Characterization of the inspiratory manoeuvre when asthmatics inhale through a Turbohaler pre- and post-counselling in a community pharmacy

Hawksworth, GM; James, Lynn; Chrystyn, Henry

doi:10.1053/rmed.1999.0768

Cited by 34 publications

(23 citation statements)

References 12 publications

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“…(7) This flow is also considered to be the minimum for the Diskus, (22) whereas that for the Easyhaler is slightly lower, (23) but that for the Aerolizer is much faster. (8) Overall, the inhalation flows with the Turbuhaler are higher than values previously reported in COPD, (24,25) adults, (26) and children (7,27) with asthma, but lower than others in COPD (28)(29)(30) and asthma. (29,31) The number of patients inhaling with an inhalation flow of < 30 L min -1 through the Turbuhaler is similar to that in other studies.…”

Section: Dry Powder Inhaler Inhalation Maneuversmentioning

confidence: 64%

“…Overall in COPD (29,30) and asthma (29,31) studies, the volumes reported were higher than those in this study, but one study using a Turbuhaler by adult asthmatics reported similar volumes. (26) This difference, like those of the other inhalation parameters, could be due to the amount of inhalation technique training that had previously been provided to each patient.…”

Section: Dry Powder Inhaler Inhalation Maneuversmentioning

confidence: 99%

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The Inhalation Characteristics of Patients When They Use Different Dry Powder Inhalers

Azouz

Chetcuti

Hosker

et al. 2015

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Background: The characteristics of each inhalation maneuver when patients use dry powder inhalers (DPIs) are important, because they control the quality of the emitted dose. Methods: We have measured the inhalation profiles of asthmatic children [CHILD; n¼16, mean forced expiratory volume in 1 sec (FEV 1 ) 79% predicted], asthmatic adults (ADULT; n¼53, mean predicted FEV 1 72%), and chronic obstructive pulmonary disease (COPD; n¼29, mean predicted FEV 1 42%) patients when they inhaled through an Aerolizer, Diskus, Turbuhaler, and Easyhaler using their ''real-life'' DPI inhalation technique. These are low-, medium-, medium/high-, and high-resistance DPIs, respectively. The inhalation flow against time was recorded to provide the peak inhalation flow (PIF; in L/min), the maximum pressure change (DP; in kPa), acceleration rates (ACCEL; in kPa/sec), time to maximum inhalation, the length of each inhalation (in sec), and the inhalation volume (IV; in liters) of each inhalation maneuver. Results: PIF, DP, and ACCEL values were consistent with the order of the inhaler's resistance. For each device, the inhalation characteristics were in the order ADULT > COPD > CHILD for PIF, DP, and ACCEL ( p < 0.001). The results showed a large variability in inhalation characteristics and demonstrate the advantages of DP and ACCEL rather than PIFs. Overall inhaled volumes were low, and only one patient achieved an IV > 4 L and DP > 4 kPa. Conclusion: The large variability of these inhalation characteristics and their range highlights that if inhalation profiles were used with compendial in vitro dose emission measurements, then the results would provide useful information about the dose patients inhale during routine use. The inhalation characteristics highlight that adults with asthma have greater inspiratory capacity than patients with COPD, whereas children with asthma have the lowest. The significance of the inhaled volume to empty doses from each device requires investigation.

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Section: Dry Powder Inhaler Inhalation Maneuversmentioning

confidence: 64%

Section: Dry Powder Inhaler Inhalation Maneuversmentioning

confidence: 99%

The Inhalation Characteristics of Patients When They Use Different Dry Powder Inhalers

Azouz

Chetcuti

Hosker

et al. 2015

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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“…13 Studies have shown that engaging pharmacists in training patients on correct device technique leads to more frequent counseling and improved asthma control and quality of life. 4,14 Patients come back to the pharmacy for their inhaler refill without a physician's prescription, giving the pharmacist the sole opportunity to review device use on continuous basis.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Using Simulation for Training Pharmacy Students on Correct Device Technique

Basheti

2014

American Journal of Pharmaceutical Education

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Objective. To assess the effect of using simulation in pharmacy student training on correct device technique. Methods. A single-blinded, repeated measures, parallel group design study was conducted in 2011, involving all final-year pharmacy students in year 5 (final year) enrolled in the Clinical Pharmacy and Therapeutics course. Students were assessed on device technique at baseline based on previously published checklists for Diskus (DIS), Turbuhaler (TH), and pressurized Metered Dose Inhaler (pMDI). Students were randomly assigned to 2 groups: Intervention A, which included supervised hands-on education in groups and peer assessment/education; and Intervention B, which included supervised hands-on education in groups, peer assessment/education, and a simulated scenario counseling real asthma patients. The simulation involved groups of 6 students counseling 3 asthma patients on inhaler device technique. The counseling involved verbal information and physical demonstration until the patient performed all steps correctly. Student assessments on device technique were repeated 1 week postintervention. Results. At baseline, none of the students in Intervention A (n554) or Intervention B (n555) performed correct technique for any of the 3 devices. One week following the intervention, a significantly higher proportion of students in Intervention B demonstrated correct technique for the Diskus, Turbuhaler, and pMDI (60.0%, 70.9%, and 69.1%, respectively) than did students in Intervention A (27.8%, 40.7%, and 42.6%, respectively, p,0.005). Conclusion. Engaging pharmacy students with real asthma patients in a simulated scenario involving correct device technique education resulted in better device technique demonstration skills among students.

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“…For example, devices such as the Turbutest measure the patient's inspiratory flow through a placebo Turbuhaler. 8,9 Portable devices for assessing some components of inhaler technique were recently reviewed. 10 One example is the Inhalation Manager, which measures inspiratory flow through inhalation devices (including a stylized powder inhaler) using a pneumotachometer; this system also predicts drug delivery mass and particle deposition based on in vitro data.…”

Section: Introductionmentioning

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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Characterization of the inspiratory manoeuvre when asthmatics inhale through a Turbohaler pre- and post-counselling in a community pharmacy

Cited by 34 publications

References 12 publications

The Inhalation Characteristics of Patients When They Use Different Dry Powder Inhalers

The Inhalation Characteristics of Patients When They Use Different Dry Powder Inhalers

The Effect of Using Simulation for Training Pharmacy Students on Correct Device Technique

Checklists for Powder Inhaler Technique: A Review and Recommendations

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