven Primary Care Networks (PCN) within Leeds Integrated Care Board (ICB) were invited to attend a multidisciplinary pilot inhaler training session in September 2022, led by a Consultant Respiratory Pharmacist and three facilitators. Inhaler technique was assessed at baseline and after education on the theory and practical issues of inhaler technique for the four most prescribed devices locally (Ellipta, Easyhaler, pMDI, NEXThaler). Inhaler technique was assessed using a seven-step checklist and scored as Optimal (no errors), Satisfactory (no critical errors, but some minor errors) or Unsatisfactory (at least 1 critical error).1 Each facilitator was allocated one inhaler device type and assessed all attendees with that same device. Attendees were asked to complete a post-training evaluation questionnaire, which asked about understanding of inhaler technique and confidence in demonstrating it. Data were subjected to descriptive statistical analysis. This evaluation of educational provision did not require ethical approval. Results Data was available for 23 of the 24 participants who completed the full session. Inhaler technique improved across all four devices post-training. The proportion of HCPs with satisfactory or optimal inhaler technique improved by 87% for Ellipta (from 4% to 91%), 65% for Nexthaler (from 22% to 87%), 17% for pMDI (from 0% to 17%) and 65% for Easyhaler (from 0% to 65%). The most common critical error made using pMDI, even after training, was inhaling too fast, whilst the most common critical error for Ellipta, Easyhaler and Nexthaler devices was not tilting the chin up prior to inhalation. This improved after training. 22 attendees completed a post-training session evaluation form. An improvement in understanding of correct inhaler technique was reported by 89% of HCPs, and 100% agreed they felt more confident demonstrating inhaler technique to patients. Discussion/Conclusion Evaluation of our expert-led inhaler technique training showed that HCPs were more likely to feel confident and achieve mastery in inhaler technique using DPIs than pMDI. Despite pMDIs being the device HCPs felt most confident using prior to training, this was the device HCPs performed poorly in. Post-training, many attendees described that to use a pMDI they inhale slowly and steadily, but on demonstration continued to inhale quickly and deeply, highlighting the difficulty in changing ingrained incorrect practice. Whilst understanding on how to use pMDIs correctly probably improved, it is likely that more practice is required. Consideration should be given to regular repeat training sessions, and the setting of these (in person, remote or eLearning) should be assessed in wider rollout of this initiative.

Education on Inhaler Technique by Pharmacists To Improve The Quality of Life of COPD Patients: A Systematic Review and Meta-Analysis

Background: This systematic review aimed to analyze the importance of education on using inhalers by pharmacists in improving quality of life, correct inhaler use steps, and medication adherence in patients with Chronic Obstructive Pulmonary Disease (COPD).Methods: The databases used to search for articles in this systematic review include Scopus, ScienceDirect, and Pubmed. The papers submitted were published between 2009 and 2022, with the most recent search being conducted in December 2022. This review included a randomized controlled trial evaluating education on inhaler use techniques by pharmacists to improve COPD patients' quality of life in inpatient and outpatient settings. This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) writing guidelines.Results: This systematic review used six articles from five different countries. The articles involved share similar characteristics so that analysis can be carried out. The total number of research subjects included was 913 subjects. Most studies show an increase in the quality of life among COPD patients who are given education on how to use inhalers by pharmacists using print or digital media. Measurements using the St. George's Respiratory Questionnaire (SGRQ) showed a decrease in scores at the 6-month and 12-month periods (-0.75 [95% CI (-1.46 - (-.005)]. Furthermore, two articles reported that education on the technique of using inhalers by pharmacists can also increase the accuracy of using inhalers, and three articles reported increasing medication adherence.Conclusion: Interventions such as education on using inhalers by pharmacists in inpatient and outpatient settings can improve the quality of life of COPD patients, the accuracy of the steps in using inhalers, and medication adherence.

Effectiveness of an educational intervention about inhalation technique in healthcare professionals in primary care: a cluster randomized trial.

Background: Incorrect inhalation technique (IT) is an important issue for chronic obstructive pulmonary disease (COPD) patients and healthcare professionals. Studies in which counseling is carried out with healthcare professionals beforehand so that they can properly educate their patients are required. The objective of the present trial is to assess the improvement in the performance of the IT in subjects with COPD and prescribed inhaled therapy after the implementation of an educational intervention conducted by their general practitioners. Methods: A cluster randomized clinical trial was conducted. A total of 286 COPD patients received scheduled inhalation therapy from 27 general practices in seven primary care centers. A teach-back educational intervention was implemented for both healthcare professionals and patients. The primary outcome of this study was the performance of the correct inhalation technique. It is considered a good technique if all steps in the inhalation data sheet are correctly performed. The secondary outcomes were assessed using forced spirometry, the basal dyspnea index, the Medical Research Council dyspnea scale, St George's Respiratory Questionnaire (SGRQ), and EuroQoL5D-5L for health-related quality of life. A one-year follow-up was conducted using an intention-to-treat analysis. Results: After the intervention, incorrect IT was observed in 92% of professionals and patients, with rates reaching 50% and 69.2%, respectively. The effectiveness in patients was significant, with a number needed to treat of 2.14 (95% CI 1.79-2.66). Factors related to correct IT in patients included the type of intervention, length of intervention (>25min), good pulmonary function, age (youngest <=65, oldest >83), and less limitation of activity due to dyspnea. There was no relation with the cluster. Conclusion: This study shows the effectiveness of direct inhaler technique training provided by a trained professional on an appropriate timescale (for example, a specific consultation for medication reviews), aiming to help subjects improve their performance using the teach-back method. This could be an encouraging intervention to improve medication adherence and health promotion in people with COPD. Clinical Trial Registration: clinicaltrials.gov, identifier ISRCTN93725230.

Evaluation of Effectiveness of a New Kit of Reagents for Detection of Mutations Associated with Drug Resistance of Tuberculous Mycobacteria to Rifampicin and Isoniazid, by PCR according to Evidences of Clinical Trials

The objective: to evalute effectiveness in clinical trials of the new kit of reagents of AmpliTest® MBT-Resist-I based on real-time PCR (RT-PCR) versus similar kits of reagent registered in Russia, to identify genetic markers of M. tuberculosis complex (MTB) resistance to rifampicin (RIF) and isoniazid (INH) in human biological samples and MTB cultures.Subjects and Methods. 200 DNA samples were studied, they had been obtained from biological specimens (sputum (N=100), bronchoalveolar lavage (N=50), biopsy (surgical material; N=50)) of pulmonary tuberculosis patients and containing MTB DNA at a concentration of at least 1 x 103 GE/ml, and from 100 DNA samples of MTB cultures. Efficiency of detecting mutations associated with MTB resistance to RIF and INH using the new kit of reagent of AmpliTest® MBT-Resist-I was evaluated in comparison with HP Amplitube-MDR-RV (OOO Sintol, Russia). In the case of discordant results, the target MTB DNA loci were sequenced by Sanger.Results. We observed complete agreement of the results and consequently high efficiency rates (positive and negative concordance of results - 100%, respectively) of the new kit of reagents of AmpliTest® MBT-Resist-I in comparison with the kit of reagent of Amplitube-MDR-RV in detection of mutations associated with MTB resistance to both RIF and INH, both for human samples and for MTB cultures. In two DNA samples of MTB cultures, an additional mutation (I572L) in the rpoB gene was detected using the new kit of reagents which was not detected by the comparison kit and was confirmed by Sanger sequencing.Conclusion. Inhalers vary significantly by the patients' ability to use them correctly. Asthma patients master the correct inhalation technique better versus COPD patients. Liquid inhalers were more difficult to be used correctly, and the best results were observed with multi-dose powder inhalers. The patient's training by a healthcare professional is critical to assure the correct use of inhalers.