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Objective Inhalation therapy is one of the key pillars in the treatment of chronic obstructive diseases, such as asthma and COPD (Chronic obstructive pulmonary disease); however, wide number of errors occur with high frequency in the inhalation manoeuvres among these patient. This review discuss the main errors made with inhalation devices, factors associated with poor IT (inhalation technique), their consequences and possible solutions. Data sources To do this, we performed a search of any publications available in PubMed between the years 2000 and 2019, using the key words: asthma, COPD, obstructive lung disease, inhalers, misuse and errors. Study selections After a review of the titles and abstracts by the working group, the articles chosen were considered the most relevant in providing evidence of the problems and establishing solutions in the inhalation treatment of asthma and COPD. Results There are several publications that associated the errors in the inhalation technique with a poor prognosis both of asthma and COPD. Most authors generally agree in that a poor IT is associated with poor control of the symptoms. Conclusions It is essential to review the IT in all our patients with asthma and COPD due to the high socio‐economic impact that it involves; an effort must be made to homogenise the evaluation of IT, so that it helps to transmit a clear message to the patients, as well as to the health professionals on what is and what is not a correct manoeuvre.
Objective Inhalation therapy is one of the key pillars in the treatment of chronic obstructive diseases, such as asthma and COPD (Chronic obstructive pulmonary disease); however, wide number of errors occur with high frequency in the inhalation manoeuvres among these patient. This review discuss the main errors made with inhalation devices, factors associated with poor IT (inhalation technique), their consequences and possible solutions. Data sources To do this, we performed a search of any publications available in PubMed between the years 2000 and 2019, using the key words: asthma, COPD, obstructive lung disease, inhalers, misuse and errors. Study selections After a review of the titles and abstracts by the working group, the articles chosen were considered the most relevant in providing evidence of the problems and establishing solutions in the inhalation treatment of asthma and COPD. Results There are several publications that associated the errors in the inhalation technique with a poor prognosis both of asthma and COPD. Most authors generally agree in that a poor IT is associated with poor control of the symptoms. Conclusions It is essential to review the IT in all our patients with asthma and COPD due to the high socio‐economic impact that it involves; an effort must be made to homogenise the evaluation of IT, so that it helps to transmit a clear message to the patients, as well as to the health professionals on what is and what is not a correct manoeuvre.
The definition of exacerbation of COPD as a syndrome, as proposed by the Spanish COPD guidelines (GesEPOC) 2021 update, and the consequences that this implies, have direct implications on patient care. This review analyzes this novel vision of the COPD exacerbation syndrome, its rationale, and its clinical implications, as opposed to the traditional symptoms-based or event-based definitions. An exacerbation conceived as a syndrome provides us with an umbrella term to include a set of diverse alterations, which, either in isolation or more frequently in combination, are clinically expressed in a similar way in patients with COPD. In patients with COPD, this occurs as a consequence of worsening expiratory airflow limitation or the underlying inflammatory process, producing a worsening in symptoms with respect to the baseline situation. This definition therefore assumes a worsening in at least one of the two key physiopathological markers, lung function and inflammation. The main features of this new physiopathological proposal include a syndromic approach with narrower differential diagnosis, the use of several biomarkers, treatable traits to better guide treatment, and a new severity classification. Further research is needed to examine the role of eosinophils in this context, but currently, the early results are promising. The evaluation of severity is key in the multidimensional characterization of exacerbation and the GesEPOC 2021 proposes new approaches and also recommends the use of multidisciplinary scores for severity categorization in patients. Finally, another innovation in the GesEPOC 2021 refers to the recurrence of exacerbations, which has implications for disease prognosis or long-term clinical impact which need to be elucidated in further studies.
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