The Impact of Adding a Training Device to Familiar Counselling on Inhalation Technique and Pulmonary Function of Asthmatics

Nicola, Mina; Elberry, Ahmed A.; Sayed, Ossama M.; Hussein, Raghda R. S.; Saeed, Haitham; Abdelrahim, Mohamed

doi:10.1007/s12325-018-0737-6

Cited by 44 publications

(78 citation statements)

References 27 publications

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“…Although systemic delivered therapy is available for asthma and chronic obstructive pulmonary disease (COPD), inhaled therapy is the most widely used option [1][2][3]. The reason behind that is the better safety index for the inhaled way [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

et al. 2020

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Add-on devices that are attached to metered-dose inhalers (MDIs) were introduced to improve aerosol delivery. The objective of this study was to determine the efficacy of drug delivery from an MDI when attached to different add-on devices at different inhalation volumes.The total emitted dose (TED) of salbutamol was estimated for the MDI alone and the MDI connected to five different add-on devices (Able valved holding chamber, Tips-haler valved holding chamber, Aerochamber plus flow Vu valved holding chamber, Dolphin chamber, and a handmade water bottle spacer), at inhalation flow of 28.3 L·min−1 with flow volume of 1, 2 and 4 L, assuming young child (aged <6 years), old child (>6 years) and adult inhalation volumes, respectively.The TED% ranged between 84.1% and 87.2% at all inhalation volumes from the MDI alone, which was significantly greater than all MDI add-on device combinations (p<0.05). The TED% delivered to MDI sampling apparatus by a homemade water bottle spacer and Dolphin chamber, as non-antistatic add-on devices, ranged between 30.5% and 35.3%. However, washing these non-antistatic add-on devices with a light detergent before use improved their TED to range between 47.6% and 51.2%. Non-antistatic add-on devices had significantly lower TED (p<0.05) than that delivered by most antistatic add-on devices, which ranged from 51.3% to 71.6%.This study suggests that antistatic add-on devices delivered much more aerosol than non-antistatic add-on devices. However, it may be advised to still use a non-antistatic add-on device, for the sake of solving the coordination problem, and wash it with light detergent before use to improve TED.

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Section: Introductionmentioning

confidence: 99%

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

et al. 2020

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“…2 Effective patient education about correct pMDI inhalation technique is an urgent requirement because Ͻ 10% of patients use their pMDI correctly. [3][4][5] Traditional verbal training includes 11 steps to ensure the correct use of the pMDI (Table 1), 4,5 most of which, in theory at least, are easily executed by the patient and easily checked by the trainer. These include shaking the device, exhaling before inhalation of the aerosol, and positioning the pMDI in the patient's mouth.…”

Section: Introductionmentioning

confidence: 99%

“…These include shaking the device, exhaling before inhalation of the aerosol, and positioning the pMDI in the patient's mouth. 4 Unfortunately, teaching the correct pMDI technique via verbal instruction at chest clinics and to elderly patients is inadequate for correcting coordination errors. 3,4 Inhaling the emitted aerosol slowly and deeply for at least 5 s is a critical step in pMDI use because fast inhalation reduces lung deposition and increases oropharyn-geal deposition of the drug.…”

Section: Introductionmentioning

confidence: 99%

Impact of Advanced Patient Counseling Using a Training Device and Smartphone Application on Asthma Control

et al. 2019

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BACKGROUND: Pressurized metered-dose inhalers (pMDIs) are among the most commonly used aerosol delivery devices. Poor lung deposition from a pMDI is often a result of incorrect inhalation technique. The aim of this study was to compare the impact of combining a newly released training device with a smartphone application (advanced counseling) in asthma control to the impact of traditional verbal training. METHODS: A total of 371 subjects with asthma were divided into 2 groups: advanced counseling (n ‫؍‬ 187) and verbal counseling (n ‫؍‬ 184). Both groups had 3 visits, each meeting being a month apart. At each visit, lung function (ie, FEV 1 , ratio of FEV 1 to forced vital capacity [FEV 1 /FVC], and peak expiratory flow) were measured, an asthma control test was given, and subjects were trained in the correct inhalation technique. Inhalation flow through the pMDI was also recorded at each visit because the correct pMDI technique requires an inspiratory flow of < 60 L/min. RESULTS: In the advanced counseling group, lung function significantly improved after both the first and the second visit (P < .001), whereas in the verbal group, lung function improved significantly only after the second visit (P < .001). Although the inspiratory flow through the pMDI improved significantly in both groups, it was closest to the target range in the advanced counseling group. In addition, more subjects in the advanced counseling group had monthly increases of > 3 points in their asthma control test scores compared to the verbal counseling group. CONCLUSIONS: The use of a training device with a smartphone application in conjunction with traditional verbal counseling in pMDI technique resulted in significant improvements in asthma control compared to traditional verbal counseling in pMDI technique alone.

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“…2,3 Patients need to be taught to synchronize their breathing with the actuation of the pMDI to enhance drug deposition in the lung. 4,5 Inspiratory flows of Ͼ 30 L/min and an insufficient breathhold after inspiration also contribute to low drug delivery via pMDIs. 4 It is difficult to teach patients to use a pMDI properly in an emergency situation where they need the drug to be administered very rapidly.…”

Section: Introductionmentioning

confidence: 99%

“…Teaching children and elderly patients is similarly challenging. 5,6 In these cases, placing an accessory device (ie, a reservoir) between the pMDI and the patient allows more time for drug inhalation. 2,7 Accessory devices enhance aerosol delivery to the patient because large particles emitted by the pMDI settle inside the accessory device rather than being deposited in the mouth and throat.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Disposable and Traditional Accessory Devices for Use With a Pressurized Metered-Dose Inhaler

et al. 2019

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BACKGROUND: The use of accessory devices with pressurized metered-dose inhalers (pMDIs) enhances aerosol delivery and helps overcome any lack of patient coordination when using the pMDI. The use of accessory devices could be influenced by the efficacy, availability, and cost of these devices. The aim of this study was to compare drug delivery with the pMDI alone and with non-antistatic and antistatic accessory devices. METHODS: The total emitted dose and aerodynamic characterization of salbutamol particles were measured for the pMDI alone and for the pMDI combined with 4 different accessory devices: a homemade spacer, the Dolphin spacer, the DispozABLE paper spacer, and the AeroChamber Plus valved holding chamber. Aerodynamic characterization was analyzed with an Andersen cascade impactor at an inhalation flow of 28.3 L/min, and drug deposition was measured with high-performance liquid chromatography. RESULTS: The mean ؎ SD total emitted dose from the pMDI alone, 155.2 ؎ 20.5 g, was the greatest of all modalities, and the difference was significant (P < .001). The homemade and Dolphin spacers had the highest mean ؎ SD deposited amounts of salbutamol remaining on their walls (ie, 124.1 ؎ 11.1 g and 131.5 ؎ 11.8 g, respectively). The mean ؎ SD total emitted doses with the AeroChamber Plus valved holding chamber (61.9 ؎ 8.9 g) and the DispozABLE paper spacer (76.4 ؎ 8.6 g) were significantly higher than the emitted doses with the other devices. The mean ؎ SD fine-particle doses emitted with the AeroChamber plus valved holding chamber (51.4 ؎ 4.7 g) and the DispozABLE paper spacer (39.7 ؎ 5.6 g) were significantly higher than those with the other devices. The AeroChamber Plus valved holding chamber had the lowest mass median aerodynamic diameter (MMAD) values, but there were no statistically significant differences in MMAD between any of the combinations of pMDI and accessory device. CONCLUSIONS: The valved holding chamber and the paper spacer had better aerodynamic characteristics than the other devices tested. We consider the antistatic devices to be the optimum devices for aerosol delivery due to their high efficacy compared to non-antistatic devices.

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The Impact of Adding a Training Device to Familiar Counselling on Inhalation Technique and Pulmonary Function of Asthmatics

Abstract: Use of a training device combined with verbal counselling improved inhalation technique. An earlier, significant improvement was also noted in pulmonary function.

Cited by 44 publications

References 27 publications

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

Impact of Advanced Patient Counseling Using a Training Device and Smartphone Application on Asthma Control

Evaluation of Disposable and Traditional Accessory Devices for Use With a Pressurized Metered-Dose Inhaler

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