Inhalation Technique In Patients Research Articles

The Effect of Educational Intervention on Inhaler Technique of Patients in Asian Countries: A Systematic Review

Background: Inhalation therapy is the main line of treatment for the management of various respiratory diseases due to localized delivery and rapid onset of action. Incorrect inhaler technique is very common and subsequently leads to poor disease management. Pharmacist can have a positive impact on patient’s education about proper inhaler technique that can lead to a significant improvement of asthma and COPD management. Objective: The objective of this study was to determine the effectiveness of pharmacist education program on inhaler technique of asthmatic and COPD patients in South Asian countries. The outcome regarding inhalation technique was reviewed and summarized. Methodology: The outcome regarding inhalation technique was reviewed and summarized. For this systematic review, basic electronic academic databases (Scopus, Science Direct, ProQuest, Web of Science and PubMed) were used for the search, along with a manual search on Google Scholar. This systematic review was conducted by following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines. Moreover, utilizing the framework of the PECO-S (Population Exposure Comparison Outcome Study design), various observational studies were recruited for this review. The ZEE tool was utilized to minimize the risk of bias among extracted cross-sectional studies. Inclusion criteria included studies on inhaler using patients of all ages from South Asian countries along with the influence of educational intervention outcomes. Results: Out of 2191 studies, 24 studies meeting the inclusion criteria were included in the current review. All of the included studies were about pharmacist intervention on inhaler technique in South Asian countries. Conclusion: The systematic literature review summarizes the impact of educational intervention provided to inhaler using patients from South Asian countries. It was assessed that patient education and counselling produced improvement in inhalation technique of various devices especially metered dose inhalers. The primary outcome of most the studies was the improvement in inhaler technique assessment and enhanced quality of life. Therefore, inhaler technique education to patients should be made compulsory by the Health-care authorities to enhance compliance and effectiveness of inhalational therapy by avoiding irrational use of inhalers.

Impact of Pharmacist-led Interventions on Medication Adherence and Inhalation Technique in Adult Patients with COPD and Asthma

Introduction: Inhalation technique and medication adherence are essential prerequisites for achieving optimal therapeutic effects in patients with chronic obstructive pulmonary disease (COPD) and asthma. Although there are various effective treatments for respiratory disorders, disease control in these patients is still sub-optimal because of incorrect inhalation techniques and poor medication adherence. Pharmacist-led interventions have demonstrated a positive impact on improving inhalation technique, better medication adherence, and thus subsequently improving the quality of life of patients. Methods: Search engines such as PubMed, Google Scholar, and Science Direct were used to identify the relevant information using keywords: Chronic Obstructive Pulmonary Disease, Asthma, Pharmaceutical care, Pharmacist Intervention, Medication Adherence and Inhalation Technique. The relevant articles that were published between 2005 to 2021 were included and reviewed for the Pharmacist-led interventions to improve medication adherence, inhalation technique, and quality of life of patients with COPD and asthma. Results: Of the 300 articles screened, a total of 14 articles met the inclusion criteria and were included for review. Pharmacist-led interventions help to improve the medication adherence, inhalation technique, and quality of life of patients with COPD and asthma. Similarly, the articles mentioned in this review found that the interventions provided by the pharmacist to COPD and asthma patients were cost-effective in terms of reducing hospitalization rates and severe exacerbation rates. Conclusion: Our review concluded that the pharmacists’ interventions have a significant improvement in medication adherence and inhalation techniques with the enhancement of therapeutic effects in adult patients with COPD and asthma.

Inhalation technique assessment and evaluation for the need of pharmaceutical intervention in respiratory pathologies patients

ObjectiveTo evaluate rate and type of errors in inhalation technique of patients seen in hospitals at the observation area in the emergency department, as well as patients seen in the outpatients clinic at the primary care pharmaceutical consultation, and at the community pharmacy. MethodDescriptive observational study carried out by a hospital pharmacist, along with a primary care pharmacist and a community pharmacist. An anonymous survey was performed in order to collect different analyzed data. Each patient was asked to execute a complete demonstration on how they used their inhalers, to actively check the inhalation technique. Two checklists regarding the type of inhaler were established in order to assess said technique. Results were tabulated through Microsoft Excel® 2010 software and analyzed through R 3.5 statistical program. ResultsA total of 66 patients (42 male, 24 female; mean age 67) were recruited. Out of all patients, 48.5% used more than one inhaler, which 34.4% used different types of inhaler, and 65.6% used different systems. A total of 39 patients were under dry powder inhaler therapy, and 38 were using pressurized metered dose inhalers. The most frequent errors –both in dry powder inhalers and pressurized metered dose inhalers– were: not performing a 10 second apnea and not slowly expelling air from the lungs. Around 50% of patients needed new learning after assessing their inhalation technique, even though 88.5% had already received previous training. Older aged patients performed a worse inhalation technique. ConclusionsThere is a high rate of errors in the use of inhaled therapy, being even higher among older aged patients. The inhalation technique training by the medical staff seems inadequate, as it is crucial to raise awareness about the importance of health education for patients and their use of inhalers, to which a scheduled follow up and a technical and feedback obtained from the patient assessment is required.

Assessment of metered dose inhalation technique in patients with chronic lung disease at a tertiary health care center

Introduction: Poor inhalation technique among patients using Metered Dose Inhaler (MDI) is one of the most common causes of increased acute exacerbations and hospital visits and leads to poor health outcome. Hence, the purpose of this research is to evaluate the correctness of inhalation steps in patients using MDI visiting Patan Hospital. Method: A total of 128 patients participated in the research. The study involved collection of basic sociodemographic information and visual observation of the inhalation technique of the patients using a standard checklist. Any mistakes made during the procedure were recorded. They were also asked to say each step as they performed it so that all of the steps could be clearly observed. Result: Out of 128 participants, only 3(2.34%) of the participants were able to perform all the eight steps correctly. Holding breath for five second was the most commonly made mistake 80(62.7%) followed by failure to exhale to residual volume 74(57.7%). Majority of participants were able to perform five steps correctly 29(22.6%). There seemed to be no association of inhalation technique with age, sex and educational status of the patient. Conclusion: Majority of the patients were unable to perform the inhalation steps correctly indicating the need for regular training programs to improve the inhalation technique and improve health outcome.

Evolving to a single inhaler extrafine LABA/LAMA/ICS – Inhalation technique and adherence at the heart of COPD patient care (TRIVOLVE)

ObjectiveIncorrect inhaler use and poor treatment adherence have a negative impact on COPD outcomes. This multi-centre, single arm, non-interventional, phase IV study investigated whether inhalation technique, treatment adherence and patient outcomes change in patients who evolve from dual therapy or multiple inhaler triple therapy to single inhaler extrafine triple therapy (beclomethasone dipropionate (BDP, 87 μg), formoterol fumarate (FF, 5 μg) and glycopyrronium (G, 9 μg)) in combination with inhalation technique training. MethodsA total of 126 COPD patients were included in the per protocol set. Inhalation technique and treatment adherence were assessed at baseline and at two visits at approximately 3 and 6 months of treatment with extrafine BDP/FF/G. In addition, lung function, symptom score, patient satisfaction and exacerbations (exploratory) were followed up. ResultsBefore switching to single inhaler extrafine BDP/FF/G (baseline), any device errors and critical errors were detected for 28.8% and 9.6% of patients, respectively. After switching to BDP/FF/G, the percentage of patients with any device errors decreased to 14.0% (visit 2) and 16.3% (visit 3), without critical errors at the two follow-up visits. Treatment adherence increased from 67.5% at baseline to 75.8% (visit 2) and 80% (visit 3). In addition, lung function, symptom and patient satisfaction scores improved, whilst exacerbation rates substantially decreased. ConclusionsThis observational study demonstrates that in eligible COPD patients in a real-life setting, the switch from dual therapy or multiple inhaler triple therapy to single inhaler extrafine BDP/FF/G in combination with inhalation technique training is associated with improved inhalation technique and adherence.

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

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

Objective Assessment of Adherence and Inhaler Technique among Asthma and COPD Patients in London: A Study in Community Pharmacies Using an Electronic Monitoring Device.

The INhaler Compliance Assessment (INCATM) device is an electronic monitoring device (EMD) that assesses both patient's adherence and inhaler technique (IT). This study aimed, first, to assess the value of using the INCATM device as an objective measure during medicine use review (MUR) consultations provided by community pharmacists (CPs) on patients' adherence and IT. Second, we aimed to explore patients' perceptions about the INCATM device. A mixed methods approach was used, involving two phases. Phase one was a service evaluation in independent community pharmacies in London with a before-and-after study design. The service included provision of an MUR consultation to asthma and COPD patients using objective feedback about adherence and IT generated with the INCATM device. Descriptive and inferential statistics were performed using SPSS. Phase two involved semi-structured interviews with respiratory patients. Thematic analysis was performed to generate key findings. Eighteen patients participated in the study (12 COPD and 6 asthma). The results showed significant improvement in the INCATM actual adherence from 30% to 68% (p = 0.001) and significant reduction in IT error rate from 51% to 12% (p = 0.002) after conducting the service. Analysis of the interviews revealed patients' positive attitudes in terms of the perceived benefits of the technology and a desire for future use and recommendation for others. Patients had also positive attitudes towards the consultations provided. Embedding an objective measure about adherence and IT during CPs' consultations showed a significant improvement in patients' adherence and IT and was accepted by patients as well.

Cognitive impairment according to Montreal Cognitive Assessment independently predicts the ability of chronic obstructive pulmonary disease patients to maintain proper inhaler technique

BackgroundMaintaining correct inhaler technique is crucial in the management of chronic obstructive pulmonary disease (COPD). We aimed to investigate the inhaler technique in patients with COPD, to compare it immediately after and at 1 month after training, and to identify the predictors of incorrect inhaler use at 1 month after training.MethodsThis prospective study was conducted at the COPD clinic of Siriraj Hospital (Bangkok, Thailand). Patients demonstrating improper inhaler use were trained face-to-face by pharmacists. Inhaler technique was re-assessed immediately after and at 1 month after training. The Montreal Cognitive Assessment (MoCA) score, pulmonary function tests, 6-min walk distance (6 MWD), modified Medical Research Council scale score, and COPD Assessment Test (CAT) score were evaluated.ResultsSixty-six patients with COPD who demonstrated at least one critical error during the use of any controller inhaler were enrolled. The mean age was 73.0 ± 9.0 years, and 75.8% patients had moderate/severe COPD. Immediately after training, all patients used dry powder inhalers correctly and 88.1% used pressurized metered-dose inhalers correctly. At 1 month, the number of patients demonstrating the correct technique decreased across all devices. Multivariable analysis revealed that MoCA score ≤ 16 was independently associated with a critical error at 1 month after training (adjusted odds ratio: 12.7, 95% confidence interval: 1.8–88.2, p = 0.010). At 1 month, CAT score (11.4 ± 8.9 vs. 8.4 ± 5.5, p = 0.018) and 6 MWD (351 ± 93 m vs. 372 ± 92 m, p = 0.009) had significantly improved in patients demonstrating the correct technique, and CAT score met the minimal clinically important difference.ConclusionsFace-to-face training by pharmacists improved patient performance. However, the number of patients following proper technique had decreased at 1 month after training. Cognitive impairment (MoCA score ≤ 16) independently predicted the ability of COPD patients to maintain proper inhaler technique. Assessment of cognitive function combined with technical re-assessment and repeated training should improve COPD management.

Assessment of inhalation technique in patients with bronchial asthma and chronic obstructive pulmonary disease

Investigate inhalation techniques using different inhalers types and their effect on the course of disease. This cross-sectional study included 110 patients with asthma, chronic obstructive pulmonary disease using the inhaler at least one month. Inhaler errors performed during demonstration were evaluated for each patient and entered in the check-lists. We also collected information about co-morbidities, education, mMRC dyspnea score, rate of exacerbations, and performed spirometry. 80.9% of patients used metered-dose inhaler, 20.9% - single-dose and 21.8% - multiple-dose dry powder inhaler, 22.7% - soft-mist inhaler. Inhaler errors were made by 80.9% patients. The mean number of mistakes in metered-dose inhaler use was 2±1.6, single-dose powder inhaler -1.5±1.3, multiple-dose dry powder inhaler - 1.25±1.4, soft-mist inhaler - 0.68±0.7 (р=0.003). Age, diagnosis, duration of disease, education level, inhalers usage by relatives have no influence on the inhalation technique. A number of errors was related to female gender (р=0.007) and usage of more than 2 inhalers (r=0.3, p=0.002), previous instruction about inhalation technique (r=0.3, p=0.001). On the other hand, there were correlations between the number of errors and degree of bronchial obstruction, asthma control, severity of dyspnea by mMRC score, exacerbation rate. Patients with bronchoobstructive diseases perform many inhaler errors, that substantially influences the severity and course of asthma and chronic obstructive pulmonary disease.

Assessing Inhaler Techniques of Asthma Patients Using Aerosol Inhalation Monitors (AIM): A Cross-Sectional Study.

A high percentage of asthma patients have symptoms that are not well controlled, despite effective drugs being available. One potential reason for this may be that poor inhaler technique limits the dose delivered to the lungs, thereby reducing the therapeutic efficacy. The aim of this study was to assess the prevalence of poor inhaler technique in an asthma patient population and to probe the impact of various demographic parameters on technique quality. This study was conducted at community pharmacies across Wales, UK. Patients diagnosed with asthma and 12 years or older were invited to participate. An aerosol inhalation monitor (AIM, Vitalograph®) was used to measure the quality of patient inhaler technique. A total of 295 AIM assessments were carried out. There were significant differences in the quality of inhaler technique across the different inhaler types (p < 0.001, Chi squared). The best technique was associated with dry-powder inhalers (DPI devices, 58% of 72 having good technique), compared with pressurized metered-dose inhalers (pMDI) or pMDIs with a spacer device (18% of 174 and 47% of 49 AIM assessments, respectively). There were some significant associations between gender, age, and quality of inhaler technique, as determined with adjusted odds ratios. It seems that the majority of asthmatic patients were not using their inhalers appropriately. We recommend that healthcare professionals place more emphasis on assessing and correcting inhaler technique, as poor inhaler technique might be responsible for the observed lack of symptom control in the asthma patient population.

Opportunistic optimization of inhaler technique in hospitalized adults with asthma: a two-phase educational study

Objective To investigate effectiveness of two different educational methods to improve inhaler techniques in patients with prior diagnosis of asthma, hospitalized with a non-asthma-related diagnosis. Methods We undertook a real-world, opportunistic quality-improvement project. Inhaler technique in hospitalized patients with prior diagnosis of asthma was assessed in two cohorts over two 12-week cycles using a standardized device-specific proforma of seven-step inhaler technique, classed: “good” if 6/7 steps achieved; “fair” if 5/7 compliant; “poor” for others. Baseline data was collected in both cycles. Cycle one involved face-to-face education by a healthcare professional; cycle two involved additional use of an electronic device to show device-specific videos (asthma.org.uk). In both cycles, patients were reassessed within two days for improvements and the two methods compared for effectiveness. Results During cycle one 32/40 patients were reassessed within 48 h; eight lost to follow-up. During cycle two 38/40 patients were reassessed within 48 h; two lost to follow-up During cycle one, two and 12 had good/fair baseline technique respectively, and 26 poor. Most commonly missed steps were no expiry check/not rinsing mouth after steroid use. On reassessment 17% patients improved from poor to fair/good. During cycle two, initial technique assessment identified: 23 poor; 12 fair; five good. Post-videos, 35% of patients improved from poor to fair/good. Proportion of patients improving from poor to fair, or poor/fair to good increased in cycle two vs one (52.5% vs 33%). Conclusion Visual instruction is associated with improved technique compared to verbal feedback. This is a user-friendly and cost-effective approach to patient education.

In silico investigation of the effect of particle diameter on deposition uniformity in pulmonary drug delivery

Systemic drug delivery via the pulmonary route has a critical limitation because dose uniformity is strongly dependent upon patient inhalation technique. The most frequent and critical errors in inhalation technique are overly forceful inspiration and insufficient breath-holding. In this study, response surface methodology was used with an in silico whole lung particle deposition model for bolus administration to investigate whether varying the inhaled drug particle size could reduce the dependence of deposition upon flow rate and/or breath-holding duration. The range of particle aerodynamic diameters studied was 0.1–10 µm for flow rates between 500–2000 mL/s and breath-holding duration between 0–15 seconds. Comparison with published experimental data showed that this modeling approach can accurately predict the lung deposition. The simulation results indicated that the deposition of particles with aerodynamic diameter in the range of 0.1–1.5 µm should be minimally affected by flow rate over the 500–2000 mL/s range. There was found to be no particle size whose deposition was completely independent of breath-holding duration. The smallest particles, whose deposition is diffusion-driven, were found to be the least sensitive to breath-holding time, but this size is of limited practical use. On the other hand, the simulations indicated that particles with a 1.5 µm diameter would provide acceptable consistency in dose reaching the acini region when the breath-holding duration was greater than 10 seconds. It is hoped that this finding could provide a means of improving dose uniformity for systemic delivery via the pulmonary route by facilitating simplified patient instructions.

An evaluation of the use of inhalers in asthma and chronic obstructive pulmonary disease

ObjectivesInhaled therapy is the treatment of choice for obstructive lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). However, the maximum benefit from such therapy depends on the correct use of inhaler devices. In this study, our primary aim was to evaluate inhaler techniques in patients with asthma and COPD in order to identify common errors. In addition, we investigated the effect of various parameters on the rate of inhaler misuse. MethodsWe enrolled a total of 300 asthma/COPD patients, who presented at the Chest Diseases and Family Medicine Outpatient Clinics of a tertiary hospital located in Ankara, Turkey. We used a face-to-face survey that included questions about sociodemographic features and inhaler therapy. Subsequently, we requested patients to demonstrate how they use their inhalers and assessed their inhalation technique according to checklists. ResultsOf the 300 patients, 70.2% used their inhaler drugs incorrectly. The rate of misuse among metered dose inhaler (MDI) users was significantly higher than those using dry powder inhalers (DPIs) (77.6% vs 64%; p = 0.002). When DPI devices were analyzed, the rates of misuse were significantly higher in Handihaler users (p = 0.012) and Diskus inhaler users (p = 0.009) when compared to Sanohaler users. Gender, type of disease (asthma/COPD), duration of inhaler use, and duration of illness had no impact on the rate of misuse. However, an advanced age (>60 years old), a level of education lower than high school, and the use of MDI were all identified as factors associated with misuse. The most common mistake was ‘failing to breath out before inhalation’ for all types of devices (for MDI: 66.7%, and for DPI: 71.1–82.8%). ConclusionsThe rate of inhaler drug misuse was high. The identification of factors associated with misuse could provide information to implement appropriate actions to reduce the rates of misuse.

The importance of reminders and patient preferences to improve inhaler technique in older adults with COPD.

Objectives: Medication non-adherence in patients with chronic obstructive pulmonary disease is common. The aim is to evaluate the efficacy of two interventions to improve the inhalation technique (IT) in patients with pulmonary disease is common. Also determine optimal IT reminder time and to test the role of preferences in the intervention selection. Method: 726 pulmonary disease in common patients (consecutive sampling) from two trials: 1) TECEPOC-study (patients' preference trial/comprehensive cohort design) 2) TIEPOC-study (randomised controlled trial). Interventions: intervention-A (ad-hoc leaflet with instructions about correct IT according Spanish Respiratory Society), intervention B (intervention A+ individual training by instructors). Four visits were performed (baseline, 3, 6 and 12months). Data on IT, sociodemographic and clinical characteristics, quality of life and respiratory drugs were recorded. Analysis under intention to treat principle. Multivariate analysis was conducted to measure the potential modifying factors of improvement in the IT along follow-up. Results: 660 patients (90.9%) did not perform a correct IT at baseline 89.75% with Handihaler, 86.95% with Turbuhaler, 84.75% with Accuhaler and 87.35% with pMDI. At 12months, 221 patients 29.9% performed correctly the IT; a decrease in the slope of the curve (correct IT) was detected at 3months follow-up. Intervention B was the most effective in both trials compared to control group or intervention A, regardless of preferences: 1) TECEPOC Study (preference trial): Intervention B versus control group, NNT = 3.22 (IC95%, 2.27-5.52); and versus Intervention A, NNT = 3.57 (CI95%, 2.41-6.8). Preferences improved 6.7% in the correct IT without statistical significance. 2) TIEPOC Study (randomized controlled trial): Intervention B versus control group, NNT = 1.74 (IC95%, 1.47-2.17), and versus intervention A, NNT = 3.33 (CI 95%, 2.43-5.55). No differences were measured between Intervention A and control group. Conclusion: Individual training significantly improves IT. Reminders every 3months are recommended. Preferences do not influence the intervention effectiveness.

Predicting the Risk of Incorrect Inhalation Technique in Patients with Chronic Airway Diseases by a New Predictive Nomogram

To develop and internally validate a nomogram for predicting the risk of incorrect inhalation techniques in patients with chronic airway diseases. A total of 206 patients with chronic airway diseases treated with inhaled medications were recruited in this study. Patients were divided into correct (n=129) and incorrect (n=77) cohorts based on their mastery of inhalation devices, which were assessed by medical professionals. Data were collected on the basis of questionnaires and medical records. The least absolute shrinkage and selection operator method (LASSO) and multivariate logistic regression analyses were conducted to identify the risk factors of incorrect inhalation techniques. Then, calibration curve, Harrell's C-index, area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA) and bootstrapping validation were applied to assess the apparent performance, clinical validity and internal validation of the predicting model, respectively. Seven risk factors including age, education level, drug cognition, self-evaluation of curative effect, inhalation device use instruction before treatment, post-instruction evaluation and evaluation at return visit were finally determined as the predictors of the nomogram prediction model. The ROC curve obtained by this model showed that the AUC was 0.814, with a sensitivity of 0.78 and specificity of 0.75. In addition, the C-index was 0.814, with a Z value of 10.31 (P<0.001). It was confirmed to be 0.783 by bootstrapping validation, indicating that the model had good discrimination and calibration. Furthermore, analysis of DCA showed that the nomogram had good clinical validity. The application of the developed nomogram to predict the risk of incorrect inhalation techniques during follow-up visits is feasible.

Impact of a Pharmacist-led Educational Intervention on Inhalation Technique among Sudanese Patients with Asthma

The proper use of inhaler devices can improve medication efficacy while decreasing dose and adverse effects. The main objective of this study was to investigate the effect of pharmacist-led asthma education interventions on inhaler techniques. This study was a controlled, randomized, prospective intervention, in Wad Medani Teaching Hospital outpatient clinic, between March and June 2021.Structured questionnaire with validated checklists of inhaler techniques were used to collect data, from patients at baseline and at three months of follow-up, for both intervention and control groups. Paired and independent t-tests were used to monitor the effectiveness of the interventions. A total of 130 asthmatic patients were enrolled in this study. The intervention group contains 70 patients (53.8%), while the control group contains 60 patients (46.2%). The mean score for the inhaler techniques of Pressurized metered-dose inhalers(PMDIs) was (3.50±1.43) for the intervention group at baseline and increased after the intervention to (6.78±0.515), this result was significant at the (P = 0.05) level, and the mean score of the dry powder inhaler technique at the initial of this study in the intervention group was (4.72 ±1.50) this means were improved after the intervention to (6.83± 0.44) this result was statistically significant. There was no significant difference between the control group before and after intervention (P=0.321).This study has shown that the pharmacist-led educational intervention improved the inhalation technique of asthmatic patients. It is important to consider these programs as routine health care to enhance inhaler techniques.

Evaluation of Metered Dose Inhaler Use Technique and Response to Educational Training

Prescribing inhalers without imparting adequate education regarding proper technique of their usage may result in suboptimal clinical improvement and wastage of medication. Training interventions using a standard check-list may help improve faulty techniques and enhance drug efficacy. Patients using metered dose inhaler (MDI) were included in the study. Inhaler technique was first evaluated at baseline using a standard check-list of recommended steps (National Institute of Health guidelines; see Table) and scores were given for each step correctly performed. Those who could not perform all steps correctly were given training intervention. The patients were assigned to two methods of educational intervention; one group was trained by providing written material giving step-wise instructions while the other group was given an actual physical demonstration using a placebo device. The technique was re-evaluated and scored following each educational session, and continued till the patient achieved a full score, or for a maximum of 3 sessions, whichever occurred earlier. Median score was calculated after each session and was compared between the two groups. Each patient was followed up after two months and the re-evaluated the same way. One hundred and seventeen subjects were enrolled in the study (59 in the written group and 57 in the practical demonstration group). At baseline, only 1 of the 117 subjects could perform all the steps of inhaler usage correctly. This patient was, therefore, not provided the inhaler technique education. The overall median (range) score of the whole group was 3 (range 1-8). This score rose to 6, 7 and 8 after each of the three subsequent educational intervention sessions. At one-month follow-up, the median score dropped to 7 and improved with a repeat educational session as previously done. A significant difference was observed in the median score improvement achieved in the practical demonstration group compared with the written instruction group (3.0 versus 2.0 respectively, p < 0.001). Inhalation technique of patients improves after imparting systematic educational intervention. A practical demonstration of all the steps proved more effective than simple verbal/written advice. In view of increasing errors being committed over a period of time, repeated demonstration of the proper technique using a standard check-list significantly improves the errors committed during inhaler use.

Effectiveness of an Educational Intervention on Inhaler Technique Proficiency in Chronic Obstructive Pulmonary Disease: A Single-Center Quality Improvement Study

Albeit inhalation therapy is the cornerstone in chronic obstructive pulmonary disease (COPD) treatment, inhaler technique is rarely evaluated, and training materials are often insufficient. In this single-center study, we aimed to evaluate the effectiveness of a teaching session complemented by a flyer on inhaler technique in COPD patients and to evaluate the perceived quality of the flyer. A total of 30 participants with stable COPD who had never used a soft mist inhaler before (Respimat®, Boehringer Ingelheim) received a brief teaching session on proper inhaler technique complemented by a flyer (visit 1). The teaching intervention was completed by a pulmonologist. Epidemiological and clinical characteristics of COPD were collected by a questionnaire, and the ability to properly handle the inhaler was assessed. After 14 days, inhaler handling was re-evaluated, and patients were asked to rate the flyer (visit 2). After the initial training, proper inhaler handling was achieved in 80.0% of patients. Inhaler proficiency was maintained after 14 days (83.0% of the patients used the Respimat® correctly, p-value &gt; 0.99). The flyer was considered at least good by 27 patients (90.0%). This study indicated that the administration of an educational intervention resulted in persistent good competence in inhaler technique at a 14-day follow-up.

Better use of inhaled medication in asthma and COPD through training, preparation and counselling: the On TRACk study protocol for a cluster randomised controlled trial

IntroductionAbout 70% of patients with asthma and/or chronic obstructive pulmonary disease (COPD) use their inhaled medication incorrectly, leading to reduced disease control, higher healthcare use and costs. Adequate guidance from...

Can electronic monitoring with a digital smart spacer support personalised medication adherence and inhaler technique education in patients with asthma?: Protocol of the randomised controlled OUTERSPACE trial

IntroductionMedication adherence and inhaler technique in patients with asthma remain suboptimal. A digital, smart spacer may support personalised adherence and inhaler technique education. The aim of this study is to...