Background: Inhaler therapy plays a crucial role in controlling respiratory symptoms in patients with chronic obstructive pulmonary disease (COPD). Incorrect or partially correct use of inhaler devices causes many chronic obstructive pulmonary disease (COPD) patients to continue to have respiratory symptoms due to poor drug deposition in the airways as a result of poor inhaler technique, leading to increased healthcare costs due to exacerbations and multiple emergency room presentations. Choosing the right inhaler device for each individual patient is a bigger challenge for doctors and chronic obstructive pulmonary disease (COPD) patients. The type of inhaler device and the correct inhaler technique depends on the control of symptoms in chronic obstructive pulmonary disease (COPD). Physicians treating patients with chronic obstructive pulmonary disease (COPD) play a central role in educating patients about the correct use of inhalation devices. The steps for the correct use of inhalation devices should be taught to patients by doctors in the presence of the family so that if the patient has difficulties handling the device correctly, the family can support them. Methods: Our analysis included 200 subjects divided into two groups—recommended group (RG) and chosen group (CG)—and aimed primarily to identify the behaviour of chronic obstructive pulmonary disease (COPD) patients when faced with deciding which type of inhaler device is most suitable for them. The two groups were monitored three times during the 12-month follow-up period. Monitoring required the physical presence of the patient at the investigating physician’s office. The study included patients who were smokers, ex-smokers, and/or with significant exposure to occupational pollutants, aged over 40 years diagnosed with chronic obstructive pulmonary disease (COPD), risk group B and C according to the GOLD guideline staging, and on inhaled ICS+LABA treatment, although they had an indication for LAMA+LABA dual bronchodilation treatment. Patients presented for consultation on their own initiative for residual respiratory symptoms under background treatment with ICS+LABA. The investigating pulmonologist who offered consultations to all scheduled patients, on the occasion of the consultation, also checked the inclusion and exclusion criteria. If the patient did not meet the study entry criteria, they were assessed and received the appropriate treatment, and if the study entry criteria were met, the patient signed the consent and followed the steps recommended by the investigating pulmonologist. As a result, patient entry into the study was randomised 1:1, meaning that the first patient was recommended the inhaler device by the doctor and the next patient entered into the study was left to decide for themselves which type of device was most suitable for them. In both groups, the percentage of patients who had a different choice of inhaler device from that of their doctor was statistically significant. Results: Compliance to treatment at T12 was found to be low, but compared to results previously published on compliance, in our analysis, compliance was higher and the only reasons identified as responsible for the better results were related to the selection of the target groups and the regular assessments, where, in addition to reviewing the inhaler technique, patients were encouraged to continue treatment, thus creating a strong bond between patient and doctor. Conclusions: Our analysis revealed that empowering patients by involving them in the inhaler selection process increases adherence to inhaler treatment, reduces the number of mistakes in inhaler use of the inhaler device, and implicitly the number of exacerbations.
Introduction. The largest challenge for patients with COPD is the correct use of inhaler devices. In COPD, inhalation therapy has a key role in symptom control, reducing the exacerbation rate, hospitalization and improving the quality of life. Choosing the active substance(s) administered by inhaler devices is an easy task because of the Gold guideline recommendations, but, when it comes to choosing the inhaler device, it is much more difficult to get recommendations. Methods. Our analysis included 200 subjects divided into two groups and its objective was the identification of some mechanisms that connect education, exacerbation and adherence to treatment, placed in the context of measuring technical skills and patients` preference for a particular inhaler device. All subjects included in the analysis were subjected to a technical skills test that included a set of 10 questions with a 30-minute solving time. The subjects in the working group were put in the position of deciding factor for the choice of an inhaler device, and implicitly for the treatment they would follow during monitoring. Results. In both groups, the lowest treatment dropout rate at T12 was recorded among those with higher levels of education, while those with poor education levels recorded very high dropout rates. In both groups we noticed that, as the level of education increased, technical skills were also increasingly better. Both in the control group and in the working group, dropout subjects at T12 had significantly lower technical skills compared to subjects who did not drop out. The level of technical skills was significantly lower in both groups in subjects with exacerbations. Statistical analysis proved the relationship between the low level of technical skills and exacerbation. The subjects with lower technical skills proved to be more prone to dropout of inhaler therapy as well. The proportion of subjects with exacerbations in the control group was significantly higher than the proportion of those with exacerbations in the work group. The proportion of subjects with exacerbations in the control group was significantly higher than the proportion of those with exacerbations in the work group. Conclusions. The authors consider that the involvement of the patient in choosing the inhaler device had a positive impact on disease control and reducing the rate of exacerbations.
Smoking is a chronic disease with a recurring character, one of the oldest habits on the globe but also a problem of modern society, which kills more than 8 million people each year. More than 50% of those deaths are the result of direct tobacco use, while around 1.2 million are the result of non-smokers being exposed to second-hand smoke(1). Nicotine addiction must be seen as a chronic disease, with numerous periods of relapse and remission, and is mandatory that the clinician must treat it properly. Smoking cessation is of critical importance to public health, various studies indicate that smoking is a major risk factor for a variety of serious health conditions, including cancer, heart disease, stroke, and chronic obstructive pulmonary disease (COPD). The risk of developing these conditions is directly related to the amount and the duration of smoking and is higher for those who start smoking at a younger age. While counseling is likely to be successful in helping individuals quit smoking, there are also other methods to reach the goal, including medication, nicotine replacement therapy, and lifestyle changes. However, these methods may not be as effective as counseling in helping individuals quit smoking. Otherwise, other methods, such as reducing the amount of smoking or switching to a less harmful form of tobacco, may reduce the risk of developing some of the conditions associated with smoking, but they do not reduce the risk to the same level as quitting smoking.
The examination of the patient with a recent episode of C19 and residual cardiorespiratory symptoms requires a complete two-line assessment of previously undiagnosed chronic pathology. As conventional investigations were insufficient in clarifying the remaining symptomatology, it was necessary to broaden the range of investigations and to take a different approach to this category of patients. Depending on the symptoms and the patient’s general condition at the beginning of the examination, the attending physician should not disregard the period of restrictions involving significant limitations regarding exercise imposed during the pandemic. Physical exertion minimization and isolation at home have led to a series of functional disorders throughout the body, particularly cardio-respiratory, musculo-articular and neuro-psychiatric disorders. The effects of a sedentary lifestyle or the lack of physical exertion are not limited to elderly individuals, nor to a single system or apparatus, but have undesirable consequences for the whole body. In this context, the pulmonologist was obliged to answer the question “does the patient have a previously undiagnosed chronic respiratory disease before COVID19 or is the patient physically deconditioned?”. This is how the cardio-respiratory exercise test - the stair-climbing exercise test - came into play in assessing this category of patients. As the medical rehabilitation units could not cope with all the patients, it was necessary to create a home-based rehabilitation programme that was cheap, fast, and allowing telephone monitoring and quantifiable results.
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