Inhalant Research Articles

Are Treatment Adherence Factors Apparent in Patients with Asthma and to Physicians? Results from the APPaRENT3 Survey.

Patient adherence to regular controller medication is critical for improving clinical outcomes in asthma, which is consistently associated with underlying pathophysiological inflammation. This survey aimed to identify types of treatment nonadherence and associated factors, including patient characteristics that predict poor adherence, in patients with asthma. This cross-sectional online survey involved patients with asthma and physicians managing such patients from Southeast Asia (Indonesia, Malaysia, Philippines, Thailand and Vietnam) and the Middle East (Saudi Arabia and United Arab Emirates) included in the Asthma Patients' and Physicians' Perspectives on the Burden and Management of Asthma (APPaRENT)3 study. Patients and physicians shared their attitudes and beliefs regarding treatment and adherence in asthma management. Most patients (82%, 1108/1354) reported having ever received treatment with daily controller inhalers, whereas 38% used inhaled relievers at least once daily for symptomatic relief. Among those prescribed maintenance and reliever therapy, 93% were prescribed a separate inhaled reliever, with significant variation by country (P < 0.01). Erratic nonadherence (primary definition) was exhibited by 55% (462/845) of patients including those who reported at least sometimes forgetting inhaler use, with its prevalence increasing with worsening asthma severity. Nonerratic nonadherence was exhibited by 49% (415/847) of patients including those who reported using controller inhalers less than once daily. Physicians reported that 73% of patients adhered to the prescribed regular medication. Regression analysis examining both erratic (primary definition) and nonerratic nonadherence revealed that current inhaled reliever used was the only significant predictor of poor adherence (P = 0.04). Sensitivity analyses revealed that the predictors of poor adherence to controller inhaler varied depending on the definition of nonadherence employed in the study. This study revealed high rates of erratic and nonerratic nonadherence to regular controller inhalers in patients with asthma as well as discordance between adherence rates reported by patients and physicians.

Factors that Affected Mortality Rate of Chronic Obstructive Pulmonary Disease Patients with Respiratory Failure

Background: Chronic obstructive pulmonary disease (COPD) is a health problem with significant morbidity and mortality rates, but until now risk factors of COPD, especially with type II respiratory failure, have not been clearly defined. This research is aimed to determine factors that affect the mortality rate of COPD patients with type II respiratory failure.Methods: Between March and May 2018, 85 MS patients from a large Hospital in the Athens region completed the questionnaires: a) Missoula-VITAS Quality of Life Index-15, which examines 5 dimensions of quality of life, b) Pain Self Efficacy Questionnaire which measures the pain self-efficacy that an individual perceives, c) Fatigue Assessment Scale (FAS) which measures fatigue, d) a questionnaire about the sociodemographic elements. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up to 0.001.Results: Variables of gender, age, number of comorbidities, smoking habits, and history of exacerbations weren’t significantly correlated with mortality of COPD patients (p&gt;0.05). Patients who do not routinely use inhalers tend to be more at risk with a mortality rate 19 times greater than patients who use inhalation therapy regularly. In addition, the longer the stay, the lower the risk of experiencing mortality.Conclusion: Factors that affected the mortality rate of COPD patients with type II respiratory failure are routine use of inhalers and length of stay.

Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England

BackgroundGuidelines recommend that asthma medication should be stepped down to the minimally effective dose that achieves symptom control. Stepping down aims to prevent adverse medication effects and unnecessary costs but...

Development and clinical assessment of a novel probiotic candy in the prevention of respiratory infections in asthmatic children.

Asthma is the most common chronic disease among children. Upper respiratory infections are often the cause of asthma exacerbation. Studies suggested that spore-forming probiotics can reduce viral infections. This study aimed to determine the effect of spore-forming probiotic Bacillus candy on respiratory illnesses in asthmatic children. In this randomized trial, 69 children aged 7-11 years with mild intermittent asthma were randomized to receive probiotic candy (containing 1010CFU probiotic Bacillus coagulans) or placebo candy, daily for 2 months. The primary outcome was the number of viral respiratory infections. Secondary outcomes included salbutamol metered-dose inhaler (MDI) use, oral corticosteroids, school absenteeism, emergency department visits and hospitalizations, and Pediatric Asthma Control Questionnaire (c-ACT). The frequency of symptomatic respiratory illnesses was significantly lower in the probiotic candy group compared to placebo in the first month (0.28±0.45 vs. 0.51±0.50, p=0.054), the second month (0.08±0.28 vs. 0.41±0.49, p=0.001) and the total study (0.37±0.54 vs. 0.90±0.73, 0.001). The percent of patients with prednisolone consumption in the probiotic group was lower than the control group (2.9% vs. 14.7%) but did not show a significant difference (p=0.081) and no difference was seen in the rate of emergency department visits and hospitalization between the 2 groups (both p=0.254). The use of salbutamol and school absenteeism in the probiotic group was significantly lower than in the control group (p=0.040 and p=0.046, respectively. There was no significant difference in the evaluated scores for asthma control (c-ACT) in both probiotic and placebo groups. After the intervention, the difference between the 2 groups has become significant (p<0.05). Adding spore-forming probiotic candy containing Bacillus coagulans to standard asthma treatments reduced symptomatic respiratory illnesses over two months. Further studies including longer treatment periods are needed before making recommendations for routine use.

Clinical effectiveness and implementation outcomes of pMDI-to-DPI switch in children between 5 and 12 years of age: a scoping review protocol

IntroductionInhalers are critical in asthma treatment, and inappropriate inhaler use leads to poor asthma outcomes. In adults and adolescents, dry powder inhalers (DPIs) are safe and effective alternatives to mainstay...

Accidental Autoerotic Deaths and Mental Disorder: A Scoping Review.

Accidental autoerotic death, more commonly known as "autoerotic asphyxia," is an extreme paraphilic behavior wherein individuals induce cerebral hypoxia during self-stimulated sexual activities, often by constricting the neck or obstructing respiratory passages. Data on accidental deaths caused by autoerotic play is very low because of the non-disclosure of the mode/circumstances of death or non-paralleled forensic systems in many countries. There is a high likelihood of coexisting mental disorders with such behavior. This review identifies the association of any comorbid mental disorder with accidental autoerotic deaths. On August 23, 2023, a systematic literature search was carried out through Cochrane, PubMed, ScienceDirect, and SCOPUS, and studies identified in the English language were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guideline. Eighteen studies identified specific mental disorders with autoerotic deaths, including paraphilia, vaginismus, gender dysphoria, multiplex paraphilia, alcohol dependence, bipolar disorder, borderline personality disorder, and substance use disorder. Inhalant use like chloroform, toluene, and xylene was implicated during autoerotic fantasies. Prospective clinical screening and comprehensive multicentric psychological autopsy studies are needed to clarify the prevalence of accidental autoerotic death and related mental health conditions in the future. Given the possibility of accidental death, it remains to be seen whether paraphilia involving a single harmful event could be classified as a specifier within the impulsive-compulsive-reward spectrum, similar to how newer diagnostic systems address substance use disorders.

The use of hyperoxia to accelerate recovery the organism after the floor exercises routines in artistic gymnastics

The research deals with the use of inhalation of concentrated oxygen in the regeneration interval after anaerobic load in Artistic Gymnastics. The aim of research ́s realization was to diagnose the impact of inhalation of concentrated oxygen (hyperoxia) on the recovery ́s duration on reaction of heart rate and the level of the lactate in capillary blood after the floor exercises. The experiment was implemented on three members of nation team of Slovakia in artistic gymnastics. During the experiment ́s realization, the heart rate of gymnasts was continuously monitored. One minute after each specific load and after 3-, 7- and 15-minute recovery, we applied measurements of the lactate levels in capillary blood. The experimental factor was anonymous inhalation of concentrated oxygen respectively air (in form of placebo) during the rest. Gymnasts regenerated after each specific load by the form of inhalation of concentrated oxygen or placebo. Diagnostics ́ results after floor exercises of all professional gymnasts suggest on decrease of anaerobic cover after oxygen´s inhalation and faster lactate ́s remetabolisation when comparing with placebo ́s inhalation. The lactate curve tended downward from the 1st minute in recovery with inhalation of concentrated oxygen. On the contrary inhaling placebo made lactate curve rise till 3rd minute, resp. till 7th minute and then tended downwards. It was also exhibited the decrease of heart rate the average 10 beats per minute less with oxygen ́s inhalation when compared with placebo ́s inhalation in 1st, 2nd and 3rd minute after floor exercises routines. According to this information we can consider that the inhalation of hyperoxic mixture was a method to accelerate the recovery after specific load of elite gymnasts.

Evaluation of Knowledge and Skills of Postgraduate Medical Students and Healthcare Assistants in Managing Asthma Using Metered-Dose Inhalers

Background: Asthma remains a significant global health concern, with its rising prevalence particularly challenging in low- and middle-income countries due to factors such as pollution, urbanization, and inadequate healthcare infrastructure. The purpose of this study was to evaluate the knowledge and skills of postgraduate medical students and healthcare assistants in managing asthma using metered-dose inhalers, with the goal of identifying gaps to inform targeted training and educational interventions. Aim of the study: The aim of the study was to assess the knowledge and skills of postgraduate medical students and healthcare assistants in managing asthma using metered-dose inhalers. Methods: This cross-sectional observational study in the Department of Internal Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, was conducted from July to December 2015, involving 200 postgraduate medical students &amp; health-assistants (nurses, ward-boys, pharmacists, drug dispensers). Data were collected through structured interviews and observations, analyzed using SPSS version 17.0, and Chi-square tests, with a significance threshold of p &lt; 0.05. Ethical approval and informed consent were obtained. Results: In a study of 200 postgraduate medical students &amp; health- assistants, with a mean age of 30.8 years, 57.4% were male, and 50% were postgraduate medical students 25% were nurses, 15% were ward-boys, 5% were pharmacist &amp; 5% were drug dispensers. All counseled-on inhaler use, but only 71.8% recommended medications. Most performed initial inhaler steps well, but adherence to final steps was inconsistent. Post gradual medical students generally outperformed nurses &amp; other health- assistants, except in "Breathe out slowly and completely" and "Hold breath for 10-15 seconds" and the nurses out-perform the pharmacist. Conclusion: Postgraduate medical students display varied proficiency in metered-dose inhaler techniques, with final steps showing ...

Optimising Asthma Self-Management: Preliminary Validation of an Arabic Version of the Inhaler Technique Questionnaire.

Correct inhaler technique is vital for managing respiratory conditions like asthma. Patients from culturally and linguistically diverse backgrounds are at higher risk of sub-optimal adherence and errors in inhaler technique. This study aimed to validate an Arabic version of the inhaler technique questionnaire for self-assessment of the metered-dose inhaler (MDI) technique by assessing agreement between observed and self-reported techniques among Arabic-speaking individuals with asthma in Australia. Observational assessments of 30 participants using an MDI, followed by completion of the translated inhaler technique questionnaire by the same participants. The questionnaire comprised nine questions pertaining to the inhaler technique. The level of agreement between the observed and self-reported technique for each of the nine MDI technique steps was subsequently determined using intraclass correlation. The majority of participants were women, aged 25-44 years (70%). An overall Kappa score of 0.768 indicated good agreement between observed and self-reported datasets, with stepwise agreement ranging from 52.4-100%. Steps involving taking a big breath before inhaler use (step 2) and exhaling slowly (step 8) were the least well correlated. The preliminary validated MDI inhaler technique questionnaire may be used as a self-assessment tool by Arabic speakers, aiding healthcare professionals, and empowering individuals living with asthma to self-manage their condition.

Addressing inhaler technique challenges in cognitively impaired chronic obstructive pulmonary disease patients: the impact of customized training programs.

Individuals with chronic obstructive pulmonary disease (COPD) and cognitive impairment (CI) often face difficulties accurately administering inhalers, which are essential for managing their respiratory condition. Many elderly individuals make major errors that prevent proper medicine administration. Maintaining proper inhaler use skills is critical in controlling COPD. Our goal was to examine and evaluate the inhaler use skills of CI patients with COPD during both the initial evaluation and subsequent appointments. The Respiratory Department of KLEs Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehru Nagar, Belagavi, Karnataka, India, was the site of this prospective interventional study. Based on the Montreal Cognitive Assessment Scale (MoCA), a subset of patients with COPD exhibited mild CI. Patients exhibiting improper inhaler-using skills were detected, corrected, and trained. Inhaler techniques were reassessed immediately and at follow-up visits. The modified Medical Research Council scale score (mMRC), COPD assessment test (CAT) score, St. George Respiratory Questionnaire (SGRQ), and pulmonary function tests were reassessed. A total of 56 COPD and CI patients who had made at least one significant mistake when using an inhaler device were added to the study. The mean age was 66.89±9.85 years. When evaluated with MoCA, the mean score was 17.02±3.91. At baseline, the mean number of mistakes was 1.38±0.93, which decreased to 0.54±0.57 after face-to-face demonstration of correct inhaler techniques. Correlational analysis revealed MoCA scores were negatively associated with the number of mistakes (r=-0.344). At follow-up, CAT score (25±5.61 vs. 18.48±5.24 p=0.001), SGRQ score (53.82±20.59 vs. 37.61±22.17 p=0.001), mMRC score (3.21±0.76 vs. 3.20±0.75 p=0.001), and forced expiratory volume in 1 second/forced vital capacity score (66.86±9.35 vs. 70.08±9.07 p=0.001) had significantly improved in patients demonstrating the correct technique. Pharmacist-led interventions demonstrated improvements in health-associated quality of life and therapeutic outcomes for individuals with COPD and CI. The study highlighted the importance of cognitive evaluation in routine COPD therapy, identifying potential impediments to effective therapy, and offering face-to-face presentations of inhaler techniques. The best inhalers and methods for COPD patients experiencing CI should be further investigated, according to the study.

Empowering the Patient With Chronic Obstructive Pulmonary Disease: Optimizing Inhalation Technique.

Introduction Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disease characterized by chronic respiratory symptoms. Validated tools such as the modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) questionnaires are commonly used to assess these symptoms. In Portugal, it is estimated that COPD affects approximately 14.2% of individuals aged 40 and over. Compliance with inhalation therapy remains a significant challenge. Inconsistent and incorrect use of inhalers contributes to suboptimal disease control and deteriorates the patients' quality of life. Regular evaluations provide a valuable opportunity to monitor symptom progression, assess therapeutic compliance, and understand patients' beliefs and expectations about their treatment. Objective The primary aim of this study was to enhance the correct use of inhalers at the Porto Centro Family Health Unit by at least 20% of the COPD patients included. The secondary goal was to evaluate how inhaler therapy compliance and proper technique impact the symptomatic control of COPD, as measured by the mMRC and CAT scales. Methods A prospective observational cohort study was developed, with an intervention component. Data were gathered through random sampling of patients diagnosed with COPD. Participants were invited for an initial evaluation, where they were educated about the disease, instructed on the correct inhalation technique, and assessed for both symptom severity and inhaler technique. They were then re-assessed at a follow-up visit. Descriptive and analytical statistical methods were applied to compare and interpret the results. This study was approved by the Ethics Committee of Local Health Unit São João. Results A total of 60 patients were randomly selected for participation. After applying exclusion criteria, refusal to participate, and missed appointments, 19 participants completed the study. Approximately two-thirds of the patients initially failed at least one step of the inhalation technique. Following the intervention, 79% of the patients were able to correctly perform all steps, reflecting a 47% improvement. Symptom assessment using the CAT questionnaire showed scores ranging from 8 to 21 (median = 8) at the first visit, which improved to a range of 0 to 21 (median = 4) at the follow-up visit. In terms of mMRC scores, only one patient showed a worsening of dyspnea classification, three patients improved, and the remaining patients had stable classifications. Discussion Inhalation therapy is crucial for effective COPD management. Following the intervention, a 47% improvement in inhaler technique was observed, which could lead to better disease control, fewer hospital admissions, and an enhanced quality of life. Although there are limitations such as the small sample size, the study demonstrated symptom improvement between the first and second visits, potentially indicating improved disease management. Conclusions This study highlights the impact that a focused intervention in managing COPD can have on improving patient outcomes and quality of life.

Combination Inhaled Corticosteroid and Short-acting Beta2 Agonist (ICS-SABA) Use for Older Adults With Asthma

The first combination inhaled corticosteroid and short-acting beta2 agonist (ICS-SABA) was approved by the Food and Drug Administration (FDA) in 2023 for as-needed treatment or prevention of bronchoconstriction and to reduce the risk of asthma exacerbations in patients 18 years of age and older. The recently approved product contains an ICS-albuterol combination. The 2024 Global Initiative for Asthma (GINA) guidelines recommend as-needed ICS-formoterol as the preferred asthma reliever therapy; however, a GINA alternative recommendation is the use of ICS whenever an as-needed (SABA) is used. There is no difference in as-needed asthma treatment recommended by the GINA guidelines in older adults, and there has been minimal study in older adults. Because of limited guidance on the use of the ICS-SABA reliever inhaler in older adults, the purpose of this review is to evaluate the DENALI and MANDALA studies and the potential role of ICS-SABA in older adults. The mean ages in both studies were 50 years. The MANDALA primary outcome result was a statistically significant lower risk of severe exacerbations in the ICS-SABA reliever group compared with the as-needed albuterol (ALB) group at 24 weeks. In the MANDALA older adults subgroup analysis, there was not a statistically significant difference in the ICS-SABA reliever group compared with the as-needed ALB-alone group but the results favored ICS-SABA. The DENALI primary outcome results were a greater change from baseline in forced expiratory volume in the first second (FEV1) area under the curve averaged over 12 weeks with albuterol/budesonide (ALB-BUD) 180/160 ug compared with budesonide alone and placebo and a greater change from baseline in trough FEV1 with ALB-BUD 180/160 ug and 180/80 ug than ALB-alone and placebo. Because of minimal adverse effects in both trials and the benefits in preventing asthma exacerbations reported in the MANDALA trial, it is important to assess and recommend that older adults with asthma receive inhaled corticosteroid with their reliever asthma inhaler.

Parental Perception about use of Inhaler Therapies in Childhood Asthma

Background: Parental attitudes towards the use of inhaled therapy in children with chronic asthma influence treatment adherence and outcome. In the present study, we evaluated the perceptions and concerns of parents of children with chronic asthma towards inhaled therapy. Objectives: The primary objective of this study is to understand how parents perceive inhaler therapies for managing childhood asthma, focusing on factors such as effectiveness, accessibility, and potential side effects. It also seeks to explore the influence of socio-cultural factors on parental acceptance and adherence to prescribed inhaler treatments. Methods: A qualitative approach was used, involving in-depth interviews with 200 parents or caregivers of children aged 5 to 12 years diagnosed with asthma. Participants were selected from Bolan Medical Complex, Quetta, through purposive sampling. The study gathered data through semi-structured interviews that focused on participants' experiences, attitudes, and knowledge regarding inhaler therapies. Results: The findings revealed that the majority of parents were aware of asthma and inhaler therapies, with a significant proportion viewing inhalers as an effective treatment option. However, concerns about side effects and the long-term use of inhalers were common. Cultural beliefs also influenced parents' willingness to embrace inhaler therapy, with some preferring alternative treatments. Conclusion: The study highlights the importance of addressing parental concerns and misconceptions about inhaler therapies. Educational interventions, clear communication from healthcare providers, and culturally sensitive approaches are crucial in improving parental acceptance and adherence to inhaler treatments, ultimately enhancing asthma management in children.

Fatal Consequences of Lighter Gas Abuse: A Case Report

Volatile solvent abuse among young people poses a significant public health threat due to its accessibility and fatal outcome potential. This case report presents a 22 year old otherwise healthy male who died after lighter gas abuse, which highlights the severity of inhalant abuse related outcomes. To conclude, volatile substance abuse proves to be a significant and rising problem across the globe especially among younger populations, driven by its immediate psychoactive effects and ease of access. Lighter gas is a commonly abused inhalant which contains volatile hydrocarbons that cause central nervous system and respiratory depression, cardiac arrhythmias, myocardial infarction and pulmonary edema. The exact mechanism of death associated with butane abuse is still uncertain, however research done by Pfeiffer et al. focused on acute and chronic myocardial changes, and lung histology that was similar to that of drowned persons which is characterized by capillary endothelial vesicular transformation and the development of obstructive microangiopathy. Intense nonspecific fibrosis with the absence of coronary disease with immunohistochemical analysis confirming acute ischemia was also noticed. Fatal arrhythmia is thought to arise from the inhaled hydrocarbons or 0.5-15% butane which are suspected to increase the myocardium’s sensitivity to adrenaline, and this sudden hormonal surge is thought to be the culprit for the occurrence of fatal arrhythmia, and ventricular fibrillation like in this case.

Clinical and sociodemographic profile of asthma and attitude of parents towards inhaled corticosteroid use in children

Background: To find out the clinical and socio demographic profile of asthma in 6–12-year-old children and also to understand the knowledge, attitude and practices of parents regarding the ICS use in a tertiary care centre, Alappuzha Kerala. Methods: Hospital based cross-sectional study, over a period of 1 year. Ethical committee clearance obtained. 141 children were selected from the asthma clinic, based on Inclusion and exclusion criteria. Questionnaire was given to parents, and methods of using MDI checked and corrected. Results: Most common reason for exacerbation of asthma are exposure to indoor air pollutants and viral infections. A major share of parents showing reluctance for using ICS due to fear of side effects. So usually using for a short course only, not as prescribed. Conclusions: The adherence of using ICS can be improved by parent-doctor communication and demonstrating the use of inhaler and its importance in asthma.

Repeated toluene inhalation in male and female adolescent rats induces persistent drug preference and impairs cognitive and social behavior.

Adolescent inhalant use is an understudied and undertreated disorder, particularly in females. Chronic exposure to inhalants, like toluene, can have long-lasting effects on behavior. However, most animal studies lack the incorporation of both sexes and do not focus on the abstinence period. We assessed the behavioral effects during prolonged abstinence following repeated toluene inhalation in adolescent male and female rats. We repeatedly exposed adolescent male and female Sprague Dawley rats to toluene vapor (1500 or 3000ppm) for 6days using the conditioned place preference (CPP) procedure. We tested drug-associated context preference, locomotion, anxiety-like behavior, object memory, social preference, and cognitive flexibility across 22days of abstinence. In females, 3000ppm toluene increased CPP on days 8 and 22 of abstinence but this effect did not reach significance in males. Instead, males showed a significant increase in locomotion on days 7 and 21. Toluene also impaired social novelty preference and reversal learning during long-term abstinence, but not anxiety-like behavior or object recognition memory. Our rodent findings suggest that female inhalant usersmayshow persistent drug preference during abstinence following chronic use. Furthermore, prolonged cognitive and social deficits should be addressed in treatment programs for adolescents.

The Effect of Inhaled Beta-2 Agonists on Heart Rate in Patients With Asthma: Sensor-Based Observational Study.

Beta-2 agonists play an important role in the management of asthma. Inhaled long-acting beta-2 agonists (LABAs) and short-acting beta-2 agonists (SABAs) cause bronchodilation by stimulating adrenoceptors. These receptors are also present in cardiac cells and, as a side effect, could also be stimulated by inhaled beta-2 agonists. This study aims to assess the effect of beta-2 agonists on heart rate (HR). The data were retrieved from an observational study, the myAirCoach Quantification Campaign. Beta-2 agonist use was registered by self-reported monthly questionnaires and by smart inhalers. HR was monitored continuously with the Fitbit Charge HR tracker (Fitbit Inc). Patients (aged 18 years and older) were recruited if they had uncontrolled asthma and used inhalation medication. Our primary outcome was the difference in HR between LABA and non-LABA users. Secondary outcomes were the difference in HR on days SABAs were used compared to days SABAs were not used and an assessment of the timing of inhaler use during the day. Patients using LABA did not have a clinically relevant higher HR (average 0.8 beats per minute difference) during the day. Around the moment of SABA inhalation itself, the HR does increase steeply, and it takes 138 minutes before it returns to the normal range. This study indicates that LABAs do not have a clinically relevant effect on HR. SABAs are instead associated with a short-term HR increase. ClinicalTrials.gov NCT02774772; https://clinicaltrials.gov/study/NCT02774772.

Effectiveness of an educational intervention on different types of errors -occurring during inhaler therapy use in COPD patients during a -Pulmonary Rehabilitation Program.

Inhaled drug therapy is an essential treatment in Chronic Obstructive Pulmonary Disease (COPD) patients as it reduces symptoms, exacerbation rate and mortality risk. Errors in inhaler use can affect drug delivery to the lungs and minimize treatment benefits. The aim of the study was to evaluate the effect of a nurse-lead educational intervention on inhaler use in a group of patients with COPD during a Respiratory Rehabilitation Program. COPD patients attending a Respiratory Rehabilitation Unit for a pulmonary rehabilitation program participated in the educational training program. The nurse-lead educational intervention included a specific checklist used to evaluate each patient's inhalation technique. Errors were scored and classified as device- dependent, device-independent and critical one. Patients completed a pre and post-intervention survey to compare pre and post nurse-lead educational intervention results. One-hundred twenty-three COPD patients attending a Respiratory Rehabilitation Unit participated in the training program. A high frequency of total errors has been found at baseline (72.1%) whose critical errors represented 35%, irrespective of the severity of airway obstruction, the length of disease history and the educational level. The structured educational intervention resulted in changes on patients' attitudes and skills on inhaler use with a significant reduction in the frequency of all types of errors (P-value < 0.01), particularly total and critical errors (35% and 12.9%, respectively), but not completely eliminated them. Patient training in the use of the inhaler and regular review of the patient's competence in using the devices by health care professionals remains a crucial aspect of effective inhalation therapy regardless of the disease trajectory. These interventions are feasible and may impact the ability to engage patients in the chronic care journey.

Nurses’ Reports of Inhaler Use Errors in Patients with Chronic Obstructive Pulmonary Disease in Hong Kong

Nurses’ Reports of Inhaler Use Errors in Patients with Chronic Obstructive Pulmonary Disease in Hong Kong

Different Carriers for Use in Dry Powder Inhalers: Characteristics of Their Particles.

In contemporary times, there has been a rise in the utilization of dry powder inhalers (DPIs) in the management of pulmonary and systemic diseases. These devices underwent a swift advancement in terms of both the equipment utilized and the formulation process. In this review, the carrier physicochemical characteristics that influence DPI performance are discussed, focusing its shape, morphology, size distribution, texture, aerodynamic diameter, density, moisture, adhesive and detachment forces between particles, fine carrier particles, and dry powder aerosolization. To promote the deposition of the active principal ingredient deep within the pulmonary system, advancements have been made in enhancing these factors and surface properties through the application of novel technologies that encompass particle engineering. So far, the most used carrier is lactose showing some advantages and disadvantages, but other substances and systems are being studied with the intention of replacing it. The final objective of this review is to analyze the physicochemical and mechanical characteristics of the different carriers or new delivery systems used in DPI formulations, whether already on the market or still under investigation.