Correct Inhaler Use Research Articles

Mastery of pMDI technique, asthma control and quality-of-life of children with asthma: A randomized controlled study comparing two inhaler technique training approaches

ObjectiveVerbal counselling (VC) is the clinical standard for training patients on correct inhaler use. Patients fail to recall their VC with time. Ethical approval was obtained to compare the pressurized metered dose inhaler (pMDI) VC with Trainhaler (TH), a novel pMDI inhalation flow and technique training device, in children with asthma. MethodsAt visit 1, 7–17 year-old children with a pMDI hand-lung coordination problem including a fast peak inhalation flow (PIF) through pMDI >60 L/min were randomized into either VC group that received verbal pMDI training; or into TH group that were trained on- and given TH to practice at home. Whereas, children with correct pMDI use formed the control group (CT). Overall pMDI technique, PIF through inhaler, asthma control (AC) and quality of life (QoL) were evaluated. Participants were re-evaluated 6–8 weeks later (visit 2). ResultsOf 105 enrolled children; 76 completed the study (VC = 21, TH = 25 and CT = 30). VC decreased non-significantly (p > 0.05) the mean PIF from 104.0 L/min at visit 1 to 84.8 at visit 2. Whilst, the TH did significantly (p < 0.05) reduce the PIF from 113.5 to 71.4 L/min. The two approaches similarly and significantly (p < 0.05) improved the inhaler technique, AC and QoL scores. ConclusionsThe TH improved the inhalation flow through the pMDI close to the ideal needed for adequate lung deposition. Both methods equally enhanced the children's mastery of pMDI use. This was reflected on better AC and QoL. Accessibility to TH might help maintaining the good inhaler use and decreasing regular VC.

Teaching-Learning Experience Regarding Skill in Using Inhalers: Medical Students Teaching Nursing Students.

Teaching-learning experience involving more than one health care discipline is a topic of great interest in the health sciences. Few such experiences are known in which medical students taught nursing students a clinical skill. The authors evaluated the effect of fourth-year medical students teaching the correct use of a metered-dose inhaler (MDI) to bachelor of science nursing (BSN) students. An fourth-year medical student investigator taught BSN students the correct use of an MDI in individual, private educational sessions, approximately 10 minutes in length, in a large health sciences center. BSN students were scored in use of MDI preeducation and posteducation. Instruction included both discussion and demonstration by the M4S. Among 20 BSN students, posteducation scores were markedly improved for total steps (p < .0001), and six of nine individual steps for MDI use. Brief teaching-learning sessions are effective in teaching nursing students the correct use of MDI. [J Nurs Educ. 2017;56(2):120-122.].

Effect of Implementing an Educational Module About Inhaler Use on Severity of Dyspnea and Adherence to Inhalation Therapy Among Patients with Chronic Obstructive Pulmonary Disease

One of the most important routes for medication administration to treat chronic obstructive pulmonary disease patients is the inhaled one. If this method is not proper, medications will not be effective. The aim of this study was to determine the effect of implementing an educational module about inhaler use on severity of dyspnea and adherence to inhalation therapy among patients with chronic obstructive pulmonary disease. A purposive sample of 140 patients with COPD was selected and divided randomly and alternatively into two equal groups, 70 in each. The study was conducted at Chest department and Medical outpatient clinics of Menoufia University and Shebin El-Kom Teaching Hospitals. Five tools were utilized for data collection: Structural interview questionnaire, Bristol COPD knowledge questionnaire, Pressurized metered dose inhaler performance observational checklist, Shortness of breath questionnaire and Morisky Medication adherence scale. Results: 62.9% of study group and 54.3% of control group complained of severe dyspnea pre education, while 44.3% of study group and 54.3% of control group still complained of severe dyspnea one month post education. The improvement of dyspnea among study group than control group was not significant. However medication adherence was significantly improved among study group compared to control group post education. Conclusion: educational module about inhaler use significantly led to improve medication adherence and decrease dyspnea severity however the difference in dyspnea severity among both groups is not significant. Recommendations: Patient's education about correct inhaler use should be ongoing process for all COPD patients and the correct use of inhaler should be observed throughout patient's life.

Parent and Clinician Preferences for an Asthma App to Promote Adolescent Self-Management: A Formative Study.

BackgroundMost youth asthma apps are not designed with parent and clinician use in mind, and rarely is the app development process informed by parent or clinician input.ObjectiveThis study was conducted to generate formative data on the use, attitudes, and preferences for asthma mHealth app features among parents and clinicians, the important stakeholders who support adolescents with asthma and promote adolescent self-management skills.MethodsWe conducted a mixed-methods study from 2013 to 2014 employing a user-centered design philosophy to acquire feedback from a convenience sample of 20 parents and 6 clinicians. Participants were given an iPod Touch and asked to evaluate 10 features on 2 existing asthma apps. Participant experiences using the apps were collected from questionnaires and a thematic analysis of audio-recorded and transcribed (verbatim) interviews using MAXQDA. Descriptive statistics were calculated to characterize the study sample and app feature feedback. Independent samples t tests were performed to compare parent and clinician ratings of app feature usefulness (ratings: 1=not at all useful to 5=very useful).ResultsAll parents were female (n=20), 45% were black, 20% had an income ≥US $50,000, and 45% had a bachelor’s degree or higher education. The clinician sample included 2 nurses and 4 physicians with a mean practice time of 13 years. Three main themes provided an understanding of how participants perceived their roles and use of asthma app features to support adolescent asthma self-management: monitoring and supervision, education, and communication/information sharing. Parents rated the doctor report feature highest, and clinicians rated the doctor appointment reminder highest of all evaluated app features on usefulness. The peak flow monitoring feature was the lowest ranked feature by both parents and clinicians. Parents reported higher usefulness for the doctor report (t(10)=2.7, P<.02), diary (t(10)=2.7, P<.03), and self-check quiz (t(14)=2.5, P<.02) features than clinicians. Specific participant suggestions for app enhancements (eg, a tutorial showing correct inhaler use, refill reminders, pop-up messages tied to a medication log, evidence-based management steps) were also provided.ConclusionsParent and clinician evaluations and recommendations can play an important role in the development of an asthma app designed to help support youth asthma management. Two-way asthma care communication between families and clinicians and components involving families and clinicians that support adolescent self-management should be incorporated into adolescent asthma apps.

Feasibility Study of Interactive Game Technologies to Improve Experience with Inhaler Spacer Devices in Young Children

The correct use of inhaler devices with facemasks and spacers in young children can be difficult for both children and parents, resulting in distress for both, poor adherence and ineffective drug delivery. The aim of this study was to develop and assess the utility and impact of an interactive electronic game designed to improve the experience of spacer devices in young asthmatic children. The Respiratory Aid For Inhaler (RAFIhaler) technology consists of a smartphone mounted on a metered dose inhaler with a valved holding chamber device (spacer) and connected to an electronic sensor adjacent to the outflow valve of the spacer. A custom-designed android application on the smartphone derives the child’s breathing patterns from the sensor, translating this information into visible effects on on-screen cartoon characters. After a period of iterative development, the final structure and software design was tested on children at Royal Manchester Children’s Hospital who had been admitted with acute wheeze. A survey, including open-ended questions, was administered to assess the parent and child’s reaction to the RAFIhaler. A total of 14 children (age range 2–7 years; 7 boys) participated in the study and used the RAFIhaler, of whom 13 completed the final survey; all 14 parents completed the survey. All 13 children reported they enjoyed playing the game. Ten of these children (91%) felt that the RAFIhaler helped them in taking their medication, and 13 of the 14 parents felt that RAFIhaler helped their children use their spacer. The one parent who felt that the RAFIhaler was not of any benefit felt his/her child already used the inhaler well. Some of the benefits of the RAFIhaler specifically voiced by parents were “enjoyable” (n = 3), “good distraction” (n = 3), “made child calmer” (n = 2), “helped in breathing/inhalation technique” (n = 3) and “would be useful in home setting” (n = 1). Young children may benefit from the incorporation of devices and game applications with use of their inhalers. Feedback from children and parents suggests potential benefits to children may include learning correct use, reducing distress and anxiety and improving overall adherence.

A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices.

Errors in the use of different inhalers were investigated in patients naive to the devices under investigation in a multicentre, single-visit, randomised, open-label, cross-over study. Patients with chronic obstructive pulmonary disease (COPD) or asthma were assigned to ELLIPTA vs DISKUS (Accuhaler), metered-dose inhaler (MDI) or Turbuhaler. Patients with COPD were also assigned to ELLIPTA vs Handihaler or Breezhaler. Patients demonstrated inhaler use after reading the patient information leaflet (PIL). A trained investigator assessed critical errors (i.e., those likely to result in the inhalation of significantly reduced, minimal or no medication). If the patient made errors, the investigator demonstrated the correct use of the inhaler, and the patient demonstrated inhaler use again. Fewer COPD patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS, 9/171 (5%) vs 75/171 (44%); MDI, 10/80 (13%) vs 48/80 (60%); Turbuhaler, 8/100 (8%) vs 44/100 (44%); Handihaler, 17/118 (14%) vs 57/118 (48%); Breezhaler, 13/98 (13%) vs 45/98 (46%; all P<0.001). Most patients (57–70%) made no errors using ELLIPTA and did not require investigator instruction. Instruction was required for DISKUS (65%), MDI (85%), Turbuhaler (71%), Handihaler (62%) and Breezhaler (56%). Fewer asthma patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS (3/70 (4%) vs 9/70 (13%), P=0.221); MDI (2/32 (6%) vs 8/32 (25%), P=0.074) and significantly fewer vs Turbuhaler (3/60 (5%) vs 20/60 (33%), P<0.001). More asthma and COPD patients preferred ELLIPTA over the other devices (all P⩽0.002). Significantly, fewer COPD patients using ELLIPTA made critical errors after reading the PIL vs other inhalers. More asthma and COPD patients preferred ELLIPTA over comparator inhalers.

Culturally Specific Evaluation of Inhaler Techniques in Asthma.

Little work has been done on identifying the impact of educational materials developed by immigrant patients themselves, along with their caregivers and health professionals in terms of inhaler use technique. The purpose of this study was to evaluate understanding of physicians' instructions on asthma management and inhaler techniques in Punjabi and Chinese subjects using educational interventions in their native languages. Eighty-seven subjects with asthma were randomly assigned to either one of 3 experimental groups (physician-led video, subject-generated community video, or both) or a control group (educational pamphlet). Medication knowledge and inhaler skills were measured during 3 in-person interviews. Subjects in all 3 experimental groups, when compared with control subjects, demonstrated improvements in the follow-up test in terms of ability to use inhalers correctly (P < .001) and understanding of physicians' instructions (P = .008). Chinese participants showed significantly greater improvements compared with Punjabi participants for the correct use of inhalers (P < .047), and females showed greater improvements compared with male subjects (P = .04). The educational interventions developed were successful in behavioral modification and beneficial beyond usual care in terms of improving proper use of inhalers and understanding of physicians' instructions. The findings can be translated to health education practice, promoting the development of short, simple, and culturally linguistically appropriate learning materials for patients. Such interventions that draw on patients' life experiences and socio-cultural context can overcome certain limitations of conventional patient education approaches. (ClinicalTrials.gov registration NCT01474928.).

ASTHMA INHALATION DEVICES

Asthma is treated mainly with inhaled medications in several forms, including the pressurized Metered Dose Inhaler (pMDI). Unfortunately, appropriate delivery of the chosen drug depends heavily on the patient’s inhaler technique. The Global initiative for Asthma (GINA) suggests that the correct use of inhalers is an important feature in preventing exacerbations of asthma. Several studies have shown that poor use of the inhaler device is the main feature in poorly controlled disease. Many asthma patients derive incomplete benefit from their inhaled medication because they do not use their inhaler devices correctly or they fail to maintain the correct inhaler technique. This is clearly one of the major limitations in treating Asthma. Informing patients about their asthma could help in achieving better control over their asthma symptoms. Asthma patients need also to be shown and trained on how to use their prescribed inhaler devices properly. Not only various patients’ characteristics but also the device that patients use to inhale the medicine has an effect on correct inhalation technique. Further, there is evidence that the use of multiple inhaler types confuses the patient and increases the risk of errors in their inhaler use.

Overuse of short-acting beta-agonist bronchodilators in COPD during periods of clinical stability

BackgroundOveruse of short-acting beta-agonists (SABA) is described in asthma, but little is known about overuse of SABA in chronic obstructive pulmonary disease (COPD). MethodsProspective 3-month cohort study of patients with moderate-to-severe COPD who were provided a portable electronic inhaler sensor to monitor daily SABA use. Subjects wore a pedometer for 3 seven-day periods and were asked to complete a daily diary of symptoms and inhaler use. Overuse was defined as >8 actuations of their SABA per day while clinically stable. ResultsAmong 32 participants, 15 overused their SABA inhaler at least once (mean 8.6 ± 5.0 puffs/day), and 6 overused their inhaler more than 50% of monitored days. Compared to those with no overuse, overusers had greater dyspnea (modified Medical Research Council Dyspnea Scale: 2.7 vs. 1.9, p = 0.02), were more likely to use home oxygen (67% vs. 29%, p = 0.04), and were more likely to be on maximal inhaled therapy (long-acting beta-agonist, long-acting antimuscarinic agent, and an inhaled steroid: 40% vs. 6%, p = 0.03), and most had completed pulmonary rehabilitation (67% vs. 0%, p < 0.001). However, 27% of overusers of SABA were not on guideline-concordant COPD therapy. ConclusionsOveruse of SABA was common and associated with increased disease severity and symptoms, even though overusers were on more COPD-related inhalers and more had completed pulmonary rehabilitation. More research is needed to understand factors associated with inhaler overuse and how to improve correct inhaler use.

Acute cardiopulmonary repercussions in the correct use of the dry-powder inhalers

Study model: It is a cross-over, clinical and comparative study. Objective: To evaluate the acute respiratory and cardiac respercussions in correct use of the dry powder inhalers (DPI) in patients with asthma. Methodology: Seventeen adult patients with asthma using DPI (Formoterol and Budesonide) were evaluated in two moments. The mensuared variables, before and after use of DPI, were: anthropometric, cognitive, muscle strength, vital signs, periferic oxygen saturation, respiratory pressures and peak expiratory flow. In the first moment (M1) was evaluated and monitored the usual performance before and immediately after using DPI and delivered an explicative leaflet about the correct use. In the second moment (M2), 30 days after M1, there was the same evaluation, however, with correct use of the DPI. Results: In the M2 there were increases to inspiratory pressure of 64,2±2,03 to 74,1±31,7 (cmH2O); expiratory pressure of 71,05±33,8 to 80±31,4 (cmH2O); vital capacity of 3,3±0,9 to 3,9±0,9 (l) and reductions in the pulse frequence of 80,3±10,7 to 72,2±9,4 (bm) and double product of 10001±1693 to 8846±1416 (paired t test, p&lt;0,05). Conclusions: The correct use of the DPI promoves the positive respiratory and cardiac repercussions, improving respiratory conditions and reducing cardiac work&gt;&lt;0,05). Conclusions: The correct use of the DPI promoves the positive respiratory and cardiac repercussions, improving respiratory conditions and reducing cardiac work

Knowledge that people with intellectual disabilities have of their inhaled asthma medications: messages for pharmacists

Fifteen percent of Australians with intellectual disability (ID) are reported to have asthma. People with ID are at risk of poor health knowledge due to deficits in intellectual and adaptive functioning, but their medication knowledge has largely been ignored in research to date. To explore the level of understanding of asthma medication use of people with ID who self-administer their inhaled medications, in order to inform future educational support. Setting The research was conducted in NSW, Australia, at the participants' homes, the point of health care access, or the offices of relevant support organisations. In this qualitative study face-to-face interviews were conducted with people with ID using a semi-structured interview guide. The interviews were recorded, transcribed and thematically analysed. Main outcome Identification of barriers to asthma medication self-management by people with ID. Seventeen people with ID who self-administer their asthma medications were interviewed. Factors influencing their asthma medication knowledge and use included understanding of their illness and the need for medication; aspects of self-management and autonomy versus dependence. This sample of people with ID had a good understanding of the importance of using their inhaled asthma medications, as well as asthma triggers, and the difference between use of preventer and reliever medications. Both enablers and barriers to asthma medication self-management were identified in the domains of managing attacks, adherence, knowledge of side effects and sources of information on correct use of inhalers. The level of autonomy for medication use varied, with motivation to self-manage asthma influenced by the level of support that was practically available to individual participants. This research investigated aspects of asthma medication self-management of people with ID. Based on the barriers identified, pharmacists should promote use of spacers and written asthma action plans as well as counsel people with ID about how to recognise and minimise side effects of asthma medications. Specific strategies for pharmacists when educating people with ID and their caregivers include active listening to determine understanding of concepts, exercising care with language, and working with the person's known routines to maximise adherence with preventer medications.

Incorrect use of metered-dose inhalers in adult patients at a hospital in Callao, Peru, 2014: cross-sectional study.

Inhalation therapy has proven to be the best way to control the asthma and chronic obstructive pulmonary disease symptoms. The most commonly used delivery system to control these symptoms is the metered-dose inhaler. The primary goal of this study is to demonstrate an association between incorrect inhaler use and patient age. This is a cross-sectional study, performed at Centro Médico Naval “Cirujano Mayor Santiago Távara”, in Callao, Peru, in 2014. Patients older than 18 years that used metered-dose inhalers were included. We used film recordings of patients using a metered-dose inhaler and compared their technique with the recommendations on the guidelines on the correct use of inhalers of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). The main variables measured were age and incorrect inhaler use. The results were analyzed with the Chi squared test for bivariate analysis, and for multivariate analysis we used the Poisson regression model with robust variance. We included 378 patients in the analysis; 167 were older than 60 years. An association was found between incorrect inhalator technique and age (p=0.014) (PR 1.19 95% CI 1.03 to 1.37). The highest prevalence of incorrect technique was found in the young adult population (88%). There was no association between the incorrect technique and the person who taught it (p=0.114). Finally, this study showed that 81.2% of the study population presented an incorrect inhalation technique. The percentage of incorrect inhaler use, in the general population is high. Even if we found no association between an incorrect technique and the person who taught it; still, there is a high percentage of errors and it was even demonstrated that being instructed by a pulmonologist does not guarantee a correct performance of metered-dose inhaler inhalations.

The role of direct support professionals in asthma management

Background Respiratory disease is common in people with intellectual disability (ID). The inhaled route is preferred for medication administration in treating respiratory diseases, including asthma. People with ID often need assistance with taking medicines due to cognitive, physical, and sensory impairments; in supported accommodation this assistance is provided by direct support professionals (DSPs).Method A qualitative study design was used to explore DSPs’ experiences with asthma medication management. Data were collected via in-depth, semistructured, face-to-face or telephone interviews.Results Key findings included the complex balance of duties undertaken by DSPs, and a lack of consistency in asthma management processes across sites.Conclusions This exploratory research suggests that DSPs are involved in asthma management and required to use clinical judgement, but are not provided with education and tools to manage asthma in, and foster correct inhaler use by, their clients. This highlights the need for tailored guidelines that integrate with the principles of the National Disability Insurance Scheme.

Education on Correct Inhaler Technique in Pharmacy Schools: Barriers and Needs

Purpose : To investigate the effectiveness of a standard educational module on pharmacy students’ inhaler technique demonstration skills. Methods : This investigational study was conducted during the Clinical Pharmacy and Therapeutics tutorial classes in 2011. All fifth-year students were given placebo inhaler devices and information leaflets explaining the use of these devices. Students were then shown, by demonstration, the correct technique for each of the inhalers. All the students were assessed on the use of each of the inhalers two weeks following the tutorial. A validated questionnaire regarding the students’ barriers to demonstrate the correct inhaler technique was completed by all the students. The inhaler techniques emonstrated were Accuhaler (ACC), Turbuhaler (TH) and metered-dose inhaler (MDI). Results : Students scored significantly better with ACC with a score of 4.38 ± 1.81 (out of 9.00) than with TH (3.96 ± 1.75 out of 9.00); p = 0.004, and MDI (2.69 ± 1.76 out of 8.00); p < 0.001, based on Friedman test 2 weeks following training. The majority of students (78 %) believed that lack of practice with the devices was the primary barrier to correct inhaler use. Conclusion : Standard educational training may not be the most appropriate method of teaching students the correct use of inhalers. Clearly, there is a practice element missing which needs to be addressed in a feasible way. Keywords : Inhaler technique, Pharmacy education, Hands-on training, Training barrier

Inhaled drug delivery in the hands of the patient.

Asthma and chronic obstructive pulmonary disease (COPD) are both diseases with an increasing prevalence worldwide. Inhaled therapy for these conditions has a number of advantages over systemic therapy, but requires the patients to use, and to master the use of, an inhaler device. However, many patients cannot use inhalers correctly, and over 50% of patients struggle to use a metered-dose inhaler properly. Poor inhaler technique is associated with a reduced asthma control, worst COPD outcomes, and wastage of economic resources. Of perhaps more concern is the fact that many health professionals also do not know how to use inhalers correctly and are therefore not in a position to coach patients effectively. Training patients and caregivers in the correct inhaler preparation and use is an essential component in the process toward achieving reliable and repeatable medication delivery. Instructions should be inhaler-specific, and they include instruction on how to load or prime the device. Providing only the leaflet that comes with the medicines does not lead to adequate inhalation technique, not even immediately after the patient has read the instructions and practiced with the inhaler. One-on-one sessions with health-care professionals probably represent the most effective educational method. However, it appears that, by itself, even repeated instruction could be insufficient to achieve improved adherence in the long term, as there is a tendency for patients or caregivers to forget what they have learned as time elapses since the training event. Thus, despite the development of several new and improved types of inhaler device, the evidence currently available points to little or no progress having been made with patients' ability to use their inhalers. As the range of drugs delivered by inhalation increases, inhaler technique checks and training need to be an integral part of the routine management of any patient with either asthma or COPD.

Inhaler technique training and health-care professionals: effective long-term solution for a current problem.

The aims of this study were (1) to assess the ability of a range of health-care professionals (HCPs: specialists [physicians specializing in management of airways disease], general practitioners, pharmacists, pharmacist assistants, nurses, and respiratory therapists) in Jordan to demonstrate the correct use of some commonly used inhalers using standardized checklists, with highest scores indicating optimal use, and (2) to evaluate the short-term and long-term effectiveness of a single educational intervention on the HCPs' skills in using inhalers. HCPs' inhaler technique was assessed at baseline. All HCPs were then invited to attend a workshop on asthma management with particular reference to inhaler use. At the workshop, HCP skills in inhaler technique were optimized. Inhaler technique was assessed before and after training. All participants were assessed on their inhaler technique at follow-up (after 4 months). Two hundred HCPs (10 specialists, 46 general practitioners, 79 pharmacists, 15 pharmacist assistants, 40 nurses, and 10 respiratory therapists) participated in the study. Specialists scored highest on baseline inhaler technique demonstration skills. All HCPs scored poorly in demonstrating the correct use of the dry powder inhalers when compared with pressurized metered-dose inhalers (MDIs) (range of mean scores ± SD: MDI, 7.24 ± 0.97 to 8.70 ± 0.67; Diskus, 4.83 ± 0.51 to 6.30 ± 1.7; Turbuhaler, 4.90 ± 0.32 to 6.40 ± 1.7). Participants attending the workshop showed improved inhaler skills (mean scores before and after training: MDI, 4.77 ± 1.60 vs 8.77 ± 0.52; Diskus, 4.40 ± 2.60 vs 8.85 ± 0.41; Turbuhaler, 4.96 ± 2.05 vs 8.63 ± 0.67). Four months after the workshop, the inhaler technique of 129 participants was again assessed. Those who had attended the workshop (n = 48) scored significantly higher mean scores for all devices (score = 7.64) than nonattendees (n = 81, score = 5.99, P < .001), by one-way analysis of covariance. With the exception of specialists, HCPs in Jordan need to be updated on their inhaler technique skills, specifically the newer dry powder inhalers. A single effective educational workshop on inhaler technique can significantly improve HCPs' long-term ability to demonstrate these skills.

Correct or incorrect use of inhalers in patients with dyspnea

Introduction: One of the medications used by patients with dyspnea and asthma is sprays whose the way of application is very important. If these medications are not used properly, they will not be effective. The purpose of this study was to investigate the correct or incorrect use of sprays by patients. Material and Method: This double-blind observational analytical study was conducted on patients attending clinics in Jahrom from 2009 to 2013 selected by convenience sampling method. After obtaining patient’s consent, a researcher-made questionnaire was completed by the patients and then they were asked to use spray in the presence of another researcher and then to complete the second questionnaire on how the patient should use the spray. Finally, the data were analyzed. Results: Of a total of 468 participants in this study, 43.6% (n=204) used sprays correctly, and 95.1% of them were trained in this regard. Incorrect use of sprays was observed more in men and older people and there was no relationship between the correct or incorrect use and patients’ education level. Conclusion: Training patients with dyspnea how to use sprays is the essential component of prescribing these medications, and physicians and healthcare providers should consider providing training on correct use of sprays to increase the effectiveness of medications.

Evaluation of a tailored implementation strategy to improve the management of patients with chronic obstructive pulmonary disease in primary care: a study protocol of a cluster randomized trial

BackgroundChronic obstructive pulmonary disease (COPD) remains a major health problem, strongly related to smoking. Despite the publication of practice guidelines on prevention and treatment, not all patients with the disease receive the recommended healthcare, particularly with regard to smoking cessation advice where applicable. We have developed a tailored implementation strategy for enhancing general practitioners’ adherence to the disease management guidelines. The primary aim of the study is to evaluate the effects of this tailored implementation intervention on general practitioners’ adherence to guidelines.Methods/DesignA pragmatic two-arm cluster randomized trial has been planned to compare care following the implementation of tailored interventions of four recommendations in COPD patients against usual care. The study will involve 18 general practices (9 in the intervention group and 9 in the control group) in Poland, each with at least 80 identified (at the baseline) patients with diagnosed COPD. The nine control practices will provide usual care without any interventions. Tailored interventions to implement four recommendations will be delivered in the remaining nine practices. At follow-up after nine months, data will be collected for all 18 general practices. The primary outcome measure is physicians’ adherence to all four recommendations: brief anti-smoking advice, dyspnea assessment, care checklist utilization and demonstration to patients of correct inhaler use. This measurement will be based on data extracted from identified patients’ records. Additionally, we will survey and interview patients with chronic obstructive pulmonary disease about the process of care.DiscussionThe results of this trial will be directly applicable to primary care in Poland and add to the growing body of evidence on interventions to improve chronic illness care.Trial registrationThis trial has been registered with Clinical Trials Protocol Registration System. Trial number: NCT01893476.

Pharmacist Knowledge &amp; Ability to Use Inhaled Medication Delivery Systems in UAE

Objective: This study was designed to compare knowledge & ability to use different inhaling devices among both educated & non-educated pharmacists. Method: A questionnaire was constructed & piloted to be used as a tool for this study. The sample was divided into two groups educated pharmacists & non-educated pharmacists. Education was in term of receiving the brochures of demonstrating how to use the different inhaled devices before assessing the pharmacists. The pharmacists were asked to demonstrate usage of placebo devices & assessment was done based on checklist designed following companies instructions. Results: Statistics have shown significant (P<0.05) higher scores; have been achieved by educated pharmacists when compared with non-educated pharmacists in term of ability to use the inhalers correctly, pharmacists’ knowledge of cleaning MDI, inhalers induced mouth irritation side effect and their place of storage. Conclusion: Pharmacists in UAE are not sufficiently aware of the steps to demonstrate correct use of different inhalers. The instructions supplied by the pharmaceutical companies are not sufficient. Appropriate and continuous educational programs concerning pharmacists’ ability and knowledge of using different inhaled devices is recommended.

Management of chronic obstructive pulmonary disease: criteria for an appropriate hospital discharge

Low adherence with prescribed treatments is very common in chronic diseases and represents a significant barrier to optimal management, with both clinical and economic consequences. In chronic obstructive pulmonary disease (COPD), poor adherence, also in terms of premature discontinuation of therapy or improper use of inhaler devices, leads to increased risk of clinical deterioration. By contrast, adherence to appropriate long-term maintenance therapy is associated with improved quality of life and significantly lower risks of hospitalization and re-hospitalization, resulting in important health benefits for the individual patient and a reduction in costs for the national health services. In considering strategies to improve adherence, three main aspects should be addressed: i) patient education; ii) pharmacological alternatives and correct use of inhalers; and iii) adherence to COPD guidelines for appropriate therapy. In this field, healthcare providers play a critical role in helping patients understand the nature of their disease and its management, explaining the potential benefits and adverse effects of treatment, and teaching or checking the correct inhalation technique. These are important issues for patient management, particularly in the immediate aftermath of hospital discharge, because the high risk of re-admission is mainly due to inadequate treatment. Thus, discharge procedure should be considered a key element in the healthcare continuum from the hospital to primary care. This implies an integrated model of care delivery by all relevant health providers. In this context, we developed a structured COPD discharge form that we hope will improve the management of COPD patients, particularly in the aftermath of hospital discharge.