This study investigated the influence of the use of different types of inhalers on the adequacy of inhalation technique among adult asthmatics. Three hypotheses were tested: first, patients using only one type of inhaler will demonstrate adequate inhalation technique more often than those with two or more types. Secondly, patients using a combination of dry powder inhalers (DPIs) will demonstrate correct inhalation technique more often than those using the combination of a metered dose inhaler (MDI) and a DPI. Thirdly, some inhalers or combinations of inhalers are more prone to erroneous inhalation technique than others.Adult outpatients with asthma who regularly used inhaled steroid therapy (n=321) participated in the study. The inhalers investigated were MDIs on the one hand, and the DPIs Turbuhaler1, Diskhaler1, Cyclohaler1, Inhaler Ingelheim1 and Rotahaler1 on the other.Of 208 adult asthmatics with only one inhaler, 71% made no inhalation errors versus 61% of 113 patients with two or more different inhalers. Of patients with a combination of DPIs 68% performed all essential checklist items correctly, versus 54% of patients with the combination of "regular" MDI and DPI. Patients using only the Diskhaler1 made fewest errors.Whenever possible, only one type of inhaler should be prescribed. If a combination is unavoidable, combinations of DPIs are preferable to MDI and DPI. The Diskhaler seems to be the most foolproof device.
Background -The percentage of patients inhaling their medication effectively varies widely, according to methods of assessment and inhalers used. This study was carried out to assess differences among four types of inhalers using inhalerspecific checklists. Methods -Inhalation technique was evaluated in adult patients with chronic obstructive pulmonary disease (COPD). Inhalers investigated were either metered dose inhalers (MDIs) or the dry powder inhalers Turbohaler (Turbuhaler), Diskhaler, and Rotahaler. Errors were recorded against inhaler-specific checklists. From these, scores were derived by dividing the number of items correctly completed by the total number of items on the checklist and the result was expressed as a percentage. For every inhaler "essential actions" were identified and scores on these key manoeuvres were calculated. The percentage of patients performing all these essential actions correctly was also calculated. Scores were also compared with adjustment for differences in relevant patient characteristics. Results -Important differences among inhalers were found. Of 152 patients with COPD (mean (SD) age 55-1 (8.7) years), those with MDIs performed worst, especially when only essential items were considered. Patients with a Diskhaler did best, although after correction for patient characteristics the differences tended to diminish. Only 60% of patients were able to perform all essential inhaler actions satisfactorily. Of those using the Diskhaler, 96% did so correctly, while the corresponding figure for those using the MDI was only 24%. Inhaled medication plays an important part in the treatment of asthma and chronic obstructive pulmonary disease (COPD). In the Netherlands two types of inhaler are in common use: metered dose inhalers (MDIs) and (in the majority) dry powder inhalers (DPIs). Both have their advantages and disadvantages. MDIs are small, easy to carry, and deliver at least 100 doses, but they require good handlung coordination to achieve the best results.' DPIs, being breath actuated, are unaffected by hand-lung coordination, but patients need an inspiratory flow ofmore than 30 1/minute which might prove difficult to achieve for patients with severe COPD.The percentage of patients inhaling their medication effectively varies from 2% to 85% according to the method of assessment and the type of inhaler.2'-A previous survey of inhalation technique in 123 patients with COPD" revealed that one third failed to use their inhaler effectively, and that inhalerspecific design features contributed significantly to the failure rate. The latter finding is confirmed in a number of other reports. [3][4][5][6][7][8][9][10][11][12][13][14][15] To our knowledge, no comparable study of inhaler technique has considered such patient variables as age, sex, educational achievement, type of health care insurance, duration of disease, previous experience with the inhaler, or instruction in inhalation technique, all ofwhich may influence the efficacy of treatment. In two studies an attempt was m...
It is known that Maxwell's equations become nonlinear if the effect of virtual electron-positron pair creation is included. The vacuum, thus behaving like a polarizable continuum, is shown to exhibit the phenomenon of birefringence.
Inhaled medication is important in the treatment of chronic obstructive pulmonary disease (COPD). In this paper a comparison of the long-term efficacy of three instruction-models is presented. A total of 152 COPD-patients were randomized into one of four groups: Personal-, video-, group-instruction and a control group. Inhalation technique was assessed by means of checklists, on which essential inhalation manoeuvres were identified. Up to 9 months later, 148 patients returned for follow-up assessment. Prior to instruction 61% of patients in the control group had a perfect score on essential actions, compared to 62, 65 and 53% for those receiving group-, personal- and video-instruction respectively. At follow-up these percentages were 49, 97, 75 and 76%. For group-(35%) and video-instruction (24%) the increase from baseline was significant. Examining the different inhalers under investigation, it is striking, that only 24% of all patients with a Metered Dose Inhaler (MDI) performed all essential checklist items correctly, versus 96% for those using a Diskhaler. The fact that for the MDI this percentage improved to 90% post-instruction, shows that time spent on instruction, is time well spent. We conclude that group instruction seems superior to personal counselling, and equally effective or even better than video instruction. Personal instruction should not be dismissed and a combination with video instruction might prove to be effective as well.
Many patients with asthma or chronic obstructive pulmonary disease (COPD) use their inhaler ineffectively. Several studies revealed that inhaler-specific design features contributed significantly to the failure rate, which clearly demonstrates the need for developing more "foolproof" inhalers. This study compared ease of use and patient preference of the Diskus'E'/Accuhaler" IDA) with theTurbuhaler@ (TH). Fifty patients with asthma or COPD aged 1 5 years and older were included in a randomized, crossover comparison of DA with TH regarding patient preference and ease of use. All had to he na'ive to DA and TH, but currently had to be using inhaled medication with another device. Inhalation technique was assessed using inhaler-specific checklists and patients had to state a preference for DA or TH regarding various aspects, as well as overall preference. With DA 46 patients (92%) made no errors regarding essential inhalation maneuvers, compared to 37 patients (74%) usingTH ( p = 0.023) This difference is exclusively caused by not loading the TH properly. When patients were asked which inhaler they woulcl prefer, 17 wanted the DA, 25 theTH, and 8 did not state a preference. The difference was not significant. TH was favored over DA regarding factors related to size and the number of avail- 148 van der Palen, Klein, and Schildkamp able dosages. The counting mechanism of the DA was preferred over the TH. It seems that patients have a clear, although not statistically significant, preference for TH, but with the DA fewer patients make crucial errors. BACKGROUND
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