First-time handling of different inhalers by chronic obstructive lung disease patients

Harb, Hadeer S.; Laz, Nabila Ibrahim; Rabea, Hoda; Abdelrahim, Mohamed

doi:10.1080/01902148.2020.1789903

Cited by 43 publications

(83 citation statements)

References 51 publications

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“…The present study allowed us to examine deeply the problems that these subjects had when inhaling from their MDI, also, to check the effectiveness of MDI continuous verbal counselling in controlling asthma. Similar to earlier studies, 5,42,43 the results showed that a high number of subjects using MDI did not achieve MDI inhalation technique correct in the visit 1 but they significantly got better in the visit 2 ( P < .001) and improved more in the visit 3 ( P < .001) 14,24,26‐28,32 . Therefore, continuous counselling of the asthmatic subjects significantly correlates with the proper MDI inhalation technique ( P < .001) 24,29,44‐46 .…”

Section: Discussionsupporting

confidence: 79%

“…Similarly, there was no clinical significance or statistical significance in the lung function test scores (FEV 1 and PEF) for the control group (group 1) 16,39 . These clinical improvements in the counselled group only, support the recommendation of continuous counselling at any possible opportunity 14,24,26‐28,32 …”

Section: Discussionmentioning

confidence: 87%

“…Mistakes were noticed and corrected with the right steps as suggested by ERS/ISAM task force report listed in Table 1 33 . These steps have been used successfully in many other studies 14,24,26‐28,32 . According to the ERS/ISAM task force report suggestions, the MDI inhalation technique was separated into several steps as it was revealed before that this separation of steps may help subjects in improving their inhalation technique as it makes the MDI counselling more operative and permit to easily notice the hard steps 33…”

Section: Methodsmentioning

confidence: 99%

“…The MDIs are still the gold standard inhaler for asthma and chronic obstructive pulmonary diseases (COPD) since they are reproducible and dependable doses 13 . However, Harb et al have shown that although the MDI was the most commonly used inhaler it is the hardest inhaler to teach compared to nine other inhalers 14 …”

Section: Introductionmentioning

confidence: 99%

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The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

et al. 2020

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Background Subjects’ improper usage of their metered‐dose inhalers (MDI) is considered a chief cause of poor asthma control. The work presented here aims to evaluate the effect of MDI verbal counselling on subjects’ lung function and inhalation technique. Method A total number of 900 asthmatic subjects (450 female) were gathered from University hospital outpatient clinics from January 2017 to May 2019 with a mean (SD) age 45.2 (17.1) years old. They were divided into two groups. The first was monthly asthma follow‐up, for three visits, (450 (266 females) subjects). The other group was monthly asthma follow‐up, for three visits plus MDI inhalation technique verbal counselling (450 (184 female) subjects). At the beginning of studying group 2 and at every monthly visit (three visits), each subject was asked to show the investigator his MDI inhalation technique and the number of mistakes was noticed and adjusted. Additionally, at each visit, their forced expiratory volume in one second (FEV1) as a percentage of the forced vital capacity (FVC) and peak expiratory flow (PEF) were measured. Results No subject dropped out from group 2; however, 95 subjects dropped out from group 1 with no improvement in the lung function tests. The mean number of accurate steps of the MDI inhalation technique observed in group 2 was improved significantly (P < .001) as the number of visits increased particularly in children. “Start to inhale slowly, through the mouth and at the same time press the canister to actuate a dose and maintain a slow and deep inhalation, through the mouth, until the lungs are full of air (This should take an adult 4‐5 seconds)” was the common repetitive mistake. There was a significant improvement (P < .05) in the lung function test scores after the counselling in group 2, especially in old subjects. Conclusions MDI’s counselling must be continually offered to the asthmatic subject at any possible chance to improve and sustain the optimal MDI inhalation technique and probably improve subjects’ lung function score.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

et al. 2020

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“…Some steps of inhaler technique are essential and failure of their achievements leads to critical errors (ie, those likely to result in the inhalation of significantly reduced, minimal or no medication) 10 . One of the essential steps during dose inhalation is the inhalation pattern of the aerosol 4‐6 .…”

Section: Introductionmentioning

confidence: 99%

In vitro and in vivo performance modelling and optimisation of different dry powder inhalers: A complementary study of neural networks, genetic algorithms and decision trees

et al. 2020

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Introduction Aerosol delivery from DPIs could be affected by different factors. This study aimed to evaluate and predict the effects of different factors on drug delivery from DPIs. Methods Modelling and optimisation for both in vitro and in vivo data of different DPIs (Diskus, Turbohaler and Aerolizer) were carried out using neural networks associated with genetic algorithms and the results are confirmed using a decision tree (DT) and random forest regressor (RFR). All variables (the type of DPI, inhalation flow, inhalation volume, number of inhalations and type of subject) were coded as numbers before using them in the modelling study. Results The analysis of the in vitro model showed that Turbohaler had the highest emitted dose compared with the Diskus and the Aerolizer. Increasing flow resulted in a gradual increase in the emitted dose. Little differences between the inhalation volumes 2 and 4 litres were shown at fast inhalation flow, and interestingly two inhalations showed somewhat higher emitted doses than one‐inhalation mode with Turbohaler and Diskus at slow inhalation flow. Regarding the in vivo model, the percent of drug delivered to the lung was highly increased with Turbohaler and Diskus in healthy subjects where continuous contour lines were observed. The Turbohaler showed increased lung bioavailability with the two‐inhalation modes, the Diskus showed a nearly constant level at both one and two inhalations at slow inhalation. The Turbohaler and Aerolizer showed little increasing effect moving from one to two inhalations at slow inhalation. Conclusions Modelling of the input data showed a good differentiating and prediction power for both in vitro and in vivo models. The results of the modelling refer to the high efficacy of Diskus followed by Turbohaler for delivering aerosol. With two inhalations, the three DPIs showed an increase in the percent of drug excreted at slow inhalations.

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The Aerosol Generators Available for Critically Ill Patient

Abdelrahim

Saeed

Harb

et al. 2021

Essentials of Aerosol Therapy in Critically Ill Patients

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First-time handling of different inhalers by chronic obstructive lung disease patients

Cited by 43 publications

References 51 publications

The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

In vitro and in vivo performance modelling and optimisation of different dry powder inhalers: A complementary study of neural networks, genetic algorithms and decision trees

The Aerosol Generators Available for Critically Ill Patient

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