ObjectivesThe aim of this study was to examine the effect of metered dose inhaler (MDI) counselling on the inhalation technique and pulmonary function test scores of patients with asthma.Methods491 subjects with asthma (281 female) attending the Beni Suef University hospital outpatient clinics were enrolled during a 2-year period. Their mean (SD) age was 42.1 (17.1) years. Their MDI inhalation technique was checked and the number of mistakes was noted and corrected at the first visit and at each of two following monthly visits (three visits in total). Their peak expiratory flow and forced expiratory volume in 1 s (FEV1) as a percentage of the forced vital capacity were checked at each visit.ResultsMost MDIs contained salbutamol, although some patients were using MDIs containing beclomethasone or a combination of beclomethasone and salbutamol. The mean number of mistakes observed decreased significantly (p<0.001) as the number of visits increased, especially in the children's group. The most common repeated mistake was failure to maintain a slow inhalation rate until the lungs were full. There was a significant improvement (p<0.001) in pulmonary function test scores after counselling in all age groups, particularly in those aged >60 years.ConclusionsMDI counselling should be frequently repeated to improve and maintain the recommended MDI inhalation technique and possibly improve patients’ pulmonary function tests scores.

Introduction: Many devices (e.g., nebulizers and spacers) are used to deliver aerosol in a non-invasive ventilation circuit (NIV) without any special recommendation. The aim of the present work was to compare the doses delivered from seven different aerosol delivery systems when placed in the NIV using automatic continuous positive airway pressure (Auto-CPAP). Methods: Three spacers and three vibrating mesh nebulizers were compared to a Sidestream jet nebulizer (SIDE). Each device was placed proximal to a breathing simulator in a standard NIV circuit with a 500 ml tidal volume, 15 breaths/min and a 1:3 inspiratory-expiratory ratio. Two ml of salbutamol solution containing 10,000 lg was nebulized using Aerogen Pro (PRO), Aerogen Solo (SOLO), NIVO and SIDE. Twelve metered dose inhaler doses, containing 100 lg salbutamol each, were delivered using AeroChamber MV (AC), AeroChamber Vent (VC) and AeroChamber Mini (MC). Total emitted dose (TED) and its percentage were determined. Aerodynamic droplet characteristics were measured using cooled Andersen Cascade Impactor. Results: The vibrating mesh nebulizers used had significantly more (p\0.001) TED compared to the jet nebulizer. The spacers used had higher TED % (p\0.001) compared to the nebulizers. The fine particle fraction of SIDE was the highest (p = 0.021) and mass median aerodynamic diameter of the spacers was the smallest (p = 0.001). The fine particle dose from vibrating mesh nebulizers was the greatest (p = 0.02).

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The aim of the work presented here was to determine the role of dry powder inhaler (DPI) counselling on inhalation technique and lung function test scores of the asthmatic patients. To decrease variability, asthmatic patients using an Aerolizer were enrolled in the study, as this was the most commonly prescribed DPI in outpatient clinics of Beni Suef University hospital. Each patient was subjected to three visits separated by 1 month each. In each visit, patient inhalation technique from the DPI was checked, and the number of mistakes was identified and corrected. Also, patients' peak expiratory flow (PEF) and forced expiratory volume in one second (FEV 1 ) presented as a percentage of the forced vital capacity (FVC) were checked. As the number of visits increased, the mean number of observed mistakes was significantly decreased (p\0.001). The most common repeated mistakes were ''To inhale fast'' and ''To maintain a fast inhalation rate until the lungs are full''. In all age groups, there was a significant increase (p\0.001) in the pulmonary function test after the period of counselling. To improve and maintain the recommended inhalation technique of DPI and possibly improve patients' lung function test scores, counselling on proper DPI technique should be repeated at every possible opportunity.

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These similarities and differences between the three aerosol generators tested suggest that aerosol delivery methods should be carefully chosen or substituted in non-invasive ventilated patients.

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