Evaluation of Conventional Press-and-Breathe Metered-Dose Inhaler Technique in 501 Patients

Larsen, Julie S.; Hahn, Mary; Ekholm, Bruce P.; Wick, Karen A.

doi:10.3109/02770909409044826

Cited by 106 publications

(62 citation statements)

References 2 publications

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“…Other studies found a high prevalence of noncompliance with MDI in COPD [31] or asthmatic [32] patients, and even in medical personnel [33]. This, together with the fact that a high proportion of the patients in the present study reported having been taught the inhaler manoeuvre (and rechecked), and that there are less mistakes made with dry powder devices than with MDI, could suggest that the problem is inherent to the MDI, rather than related to the patients or physicians.…”

Section: Discussionmentioning

confidence: 99%

Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

et al. 2000

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There is little information available concerning the extent to which chronic obstructive pulmonary disease (COPD) patients are satisfactorily managed, especially, regards factors supposedly related to COPD exacerbation. The present study assessed the prevalence rates of potentially modifiable risk factors of COPD exacerbation in patients hospitalized for this reason.A systematic sample of one out of two patients admitted for COPD exacerbation, during 1 yr, in four tertiary hospitals in the Barcelona area, Spain, was performed. Patients answered a questionnaire and underwent anthropometric measurements, spirometric tests and arterial blood gas sampling. Prevalence rates and 95% confidence intervals (95% CI) for risk factors were obtained, and the generalized estimating equation (GEE) method was used to allow for patients to provide information on different admissions.The study recruited 353 patients (29 female) with a total of 404 admissions age (mean SD) 69 9, median forced expiratory volume in one second (FEV1) 31% of predicted and mean partial pressure of oxygen (PO 2 ) 63 13 mmHg. Of these, 28% had not received an influenza vaccination; a high number (86%) did not attend rehabilitation programmes; 28% of patients with PO 2 #55 mmHg were not using long-term oxygen therapy (LTOT); among LTOT users, 18% used it <15 h a day; 43% of the total failed in some of the essential inhaler manoeuvres; 26% were current smokers; 21% of noncurrent smokers were exposed to passive smoking at home; current occupational exposure was low (5%).In summary, the authors found a moderate to high prevalence of potentially modifiable risk factors in a large representative sample of patients hospitalized for a chronic obstructive pulmonary disease exacerbation, suggesting unsatisfactory features in their management. Eur Respir J 2000; 16: 1037±1042. Chronic obstructive pulmonary disease (COPD) is characterized by a chronic slowly progressive limitation of the airflow. As the damage is largely irreversible, the major goals of COPD management are to lessen airflow limitation, prevent and decrease symptoms, prevent and treat medical complications and improve daily living and quality of life [1]. The acute exacerbation of COPD is among the relevant events in the progression of the disease, and its occurrence has been related to the lower survival [2] and decrease in the quality of life [3] of COPD patients. Acute exacerbations are also an important cause of health expenditure, due to hospitalization, outpatient care and drug consumption [1].Although respiratory infection is assumed to be the main risk factor for the exacerbation of COPD [4], other factors are also involved. Health education of patients, smoking cessation, pulmonary rehabilitation, good nutritional status, and early medical intervention are all considered helpful in preventing exacerbations [5]. Information concerning the extent to which COPD patients are satisfactorily managed with regards these factors, although likely to show strong local variations, is relevant ...

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Section: Discussionmentioning

confidence: 99%

Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

et al. 2000

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“…One of the biggest challenges associated with effective lung delivery using MDIs is the difficulty some patients have actuating the device at the appropriate point in the inspiratory cycle (68,69). Lung deposition is reduced (sometimes, greatly) when the patient actuates the device before or after inhaling (70).…”

Section: Breath Actuationmentioning

confidence: 99%

Advances in Metered Dose Inhaler Technology: Hardware Development

et al. 2013

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Abstract. Pressurized metered dose inhalers (MDIs) were first introduced in the 1950s and they are currently widely prescribed as portable systems to treat pulmonary conditions. MDIs consist of a formulation containing dissolved or suspended drug and hardware needed to contain the formulation and enable efficient and consistent dose delivery to the patient. The device hardware includes a canister that is appropriately sized to contain sufficient formulation for the required number of doses, a metering valve capable of delivering a consistent amount of drug with each dose delivered, an actuator mouthpiece that atomizes the formulation and serves as a conduit to deliver the aerosol to the patient, and often an indicating mechanism that provides information to the patient on the number of doses remaining. This review focuses on the current state-of-the-art of MDI hardware and includes discussion of enhancements made to the device's core subsystems. In addition, technologies that aid the correct use of MDIs will be discussed. These include spacers, valved holding chambers, and breath-actuated devices. Many of the improvements discussed in this article increase the ability of MDI systems to meet regulatory specifications. Innovations that enhance the functionality of MDIs continue to be balanced by the fact that a key advantage of MDI systems is their low cost per dose. The expansion of the health care market in developing countries and the increased focus on health care costs in many developed countries will ensure that MDIs remain a cost-effective crucial delivery system for treating pulmonary conditions for many years to come.

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“…Therefore, they are not appropriate for young children, people with arthritis and many elderly patients. Studies have shown that 50% to 80% of adults have diffi culty using a pMDI [4][5][6]. The breath-actuated pMDIs (e.g.…”

Section: Evidence To Datementioning

confidence: 99%

Effectiveness of Asthma Inhaler Pharmacotherapy must take into consideration both the device and drug and which is guided by clinically meaningful outcomes

McDonald¹,

Ram²

2017

Arch Pulmonol Respir Care

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Evaluation of Conventional Press-and-Breathe Metered-Dose Inhaler Technique in 501 Patients

Cited by 106 publications

References 2 publications

Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

Advances in Metered Dose Inhaler Technology: Hardware Development

Effectiveness of Asthma Inhaler Pharmacotherapy must take into consideration both the device and drug and which is guided by clinically meaningful outcomes

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