Inhaler Medication Research Articles

Patient characteristics and mortality across diagnostic settings in COPD

BackgroundMany patients with chronic obstructive pulmonary disease (COPD) are diagnosed late, e.g., at first acute exacerbation of COPD (AECOPD). AECOPD increases the risk of death. We aim to investigate patient characteristics and mortality across diagnostic settings among patients with COPD. MethodsThis nationwide Danish study allocated 107,023 patients with a first-time registered COPD-related hospital contact between 2010 and 2018 based on diagnostic setting: primary care (prior inhalation medication use), hospital outpatient clinic or hospital admission. Multivariable logistic regression was employed to investigate patient characteristics and mortality across these diagnostic settings. ResultsIn total, 81,035 (75.7 %) patients were diagnosed in primary care, median age 63 years (interquartile range (IQR) 53–71); 11,302 (10.6 %) at an outpatient clinic, median age 68 years (IQR 60–76), and 14,686 (13.7 %) during hospital admission, median age 73 years (IQR 65–81). Patient characteristics associated with diagnosis during hospital admission encompassed age (odds ratio (OR) 1.05, 95 % confidence interval (CI) 1.05–1.05, p < 0.001), male sex (OR 1.14, CI 1.10–1.19, p < 0.001), and number of comorbidities, which increased from one comorbidity (OR 2.64, CI 2.50–2.79, p < 0.001) to six or more comorbidities (OR 12.37, CI 11.26–13.60, p < 0.001). Diagnosis during hospital admission due to AECOPD was associated with increased one-year mortality (OR 1.24, CI 1.16–1.33, p < 0.001) compared to diagnosis in primary care. ConclusionPatients diagnosed with COPD in hospital settings were generally older, predominantly male, and had more comorbidities. Patients diagnosed in primary care prior to their first AECOPD admission had higher one-year survival.

Emotion regulation among adults with asthma: Links with short-acting inhaler medication overuse and utilization of acute medical care

Objective Existing research suggests that emotion plays an important role in airway inflammation and asthma symptom control. The objective of this study was to determine whether difficulties regulating emotion were associated with overuse of short-acting inhaled medications and acute medical care usage in adults with asthma. Methods The sample included 401 adults with asthma recruited from an online panel of adults with chronic respiratory disease. Sequential binary logistic regression models were used to examine the associations of emotion regulation with short-acting inhaled medication use and acute medical care use, controlling for patient characteristics and comorbid mental health conditions. Results Greater difficulties with emotion regulation were significantly associated with greater odds of short-acting inhaler medication overuse (p < 0.001), emergency department visits (p < 0.001), and hospitalizations (p = 0.001). Conclusions Emotion dysregulation may play an important role in asthma management. Evidence-based interventions to reduce difficulties in emotion regulation may help improve problematic patterns of short-acting medication overuse and acute service use. The current findings should be interpreted in the context of several limitations, including the use of self-report measures. Future research should use electronic medical records or metered dose inhalers to objectively assess short-acting inhaler overuse and acute medical care use.

Investigation of the Effects of Oral Care Methods on Oral Health in Children with Asthma Using Inhalers: A Quasi-Experimental Trial

Objective: This study was conducted to determine the effects of tooth brushing, wiping the mouth with bicarbonate, and rinsing the mouth with water on the oral care of children with asthma using inhalers. Methods: The study used a quasi-experimental quantitative research design with a pretest-posttest control group. The sample of 6-10-year-old asthmatic children was divided into the tooth brushing training group (n=49), the bicarbonate mouth wiping training group (n=49), the water rinsing training group (n=49), and the control group (n=49). Data were collected using a “Sociodemographic Information Form” and an “Oral Assessment Guide”. The oral assessment guide was re-administered 6 weeks after the children had received the education. Results: The findings showed that the gums were better in the group applying the wiping the mouth with bicarbonate method (P=.046), swallowing complaints decreased in the group applying the rinsing the mouth with water method (P=.003), and mucous membranes were better in the group applying the wiping the mouth with bicarbonate method (P=.046). Conclusion: As a result of the study, the method of rinsing the mouth with water was found to be more functional. Accordingly, it is recommended to rinse the mouth with water after using inhaler medication.

Effect of inhalation therapy on oral health in patients with chronic airway disease

The primary treatment for both chronic obstructive pulmonary disease (COPD) and asthma is inhalation therapy. When utilized over an extended period of time, inhalation treatment serves as both a controller and a relief therapy. Oral adverse effects can result from inhaled medications, particularly bronchodilators and corticosteroids that are deposited in the oropharyngeal region. Reduced saliva flow rate, periodontal disease, oral thrush, dental caries, and dental erosion are just a few of the side effects and difficulties associated with using inhaler therapy that are frequently discovered in the oral region. This problem may arise from improper inhaler use, concomitant diseases and conditions of the patient, inadequate education, and inadequate assessment of oral health during inhalation medication. In order to prevent side effects and complications from inhaler therapy, it is essential to comprehend the different types of inhaler drugs and the pathophysiology associated with oral health complications. This will enable clinicians to modify the components of the drug type, the type of inhaler therapy device, and the appropriate method of use based on the unique characteristics of each patient.

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 &amp;#62;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.

PERANCANGAN SIMULASI COUNTDOWN TIMER PADA ALAT KESEHATAN BERBASIS ARDUINO UNO DAN SIMULASI WOKWI

A countdown timer is a device or function in software that is designed to count down time from a starting point until it reaches zero. Its function is simple, namely to provide a visual or auditory indication of the remaining time remaining before a certain event or time limit is reached. The countdown timer implemented in this health device aims to provide clear time warnings to users regarding certain times related to health monitoring. For example, when using inhalers for asthma patients, a countdown timer can provide a countdown warning before the next inhalation, helping patients to follow the medication schedule more regularly. In this Countdown Timer series, we use an Arduino Uno manager to display it on the I2C 2x16 Liquid Crystal Display (LCD) and various other components. By implementing logic methods for countdown timers and alarms when the time reaches zero, it can provide an effective and efficient solution for monitoring critical time in various health applications, such as the use of inhaler medication for asthma patients. Further implementations may include integration with an RTC module for better timing accuracy and the use of additional sensors for more complex functions.

Are there any potential drug-drug interactions with oral inhaler medications?: A retrospective study

BackgroundOral inhaler medications (OIMs) are widely used for many respiratory diseases. Although OIMs have minimal systemic effects, they may cause potential drug-drug interactions (pDDIs).Objectives: This study aims to evaluate drug interactions in patients using OIMs. MethodsThis retrospective, and descriptive study was conducted in a community pharmacy in Istanbul (Turkey) between January 1, andMay 312,021. Prescriptions of all asthma and COPD patients aged 18 and over on the specified date were included in the study. Data were collected from the pharmacy information system. Sociodemograhic characteristics were recorded. pDDIs were analyzed via Medscape and Lexicomp drug interaction checker databases. Significant (monitor closely), Serious (use alternative), Contraindicated categories in the Medscape database and D (consider treatment modification) and X (avoid combination) categories in the Lexi-Interact™ database were evaluated as pDDIs. SPSS analysis was performed. ResultsA total of 54 asthma and 42 chronic obstructive pulmonary disease (COPD) patients were included in the study. Most asthma (76%) and COPD (83%) patients were found to have at least one comorbid disease. A total of81 pDDIs were identified in the Medscape database in asthma patients, and 86.5% of them were classified as “monitor closely”. A total of 12 drug interactions were detected in the Lexicomp database, with 75% of them were “D” category for asthma patients. In the prescriptions of COPD patients, a total of 162 drug interactions were determined via the Medscape database, with 94.4% classified as “monitor closely”. A total of 13 drug interactions were detected in the Lexicomp database, with 61.5% of them falling into the “X” category for COPD patients. ConclusionsAccording to the results of this study COPD patients who may be at a high risk of experiencing pDDIs. Healthcare providers should consider the individual patient's clinical profile, including comorbidities and medication regimen, to minimize the risk of pDDIs and optimize treatment outcomes. Further research is needed to elucidate the mechanisms underlying these findings and develop tailored strategies to diminish the risks associated with pDDIs in respiratory disease management.

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.

Myocardial Protection in Cardiac Surgery: Exploring the Influence of Anesthetic Agents.

This review assesses the efficacy of inhalation anesthetics and propofol in cardiac surgery, primarily focusing on their impact on myocardial protection and subsequent clinical outcomes. The review provides a concise summary of the current scientific information regarding the protective efects of inhalation anesthetics and propofol, particularly in the context of ischemia-reperfusion injury during cardiac surgery. The review delves into the mechanisms of action and discusses clinical studies comparing the 2 anesthetic strategies regarding mortality, complication rates, and length of hospital stay. Inhalation anesthetics exhibit cardioprotective properties through many mechanisms, such as preconditioning, scavenging of free radicals, and stabilizing mitochondria. Propofol demonstrates certain protective benefits but does not possess the preconditioning capability of inhalation medications. Clinical investigations yield contradictory findings, as several studies indicate enhanced outcomes with inhalation anesthetics, while others observe no substantial disparity between the 2 approaches. The cardioprotective efcacy of propofol against ischemia-reperfusion injury remains limited. While its inherent antioxidant properties ofer direct myocardial protection, propofol demonstrably lacks the preconditioning-mediated signaling pathways triggered by inhalation anesthetics. As a result, propofol's protective efect may be slightly inferior to preconditioning strategies, and its potential to inhibit organ-protective impact of other interventions needs further investigation. The question of which anesthetic approach ofers superior myocardial protection remains debatable. Current evidence is inconclusive, potentially due to patient heterogeneity, surgical complexity, and methodological limitations of existing studies. Future research, including pharmacogenetic studies and large, welldesigned, randomized controlled trials, are necessary to provide definitive guidance on anesthetic selection for optimal myocardial protection in cardiac surgery.

A Review of 20 Years Research Progression on Prodrug Technology in Inhaled Medications

A Review of 20 Years Research Progression on Prodrug Technology in Inhaled Medications

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.

Smoking cessation encouragement by community pharmacists.

Background: Pharmaceutical care interventions have shown to improve health outcomes in specific patient populations. However, which smokers could be reached by community pharmacists in Belgium is unknown. Moreover, the impact of behavioural interventions for smoking cessation (such as brief motivational interviewing) on short term health outcomes remains unclear. Therefore, we aimed to describe the population reached and potential impact on health outcomes among persons who received a brief motivational interview by their community pharmacist.&#x0D; Methods: Demographics of approached smokers in Flemish community pharmacies during the months May-June 2021, and objectifiable outcomes of a brief motivational interview were retrieved from the pharmacy database. Smoking cessation aids use as well as the impact on cough, inhaler or exacerbation medication use was evaluated 90 and 180 days after the encouragement. Data were analysed using the Mann-Whitney U test, ꭕ² test and binary logistic regression analysis.&#x0D; Results: Community pharmacists provided a brief motivational interview to a broad population of smokers of both sexes, including young persons and persons without chronic medication use. Two out of three smokers were motivated to quit (67.7%) and a third of the included population (33.0%) purchased a smoking cessation aid on the index date (36.7% after 90 and 39.3% after 180 days). Smokers motivated to quit who purchased a smoking cessation aid on the index date had a significantly lower use of cough (OR = 0.37; p = 0.032) and inhaler medication (OR = 0.37; p = 0.009) after 90 days than those not motivated to quit. Effects were less pronounced after 180 days but still statistically significant for lower inhaler use (OR = 0.46; p = 0.031).&#x0D; Conclusions: By implementing a brief pharmaceutical counselling in Belgian community pharmacies, a broad range of smokers can be reached and triggered to start smoking cessation aids with suggestive short-term health benefits.&#x0D; Acknowledgements&#x0D; The authors want to thank the Flemish Pharmacists Network (VAN) for training the pharmacists and Farmaflux and the Association of Pharmacists Belgium (APB) for providing the data with special acknowledgements to Karel Verlinde, An Vanthienen, Corine De Winter and Marc Buckens.

Contrasting healthcare costs of COPD and asthma in elderly

BackgroundCaring for ageing populations creates new challenges for society. Obstructive pulmonary diseases, asthma and especially COPD, are responsible for considerable morbidity, mortality, and financial costs in the elderly. We present the change in the burden of asthma and COPD in those aged ≥60 years in Finland from 1996 to 2018. MethodsWe collected national register data from 1996 to 2018 from Statistics Finland, Care Register for Health Care, and the Social Insurance Institution. We estimated the prevalence of asthma and severe COPD, use of healthcare, social services, reimbursed inhalation medications, and societal costs. ResultsIn subjects aged ≥60 years, the prevalence was 8% for asthma with reimbursed medication and 0·7% for severe COPD in 2018. In 1996–2018, total costs increased from 33 M€ to 58 M€ (+57%) for asthma and decreased from 38 M€ to 30 M€ (−27%) for COPD. Costs per patient decreased for asthma from 720 € to 460 € (−57%) and remained stable for COPD (2700 € in 2018). Potential years of life lost (PYLL) increased in COPD from 5000 to 6400 (+28%) and the number of emergency department visits increased from 3700 to 6000 (+62%). ConclusionsIn a population aged ≥60 years, the total burden caused by asthma decreased but remained stable and high in COPD. PYLL and visits in emergency care increased in COPD.

Clinical efficacy of a triple combination of budesonide/ glycopyrronium bromide/formoterol in the treatment of chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a chronic condition characterized by persistent airflow limitation, caused by chronic inflammation in response to exposure to inhaled damaging particles or gases. Exacerbations of COPD lead to the progression of symptoms, worsening lung function, reduced physical tolerance, and, as a result, contribute to an increase mortality. Therefore, the prevention of exacerbations is a primary objective in the management of COPD. The foundation of COPD therapy involves prescribing long-acting bronchodilators, and for some patients, the use of anti-inflammatory agents, such as inhaled corticosteroids (ICS). ICS are used in combination with long-acting beta2-agonists (LABA) or as part of triple therapy (ICS/LABA/ LAMA). The choice of triple therapy depends on the patient’s exacerbation history, severity of symptom, level of peripheral blood eosinophilia, risk of infectious complications, and the presence of a concomitant diagnosis of bronchial asthma. Triple therapy offers advantages in terms of improving lung function, disease symptoms, reducing exacerbation frequency, and significantly decreasing mortality compared to other inhaled therapy options for COPD. A significant advantage of this therapy has been shown in patients with eosinophilic COPD. Currently, three combined inhalation medications containing ICS/LABA/LAMA are available for COPD treatment in our country. This review provides basic information on the clinical efficacy and safety profile of one of them, budesonide/glycopyrronium bromide/formoterol, in patients with various COPD phenotypes.

Shared decision making and medication adherence in patients with COPD and/or asthma: the ANANAS study.

Background: Medication adherence to inhalation medication is suboptimal in patients with COPD and asthma. Shared decision making (SDM) is proposed as an intervention to improve medication adherence. Despite its wide promotion, evidence of SDM's association with greater medication adherence is scarce. Also, it is unknown to what degree patients presently experience SDM and how it is associated with medication adherence. Objective: To (i) assess the level of SDM and (ii) medication adherence, (iii) explore the relation between SDM and medication adherence and iv) investigate possible underlying mechanisms. Methods: Cross-sectional observational study. A survey was distributed among Dutch patients with COPD and/or asthma using inhaled medication. Medication adherence was measured using the Test of Adherence to Inhalers (TAI-10), and SDM by the 9-item Shared Decision-Making questionnaire (SMD-Q-9). Feeling of competence, relatedness and feeling of autonomy from the Self-Determination Theory (SDT) were considered as possible mechanisms. The primary outcome was adherence. Results: A total of 396 patients with complete information on relevant covariates were included. Mean SDM-Q-9 score was 26.7 (SD 12.1, range 0-45) and complete adherence was 41.2%. The odds ratio for the association of SDM with adherence was 1.01 (95% CI: 0.99, 1.02). This only changed minimally when adjusted for mediators (mediating effect <3%). Conclusion: The patient experienced level of SDM in daily practice and medication adherence have room for improvement. No association between SDM and medication adherence was observed. Factors related to feeling of competence, relatedness and feeling of autonomy did not meaningfully explain this finding.

Patterns of Asthma Medication Use in New Zealand After Publication of National Asthma Guidelines.

In June 2020, the New Zealand (NZ) adolescent and adult asthma guidelines recommended budesonide/formoterol, taken as maintenance and/or reliever therapy, as the preferred therapeutic approach. To investigate whether these recommendations were associated with changes in clinical practice indicated by asthma medication use trends. NZ national dispensing data for inhaler medications from January 2010 to December 2021 were reviewed. Monthly "dispensings" of inhaled budesonide/formoterol, inhaled corticosteroid (ICS), other ICS/long-acting β2-agonists (LABA), and inhaled short-acting β2-agonists (SABA), for the 12+ age group, were displayed graphically with piecewise regression used to produce plots of rates by time with a July 1, 2020, break point. The number of dispensings in the last 6 months that data were available (July-December 2021) was compared with the corresponding period, July-December2019. Budesonide/formoterol dispensing increased markedly after July 1, 2020 (regression coefficient 41.1 inhalers dispensed/100,000 population per month [95% confidence interval (CI): 36.3-45.6, P < .0001]; 64.7% increase in the number of dispensings between July-December 2019 and July-December 2021), in contrast to "other ICS/LABA" (regression coefficient:-15.9 [95% CI:-22.2 to-9.6, P < .0001];-1.7% decrease) and SABA (regression coefficient:-14.7 [95% CI:-29.7 to 0.3, P= .055];-10.6% decrease), respectively. In NZ, a progressive increase in budesonide/formoterol dispensing, accompanied by a reduction in SABA and "other ICS/LABA" dispensing, occurred after publication of the 2020 NZ asthma guidelines. While acknowledging the limitations in the interpretation of temporal associations, these findings suggest that the transition to ICS/formoterol reliever-based therapy can be achieved if recommended and promoted as the preferred therapeutic approach in national guidelines.

The Intention of Inhaled Medication Adherence Scale (IMAS): The Development of a New Instrument for Assessing Inhaled Medication Adherence Among Patients with Chronic Obstructive Pulmonary Disease (COPD) Using Theory of Planned Behavior.

Inhaled medication adherence is an important issue for patients with chronic obstructive pulmonary disease (COPD) because adhering to inhaled medications could substantially improve their health. However, patients with COPD may not be always adhere to the prescribed inhaled medications. Therefore, understanding the underlying reasons for patients with COPD adhering to inhaled medications is important. The present study used Theory of Planned Behavior (TPB) as a theoretical framework to develop the Intention of Inhaled Medication Adherence Scale (IMAS) and assess its psychometric properties. After reviewing papers using the TPB to design psychometric scales and the TPB scale development guidelines, 28 items were generated for expert evaluation. Eight experts reported that the 28 items all had good content validity (content validity index ranged from 0.88 to 1.00 at item-level; and from 0.981 to 0.987 at scale-level) comprising four factors. Following initial development, 235 patients with COPD (mean age 73.12 years; 93.6% males) completed the IMAS via interview with a respiratory therapist and a research assistant. The four-factor structure of the IMAS was evaluated using confirmatory factor analysis (CFA). Nine IMAS items were removed because of low factor loadings or offending estimates. The 19-item IMAS was confirmed as having a four-factor structure supported by the CFA results (comparative fit index=1.00; Tucker-Lewis index=1.00; root mean square error of approximation=0.00; standardized root mean square residual=0.06). The 19-item IMAS had satisfactory psychometric properties in construct validity. The 19-item IMAS is an instrument that could help healthcare providers understand potential factors associated with adherence to inhaled medications among people with COPD.

Video-based teach-to-goal intervention on inhaler technique on adults with asthma and COPD: a randomized controlled trial

The incorrect use of inhalers is highly associated with poor patient outcomes. This randomized controlled trial investigated the impact of a novel video-based teach-to-goal (TTG) intervention on the following outcomes; mastery of inhaler technique, disease control, medication adherence, and disease-related QoL over time among patients with asthma and COPD.&#x0D; After baseline assessment, participants received either a verbal (control group) or a video-based (intervention group) TTG strategy and were assessed after three months for the impact of the intervention on the intended outcomes. At baseline, intervention (n=51) and control (n=52) groups had comparable characteristics. At follow-up, inhaler technique and medication adherence improved among the intervention group compared to control group ((93.4% vs 67%) and (88.2% to 61.5%), respectively (p&lt;0.05)) as well as to baseline ((93.4% to 49.5%) and (88.2% to 66.7%), respectively (p&lt;0.05)). Similarly, disease control was also ameliorated among the intervention group compared to baseline (35.3% to 54.9%) (p&lt;0.05). QoL scores improved significantly among asthma patients (intervention group) at follow-up in comparison to baseline. Better scores were also observed for COPD patients compared to controls, (p&lt;0.05).&#x0D; Interventions using video-based TTG education are effective in enhancing and retaining the inhaler technique over time, with a positive impact on disease outcomes among patients with asthma and COPD.

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.

Budget impact analysis of a digital monitoring platform for COPD

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive debilitating condition with frequent exacerbations that have a high burden for patients and society. Digital tools may help to reduce the economic burden for patients and payers by improving outcomes. The Propeller platform is a digital self-management tool that facilitates passive monitoring of inhaler medication utilization, potentially assisting the healthcare team to identify patients at risk of a COPD exacerbation who may require further intervention. This study estimated the budget impact of Propeller from commercial payer and Medicare fee-for-service payer perspectives.MethodsAn Excel-based model was used to estimate the budget impact of Propeller for COPD patients in commercial and Medicare population sizes of 5 million members. Data on prevalence, baseline healthcare resource utilization (HCRU), and baseline use of rescue and controller inhaler medications with unit costs (adjusted to 2020 US dollars) were obtained from peer-reviewed literature. Data on reductions in HCRU during Propeller usage were based on direct evidence. Estimates for costs of remote monitoring were obtained from publicly available information. All patients were assumed to have insurance claims related to ongoing remote monitoring.ResultsThe estimated number of annual eligible COPD patients for commercial and Medicare was 212,200 and 606,600, respectively. Propeller decreased costs by an estimated $2,475 (commercial) and $915 (Medicare) per enrolled patient. The greatest increase in expenditure was for remote monitoring related expenses. After accounting for estimated reductions in hospitalizations, emergency department visits and short-acting beta-agonist use, total net savings were approximately $1.60 and $1.70 per-member per-month for commercial and Medicare payers, respectively.ConclusionPropeller is projected to be cost saving from both the commercial and Medicare payer perspectives.