Assessment of the ability of young children to use a powder inhaler device (Turbuhaler)

Goren, Avner; Noviski, Natan; Avital, Avraham; Maayan, Channa; Ståhl, Elisabeth; Godfrey, Simon; Springer, Chaim

doi:10.1002/ppul.1950180204

Cited by 43 publications

(34 citation statements)

References 9 publications

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“…Incorrect or inefficient inhaler usage may be a direct consequence of poor instruction, 39 but this is improved (albeit temporarily) by training. 40,41 The quality of this training is of paramount importance. The manufacturer's instruction sheet alone is ineffective in achieving correct technique.…”

Section: Resultsmentioning

confidence: 99%

The ADMIT series - Issues in Inhalation Therapy. 6) Training tools for inhalation devices

Lavorini

Levy

Corrigan

et al. 2010

Primary Care Respiratory Journal

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Section: Resultsmentioning

confidence: 99%

The ADMIT series - Issues in Inhalation Therapy. 6) Training tools for inhalation devices

Lavorini

Levy

Corrigan

et al. 2010

Primary Care Respiratory Journal

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“…The strongest confirmation of the value of inhaler checklists comes from studies in which inhaler assessment and skills training were associated with significantly improved asthma outcomes. 14 Again, there are few studies, but in young children, Goren et al 73 showed that improved Turbuhaler technique with a rudimentary child-specific checklist was associated with greater bronchodilator effect. In the 6-month study by Basheti et al, 14 a brief pharmacy intervention, with assessment and correction of inhaler technique and checklistbased inhaler labels, led to significant improvement in asthma outcomes compared with a control group.…”

Section: Clinical Impact Of Using Inhaler Technique Checklistsmentioning

confidence: 99%

Checklists for Powder Inhaler Technique: A Review and Recommendations

et al. 2013

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Turbuhaler and Diskus are commonly used powder inhaler devices for patients with respiratory disease. Their effectiveness is limited in part by a patient's ability to use them correctly. This has led to numerous studies being conducted over the last decade to assess the correct use of these devices by patients and health care professionals. These studies have generally used device-specific checklists to assess technique, this being the most feasible and accessible method for assessment. However, divergence between the checklists and scoring systems for the same device in different studies makes direct comparison of results difficult and at times inappropriate. Little evidence is available to assess the relative importance of different criteria; however, brief patient training based on specific inhaler technique checklists leads to significant improvement in asthma outcomes. This paper reviews common checklists and scoring systems used for Turbuhaler and Diskus, discusses the problem of heterogeneity between different checklists, and finally recommends suitable checklists and scoring systems for these devices based on the literature and previous findings. Only when similar checklists are used across different research studies will accurate comparisons and meta-analysis be possible.

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“…Studies in children have indicated that, above the age of 5 yrs, most children can generate PIFs above 30 L·min -1 when inhaling through the Turbuhaler®, but that below this age PIFs above 30 L·min -1 are less common [14]. Despite this, clinical studies have indicated that useful clinical effects can be demonstrated in preschool children as young as 3 yrs of age [19,20].…”

mentioning

confidence: 97%

Lung deposition from the Turbuhaler in children with cystic fibrosis

Devadason¹,

Everard²,

MacEarlan³

et al. 1997

Eur Respir J

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Drug delivery to patients using dry powder inhalers, such as the Turbuhaler®, is believed to be influenced by the inspiratory flow used. Clinical studies have indicated that this delivery system can be used effectively by children. However, it is not known how the total and weight-corrected dose delivered to the airways varies with age. A deposition study using technetium-99m ( 99m Tc)-labelled budesonide was performed in order to determine the effect of age on delivery.Twenty one children with cystic fibrosis, aged 4-16 yrs, were recruited. They were clinically stable with normal lung function. Initially, a gamma camera scan was taken in front of a flood source containing 37 MBq of 99m Tc. Subsequently, subjects inhaled through a low resistance inspiratory filter connected to a commercially available Turbuhaler®. Immediately afterwards they inhaled from a noncommercial Turbuhaler® containing budesonide labelled with 99m Tc, and then underwent anterior and posterior gamma camera scans. Both Turbuhaler® inhalers were attached to a portable spirometer and the peak inspiratory flow through the Turbuhaler® was recorded for each inhalation. The total body dose was calculated from the dose deposited on the inspiratory filter connected to the commercial Turbuhaler®. Analysis of the gamma camera images provided information on the proportion of the radiolabel delivered to the lungs compared to that deposited in the upper airway and stomach.As expected, a highly significant positive correlation was noted between the peak inspiratory flow generated by the patient through the Turbuhaler® and the dose delivered to the lung. Similarly, there was a highly significant positive correlation between age and "total lung dose". However, when total lung dose was corrected for body weight, there was a nonsignificant negative correlation with age. This study suggests that the "weight-corrected lung dose" achieved when children aged >6 yrs use the Turbuhaler®, is largely independent of age. It would appear that the flow-dependent properties of this device are such that the reduced peak inspiratory flow generated by younger children results in a lower dose to the lungs, but that this is off-set by their lower body weight. This is unlikely to be a property of other devices with different flow/drug delivery characteristics. Eur Respir J 1997; 10: 2023-2028 The convenience and ease of use of Turbuhaler®, a multidose dry powder inhaler (DPI), has resulted in its widespread use for the treatment of children with respiratory disease. Scintigraphic and pharmacokinetic deposition studies have indicated that this device is capable of delivering a mean of 20-30% of the nominal dose to the lungs of adults [1,2]. Although it is difficult to compare results from studies utilizing different methods [3], these results suggest that the device delivers a greater proportion of the nominal dose to the lungs of adult patients than do other DPIs [4,5], metereddose inhalers (MDIs) [4,6,7], and jet nebulizers [8,9], and these results are similar to o...

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Assessment of the ability of young children to use a powder inhaler device (Turbuhaler)

Cited by 43 publications

References 9 publications

The ADMIT series - Issues in Inhalation Therapy. 6) Training tools for inhalation devices

The ADMIT series - Issues in Inhalation Therapy. 6) Training tools for inhalation devices

Checklists for Powder Inhaler Technique: A Review and Recommendations

Lung deposition from the Turbuhaler in children with cystic fibrosis

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