Type Of Inhaler Research Articles

Treatment Transitions in Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases

IntroductionPrevious studies have reported that more patients receive inhaled corticosteroid (ICS)-containing therapies than would be expected based on exacerbation history, suggesting overprescribing. We aimed to describe patterns of treatment switching from first (1MT) to second maintenance therapy (2MT) among COPD patients in the US and UK.MethodsWe used healthcare data from the US IBM® MarketScan® and UK Clinical Practice Research Datalink databases (2015 – 2018) to assess transitions between 1MT and 2MT among COPD patients. Patients with a recorded asthma diagnosis prior to 1MT were excluded. We assessed whether prescribed treatments (long-acting muscarinic antagonists [LAMA], long-acting β2-agonists [LABA], inhaled corticosteroids [ICS], as monotherapy or in combination) were consistent with global and national recommendations for COPD, identified patient characteristics associated with treatment transitions, and evaluated treatment duration.ResultsOverall, 7028 patients in the US and 2461 in the UK initiated 2MT within a median (IQR) 160.0 (76.0; 335.0) and 218.0 (86.0; 428.0) days after 1MT, respectively. In the US, 33.6% of patients initiating 2MT had no recorded exacerbations in the previous year, whereas 23.1% had one and 43.3% had ≥ 2. In the UK, 54.9% of patients had no recorded exacerbations in the previous year, whereas 20.9% had one and 24.2% had ≥ 2. At 2MT, most patients switched to LAMA/LABA/ICS (26.1%) or LABA/ICS (25.8%) in the US, and LAMA/LABA (39.4%) or LAMA/LABA/ICS (27.8%) in the UK; 62.2% (US) and 47.5% of patients (UK) were prescribed ICS-containing regimens. The most common treatment transition from 1MT to 2MT was LABA/ICS to LAMA/LABA/ICS (13.0%) in the US; and LAMA to LAMA/LABA (32.5%) and LAMA to LAMA/LABA/ICS (14.3%) in the UK.ConclusionsAt 2MT, the proportion of patients on LAMA/LABA/ICS was similar between the US and UK, but treatment pathways were different.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-021-00180-7.

Flow–Characterization of Oral Cavities for the Mechanical Lung Simulator xPULM

Mechanical lung simulators play an important role in research into breathing and ventilation processes. They can be used in investigation into the deposition of drugs in the mouth and throat up to the bronchi, if this is simulated mechanically, but is also understood in terms of flow physics. Research in this subject area is complicated by the fact that inhalers generally cannot be examined independently of the rest of the mechanical simulator. We present the testings of flow analysis on two modules of the mouth and throat for the mechanical lung simulator xPULM and show that the degree of turbulence of the flows examined is significantly influenced by the type of inhaler used. The results are obtained through measurements on four different inhalers.

Two-way coupling and Kolmogorov scales on inhaler spray plume evolutions from Ventolin, ProAir, and Qvar.

Previous numerical studies of pulmonary drug delivery using metered-dose inhalers (MDIs) often neglected the momentum transfer from droplets to fluid. However, Kolmogorov length scales in MDI flows can be comparable to the droplet sizes in the orifice vicinity, and their interactions can modify the spray behaviors. This study aimed to evaluate the two-way coupling effects on spray plume evolutions compared to one-way coupling. The influences from the mass loading, droplet size, and inhaler type were also examined. Large-eddy simulation and Lagrangian approach were used to simulate the flow and droplet motions. Two-way coupled predictions appeared to provide significantly improved predictions of the aerosol behaviors close to the Ventolin orifice than one-way coupling. Increasing the applied MDI dose mass altered both the fluid and aerosol dynamics, notably bending the spray plume downward when applying a dose ten times larger. The droplet size played a key role in spray dynamics, with the plume being suppressed for 2-µm aerosols and enhanced for 20-µm aerosols. The Kolmogorov length scale ratio dp/η correlated well with the observed difference in spray plumes, with suppressed plumes when dp/η < 0.1 and enhanced plumes when dp/η > 0.1. For the three inhalers considered (Ventolin, ProAir, and Qvar), significant differences were predicted using two-way and one-way coupling despite the level and manifestation of these differences varied. Two-way coupling effects were significant for MDI sprays and should be considered in future numerical studies.

Interventional, Quasi-Experimental Study of a Chronic Obstructive Pulmonary Disease Education Care Plan for Hospital Discharge.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity, mortality, and reduced quality of life for patients. Proper use of inhaler devices is critical for effective drug delivery and prevention of COPD progression. The primary endpoint of this study was a mean percent increase in correct steps associated with inhaler technique after pharmacist education. The co-primary endpoint was a 25% increase in the proportion of patients correctly identifying the appropriate use of short-acting versus long-acting inhaler types. This was an interventional quasi-experimental study of patients hospitalized at a 491-bed tertiary academic medical center with a COPD exacerbation to assess a pharmacist-led COPD care plan. Eligible patients included general floor, adult patients admitted with a primary diagnosis of COPD exacerbation. The primary investigator recorded initial inhaler technique scores through a paper checklist, and provided education about device types and usage. Patients were reassessed within 48 h to determine if pharmacist education improved inhaler knowledge. A total of 67 patients received the COPD care plan before hospital discharge. At baseline, patients scored a median of 81.8% (67.5–97.0) of steps correct across all inhaler device types. After pharmacist education, patient scores increased to a median of 100% (90.9–100.0) (p < 0.0001). The proportion of patients correctly identifying when to use short-acting versus long-acting inhalers increased from 73.1% to 98.5% (p < 0.0001). Implementation of a pharmacist-led care plan for patients admitted for COPD exacerbation was associated with an increase in correct steps for appropriate inhaler technique and understanding of inhaler device types after pharmacist education.

The environmental impact of inhaled therapy: making informed treatment choices.

When selecting the best inhaler and drug combination for a patient with respiratory disease, a number of factors should be considered. While efficacy and safety of medical treatments are always a priority, in recent years the environmental impacts of all aspects of life have become an increasingly necessary consideration and inhaled therapies are no exception. The carbon footprint of an item, individual or organisation is one of the most important and quantifiable environmental impacts, assessed by the amount of greenhouse gases (often expressed in terms of carbon dioxide equivalents) generated throughout the life cycle. The two most commonly prescribed and manufactured inhaler types worldwide are pressurised metered-dose inhalers (pMDIs) containing hydrofluorocarbon (HFC) propellants and dry powder inhalers (DPIs). Most of the carbon footprint of current pMDIs is a result of the propellants that they contain (HFC-134a and HFC-227ea, which are potent greenhouse gases). In comparison, the powder in DPIs is dispersed by the patient's own inhalation, meaning DPIs do not contain a propellant and have a lower carbon footprint than most pMDIs currently available. Soft mist inhalers are another propellant-free option: the device contains a spring, which provides the energy to disperse the aqueous medication. In this review, we examine the published data on carbon footprint data for inhalers, providing an analysis of potential implications for treatment decision making and industry initiatives.

Application aspects of medications for inhalation at the prehospital stage of medical evacuation

This study aimed to determine the aspects of inhalation application of drugs as medical means of protection against lesions by factors of radiation, chemical, and biological nature at the prehospital stage of medical evacuation. Advantages of inhalation administration of drugs and use of individual inhalers of portable type over parenteral and oral administration methods are described. The existing drugs that are most suitable for inhalation at the prehospital stage of medical evacuation include emergency prevention and treatment of toxic pulmonary edema, analgesics, antiradiation, drugs for arresting radiation primary reaction, agents for accelerated radionuclides elimination, and antibacterial and antiviral agents. This list is conditioned by the rapid achievement of the protective effect of the drug during inhalation, both due to the local action in the area of the entrance gate of the intake of damaging agents and the accelerated absorption and systemic action on target organs. This study presents data on existing and promising inhalation drugs (antidotes for warfare agents, recombinant forms of acetyl- and butyrylcholinesterase) and technical means of their delivery (a metered aerosol inhaler, a metered dry powder inhaler) in the Armed Forces of the European North Atlantic Treaty Organization bloc and the United States for the prevention and treatment of damage e to chemical agents, as well as the prospects of radiomitigator usage (granulocyte-macrophage colony-stimulating factor) by inhalations for acute radiation syndrome treatment and inhalation of complexones of radioactive isotopes. The prospects of inhalation in combination with bronchodilators in the development of acute respiratory failure and toxic pulmonary edema on the background of poisoning with the use of a metered-dose powder inhaler are described. The introduction and use of a metered-dose dry powder inhaler at the prehospital stage of medical evacuation determines the need for its development, taking into account the specifics of the drug usage, as well as the need to unify the dosage form of drugs in combination with one type of inhaler (single-dose or multi-dose).

Evaluating Technical Knowledge of Using Inhalation Devices Amongst Medical Students and Pediatrics Residents in Iran

Background: Asthma is a common chronic respiratory disorder in children and adults worldwide. Inhalers are vital medications that are prescribed to control the disease and reduce its mortality and morbidity. Objectives: This study aimed to assess the knowledge and skills of Medical Students (MSs) and pediatric residents (PRs) in using different inhaler devices (IDs). Methods: This cross-sectional study included 243 MSs and PRs at Shiraz University of Medical Sciences, Iran, from March 2018 to March 2019. The MSs were divided into the senior medical students (SMSs) and junior medical students (JMSs). Data regarding participants’ knowledge on metered dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulizers (NBs) were gathered using questionnaires and a face-to-face interview. Results: Of the 243 participants in the study, 113 (46.5%) were SMSs, 87 (35.8%) were JMSs, and 43 (17.7%) were PRs. The mean age of the participants was 26/20 ± 4/25 years. There was no significant difference between studied groups regarding recognition of MDI device (P = 0.072). PRs were more familiar with the DPIs than MSs (P &lt; 0.001). They also could recognize the NBs better than the MSs (P &lt; 0.001). In terms of using DPIs correctly, PRs executed all the steps better than MSs (P &lt; 0.001) except for the third step which all the participants had the same knowledge (P = 0.13). Regarding correct use of NBs, PRs had better performance compared to MSs (P &lt; 0.001). Conclusions: According to our results, there was an educational vacancy in training MSs regarding using IDs correctly, which can lead to poor compliance in asthmatic patients and deteriorating their lifestyle. The current research supports the need to redesign the educational curriculum of MSs and PRs in Iran to teach them sufficient knowledge and skills about how to use different types of inhalers properly.

Computational investigation of particle penetration and deposition pattern in a realistic respiratory tract model from different types of dry powder inhalers

The aim of this study was to evaluate the device performance of a new design by comparing with a typical commercial DPI. Computational fluid dynamics (CFD) coupled with the discrete element method (DEM) collision has been utilized in this study to characterize and examine the flow field and particle transportation, respectively. A typical commercial DPI and an in-house designed novel DPI with distinct design features were compared to explore their dispersion capabilities and suitability for delivery to the respiratory tract. For this exploration, realistic oral to larynx and tracheobronchial airway models consisting of bio-relevant features were adopted to enhance practical feasibility. Distinct aerosol performances were observed between the two DPIs in the respiratory tract, where the in-house DPI, in comparison with the commercial DPI, has shown approximately 30% lower deposition fraction in the mouth-throat region with approximately 7% higher escape rate in the tracheobronchial region under the identical inhalation condition. This observation demonstrates that a novel in-house designed DPI provides higher device efficiency over the selected typical commercial DPI.

Oral health assessment in children aging 8–15 years with bronchial asthma using inhalation medication

Objectives:The aim of the present study was to evaluate and compare oral health status of bronchial asthma patients between the age group of 8–15 years with healthy individuals and examines the relationship between the severity of asthma, dose duration, method of taking medication, and use of AeroChamber on the dental health of children diagnosed with asthma.Materials and Methods:The present cross-sectional study assessed the oral status of asthmatic patients and compared with a control group of 200 nonasthmatic patients. Both groups were matched in relation to age and gender. The oral health was assessed by measuring oral hygiene, caries status, periodontal health, and candidiasis of participants. Oral hygiene was measured by plaque index, caries assessment was done with the decayed missing filled teeth index/decayed extracted filled (DMFT/def index) and the periodontal status was measured with community periodontal index (CPI) adapted from the WHO (1997).Results:Plaque index score among asthmatics group was 1.49 ± 0.65 was significantly higher than healthy group 1.08 ± 0.57. The significant difference was noted in the mean caries (DMFT/def) score for asthmatic patients (2.31 ± 1.65/1.02 ± 0.39) and the controls (1.98 ± 1.54/0.74 ± 0.39). The CPI score was also significantly high in asthmatics (3.19 ± 1.68) in comparison to healthy individuals (2.32 ± 2.07). The candidiasis was absent in healthy individuals while it was present among 28 patients in the asthmatic group. The patients who were taking medication from longer period of time (9–12 months) had significantly worse oral health. The study result did not show any significant difference with the type of inhalation. However it showed significantly improved oral health for patients using AeroChamber in comparison to the patients not using it.Conclusion:Oral health was significantly poor in asthmatic patients in comparison with the healthy individuals. Increased frequency of asthma medication use was associated with increased likelihood of poor oral health. Use of AeroChamber improves the oral health of patients.

Ефективність різних засобів доставки інгаляційних препаратів у дітей із бронхіальною астмою

Мета дослідження — оцінити ефективність техніки інгаляції при використанні різних видів інгаляторів. Матеріали та методи. 45 пацієнтам 6–17 років була проведена оцінка правильності виконання інгаляції за допомогою апарата імітації внутрішнього опору деяких видів інгаляторів та виміру швидкості, з якою відбувається вдих (In-Check-Dial). Вивчена частота помилок у різних вікових групах. Результати. 80 % дітей молодшої групи помилилися при використанні турбухалеру, 73,3 % — дозованого аерозольного інгалятора, 60 % — ізихалеру. Жоден пацієнт 6–7 років не зробив помилку при використанні дискхалеру. 100 % дітей 12–14 років зробили помилки при застосуванні дозованого аерозольного інгалятора. При використанні ізихалеру частота помилок становила 66,6 %, дискхалеру — 26,6 %. Серед дітей старшого віку частота помилок при застосуванні турбухалеру була вірогідно меншою, а саме: 40 % — у дітей 12–14 років, 25 % — 15–17 років (р &lt; 0,05). Діти 15–17 років найбільш правильно використовували турбухалер та дискхалер (помилки в 33,3 та 46,6 % відповідно). Тоді як за допомогою дозованого аерозольного інгалятора жоден пацієнт не зробив правильну інгаляцію, 93,3 % хворих також помилились у використанні інгаляції через ізихалер. Висновки. Частота помилок залежно від віку та виду інгалятора сягає 26–100 %. Найменша кількість помилок спостерігається при застосуванні дискхалеру (у всіх вікових групах), найвища — дозованого аерозольного інгалятора. З метою вибору оптимального інгалятора для дитини з бронхіальною астмою доцільно вимірювати інспіраторний потік за допомогою In-Check-Dial перед призначенням терапії.

Impact of PIF, Inhalation Technique and Medication Adherence on Health Status and Exacerbations in COPD: Protocol of a Real-World Observational Study (PIFotal COPD Study).

IntroductionDry powder inhalers (DPIs), a commonly prescribed inhaler type for respiratory diseases, require patients to generate sufficient peak inspiratory flow (PIF) to ensure optimal drug delivery to the airways. Effectiveness of therapy also requires a good inhalation technique and adequate medication adherence. For patients with chronic obstructive pulmonary disease (COPD), recent studies conducted in tertiary care suggest that DPI users with suboptimal PIF have poorer COPD-related health status and increased exacerbation risk versus those with optimal PIF. The PIFotal study will investigate the impact of PIF, inhalation technique and medication adherence on patient-reported outcomes in patients with COPD in primary care using a DPI for their maintenance therapy.Methods and AnalysisThis cross-sectional observational study will assess 1200 patients (aged ≥ 40 years, diagnosed with COPD and using a DPI for COPD maintenance therapy for ≥ 3 months) from the Netherlands, Spain, Portugal, Poland, Greece and Australia. Assessments will consist of (1) PIF measurements (usual patient inhalation manoeuvre, maximal PIF against resistance of own inhaler, and maximal PIF against low resistance); (2) Clinical COPD Questionnaire (CCQ), COPD Assessment Test and Test of Adherence to Inhalers scores; and (3) video recordings of patient inhalation technique. Dependent variables include health status (CCQ score), number of self-reported exacerbations in previous 12 months, and healthcare resource utilisation in previous 6 months. Independent variables include PIF values, inhalation technique errors, medication adherence, and demographic and clinical characteristics. In the primary analysis, the mean difference in CCQ score between patients (1) with optimal/suboptimal PIF, (2) exhibiting/not exhibiting inhalation technique errors, and (3) adhering/not adhering to medication will be examined in a multivariable linear mixed model.EthicsThe study protocol was approved by ethics committees/institutional review boards of all participating sites prior to enrolment; written informed consent was obtained from all study participants.Trial Registration NumberClinicalTrials.gov: NCT04532853.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-021-00172-7.

Interventions to improve adherence to pharmacological therapy for chronic obstructive pulmonary disease (COPD).

Interventions to improve adherence to pharmacological therapy for chronic obstructive pulmonary disease (COPD).

Impact of inhalers used in the treatment of respiratory diseases on global warming.

The term "carbon footprint" describes the emission of greenhouse gases into the environment as a result of human activities. The healthcare sector is responsible for 5-8% of the value of global greenhouse gas emissions, of which medical aerosols account for only 0.03% of the total emissions. The reduction of greenhouse gases, including those used for the production and use of medicinal products and medical devices, is part of the responsibilities that Poland and the respective countries should undertake in order to implement the assumptions of international law. At the level of medical law, this obligation correlates with the need to exercise due diligence in the process of providing health services, including the selection of low-emission medical products and devices (inhalers) and providing patients with information on how to handle used products and devices, with particular emphasis on those that imply greenhouse gas emissions. Pressurized metered dose inhalers (pMDI) containing the hydrofluoroalkane 134a demonstrate the largest carbon footprint, followed by a metered dose liquid inhaler and dry powder inhalers (DPI). The carbon footprint of DPI with a given drug is 13-32 times lower than it is in the case of the corresponding pMDI. Replacement of pMDI by DPI is one of the effective methods to reduce the carbon footprint of inhalers, and the replacement should be based on current medical knowledge. A recycling system for all types of inhalers must be urgently implemented.

Évaluation des connaissances des médecins généralistes sur les inhalateurs. Les médecins généralistes savent-ils utiliser les inhalateurs qu’ils prescrivent dans le traitement de l’asthme ?

Inhaled drug delivery is the cornerstone treatment for asthma. General practitioners (GPs) have a key role for educating patient about how to use their inhalers. The purpose of this study was to find out whether GPs know how to use the inhalers they usually prescribe. This was a descriptive and analytical cross-sectional study among GPs from the Paris metropolitan area. GPs had to choose the inhalers they usually prescribe and then demonstrate their use. The technique of use was assessed using a scale specific to each type of inhaler. Overall success was defined by the use of prescribed inhalers without critical errors. Thirty-seven GPs were recruited between July 2018 and July 2019. Nineteen GPs (51.4%) were able to use the inhalers they prescribed without critical errors. The success rate without critical error was better with the pressurized metered dose inhalers with spacer than with other inhalers. The overall success rate was better among GPs who had previously used an inhaler on a personal basis (OR 7.58 95%CI [1.86, 37.02]) or who had prescribed only one type of inhaler (OR 4,8 95%CI [1.21, 22.41]). Half of the GPs in our study did not know how to use the inhalers they prescribe and therefore may have difficulty educating their patients.

A Study to Investigate the Prevalence of Device-Specific Errors in Inhaler Technique in Adults With Airway Disease (The SCORES Study): Protocol for a Single Visit Prevalence Study.

BackgroundIt is a recurring theme in clinical practice that patients using inhaled medications via an inhaler do not use their device to a standard that allows for optimum therapeutic effect, and some studies have shown that up to 90% of people do not use their inhalers properly. Observation and correction of the inhaler technique by health care professionals is advised by both national and international guidelines and should be performed at every opportunity to ensure that the optimum inhaler technique is achieved by the user. This study will provide a greater understanding of the most frequent technique errors made by people using 13 different inhaler types.ObjectiveThis study aims to identify and compare inhaler technique errors and their prevalence in adults, using device-specific checklists in accordance with manufacturers’ guidelines, for 13 specific inhaler types across all lung conditions and to correlate these errors with possible determinants of poor technique. It also aims to assess the error frequency at each step in the device-specific questionnaires and compare the error rates among device types.MethodsIn a single visit, participants using an inhaler included in the inclusion criteria will have their inhaler technique observed using an identical placebo device, which will be recorded using device-specific checklists, and technique-optimized, or switched to a suitable inhaler.ResultsThe study is already underway, and it is anticipated that the results will be available by 2022.ConclusionsThe SCORES (Study to Investigate the Prevalence of Device-Specific Errors in Inhaler Technique in Adults With Airway Disease) study will ascertain the prevalence of device-specific inhaler technique errors at each step in the device-specific checklists, compare error rates among 13 device types, and correlate these errors with possible determinants of poor technique. Future work will involve the clarification and classification of these errors into critical and noncritical categories.Trial RegistrationClinicalTrials.gov NCT04262271; https://clinicaltrials.gov/ct2/show/NCT04262271International Registered Report Identifier (IRRID)DERR1-10.2196/26350

The effect of repeated education using live demonstrations and videos of how to use inhalation drugs on quality of life for COPD patients

Repeated education regarding the proper use of inhalers can reduce the error rate in inhaler-using patients and improve COPD patients’ quality of life. This study investigates the effect of repeated education on the quality of life of COPD patients during the pandemic of COVID-19 from February to June 2020. Repeated education is provided using direct demonstrations to patients through educational media in the form of short videos made by the researchers for each inhaler type. This is a pre-experimental study design which was carried out prospectively at Grha Permata Ibu Hospital, Depok. The quality of life of 22 subjects was examined using the COPD assessment test (CAT) questionnaire. Each patient was given a direct verbal demonstration of the appropriate use of the inhaler. One month later, each patient was provided further education using less than 2 min of video sent to them online via the WhatsApp application. Final quality-of-life examination and assessment of inhaler technique were carried out three months after the initial examination. Assessment of proper inhaler technique was carried out using a specific checklist regarding the use of inhaler translated by the researcher. Before and after delivery of repeated education, the mean CAT score showed a decrease of two points, i.e., 12.8 ± 1.3 and 10.8 ± 2.0, respectively. This indicated that quality of life of the patients had significant improvement. However, as many as 63.6% of patients still made mistakes in using inhaler even though they had been educated. For DPI-type inhalers, mistake mostly happened at step “breath out gently, away from inhaler”. For pMDI-type inhalers, mistake mostly happened at step “while holding breath, remove inhaler from mouth”. It can be concluded that repeated education regarding proper inhaler technique with direct demonstrations and further maintained by videos can improve the quality of life in COPD patients.

Hands-on training on inhaled devices to boost pharmacy students’ performance during inhaler counselling

Objective: The effective use of inhalers depends on completeness of information from healthcare providers. As pharmacists acquire foundational skills on inhalers from their undergraduate curriculum, the experience and performance of pharmacy students regarding inhaler counselling should be explored. Methods: Pharmacy students who completed their final year of study answered an online questionnaire on their experience with teaching-learning activities on inhalers. Students also underwent an objective structured clinical exam that included Turbuhaler device counselling. Results: 84 students who completed the online questionnaire strongly agreed that the curriculum increased their awareness of different types of inhalers (65.5%) and specific techniques for use (64.3%). Students reported being able to counsel on metered-dose inhaler (98.8%) and dry-powder inhaler (92.8%) techniques. Students performed well (M=9.4, SD=2.7) at Turbuhaler counselling from a full score of 14. Conclusions: The current training on inhaler devices was useful for the pharmacy students. Future training should emphasise supplementary advice on inhaler taste and gargling.

Degradation of lipid based drug delivery formulations during nebulization

Encapsulating pharmaceuticals in protective lipid based nanoparticles, and nebulizing them towards the target area in the body offers a range of clinical advantages. However, the process of nebulization might possibly damage sensitive nanoparticle structures, such as liposomes, resulting in loss of active pharmaceutical ingredients. We compare this loss for two types of lung inhalation devices: high-frequency piezo-actuated vibrating mesh nebulizers and non-actuated continuous jet nebulizers. We find that vibrating mesh nebulizers cause model liposomes to release more than ten times as much encapsulated material as the continuous jet nebulizers because the energies involved in nebulization are much larger. This result highlights the importance of applying a mild nebulization technology when administering shear-sensitive drug formulations such as lipid nanoparticle based drugs to the lungs.

An investigation into hospital prescribers' knowledge and confidence to provide high-quality, sustainable respiratory care

The number and range of inhaler combinations and brand names has increased significantly over recent years, making prescribing more complex. Inhalers contribute 3% of the NHS's carbon footprint, therefore appropriate inhaler prescribing, use and disposal could contribute significantly towards the NHS's target of net zero carbon emissions by 2040. We developed a survey to assess prescriber knowledge of inhaled medications, inhalation devices and environmental impacts of inhalers. One-hundred and two secondary care prescribers from one NHS trust responded. Knowledge of the contents and device types of inhalers, and of the environmental impacts of inhalers was lacking. Only 9% of respondents discuss the environmental impact of inhalers with patients and 13% have discussed inhaler disposal with patients, but 46% of respondents expressed that they would educate patients about the environmental impacts of inhalers if they were provided with education and support to do so.

Evaluation of inhaler use technique among patients with chronic obstructive pulmonary disease

Introduction: Chronic obstructive pulmonary disease (COPD) is a common medical problem. The improper implementation of inhaler techniques thatare used in such patients leads to the reduced effect of medicines. This study was conducted to evaluate the correct use of various inhalers among COPD patients. Materials and Methods:This observational, cross-sectional study was carried out on 96 patients with COPD aged over 40 years. The samples were selected using asystematic random samplingmethod from patients with COPD referring to the clinics of Ghaem and Imam Reza hospitals, Mashhad, Iran, from March 2018 to March 2019. The subjects were informed that their participation in the study was voluntary. These cases were under the treatment of using at least one inhaled medicine for a month or more. The adopted technique of applying four types of inhalers was evaluated by a standard checklist. The patients' performance scores of all procedures were recorded, and the collected data were analyzed in SPSS software (version 16). Results: Our study revealed that more than 98% of patients used metered-dose inhaler (MDI) spray (P=0.05). The patients' scores on the correct use of MDI, Diskus, Turbuhaler, and HandiHaler inhalers were estimated at 68, 77, 87, and 90%, respectively. The most common mistakes in using MDI and HandiHaler inhalers were related to the 'holding the breath' and taking a deep inhale' steps after using the inhaler, respectively. Conclusion: Physicians must evaluate and modify the use of inhalers in every COPD patient. It is recommended that easy-to-use inhalers, such as HandiHaler, be prescribed for such patients.