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PubMed1992

Bronchodilating effect of ipratropium bromide inhalation powder and aerosol in children and adolescents with stable bronchial asthma.

The purpose of this study was to compare the bronchodilating effect of ipratropium bromide (IB) administered by a conventional Ingelheim powder device system (IPI) and by a metered dose inhaler (MDI) in children and adolescents with stable bronchial asthma. Seventy patients, aged 7 to 16 years, with stable bronchial asthma from our outpatient clinic were tested for bronchial responsiveness to inhaled IB. Fifteen (21%) of the 70 subjects were found to have a substantial bronchial response to inhalation of 40 micrograms IB, i.e. at least 15% increase in FEV1 30 min after inhalation; the remaining 55 subjects had less than 15% increase in FEV1. No relationship between severity of asthma, age or sex and bronchial responsiveness to inhaled IB was found. Among the 15 subjects who had substantial bronchial response to IB, the increase in FEV1 after inhalation of fenoterol tended to be greater than the response to inhaled IB, although this did not reach statistical significance. Responders, i.e. subjects who had at least 15% increase in FEV1 after inhalation of IB, took part in a double-blind, cross-over study of the bronchodilating effect of 40 micrograms IB delivered by IPI and MDI. We found no significant differences in the bronchodilating effect during a 6-h follow-up. Maximum bronchodilating effect of IB was reached after 30 min and the maximum response lasted for 90 min. No side or adverse effects were observed following inhalation of IB.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Milk antibodies in pulmonary inhalation.

To determine the association between inhalation and increased circulating milk antibodies, the presence of milk precipitins and haemagglutinating titres of antibody to casein and lactalbumin were determined in a series of 100 children studied by radionuclide 'milk scan' and/or barium swallow for possible milk inhalation. Sixty-five were investigated because of reflux and/or inhalation (REFLUX), while 35 were evaluated after near-miss sudden infant death (SID). Inhalation was demonstrated in 23/65 Reflux and 9/35 Sid patients. The incidence of milk precipitins was 22% (5/23) of the REFLUX with demonstrable inhalation, 12% (5/42) of the REFLUX without demonstrable inhalation, 0% (0/23) SID and 2% (21/1005) of an unselected series of hospital patient sera. The incidence of milk precipitins was increased in cases with demonstrated inhalation and lower respiratory tract symptoms. Determination of antibody titres to casein and lactalbumin did not provide additional benefit in the diagnosis of milk inhalation. Detection of milk precipitins can provide additional support to the diagnosis of milk inhalation.

Animals↗
PubMed2006

The influence of cigarette smoke inhalation and its cessation on the tooth-supporting alveolar bone: a histometric study in rats.

OBJECTIVE: It has been previously shown that smoking may enhance periodontal breakdown and impair bone healing around titanium implants. However, there is a lack of information concerning the effect of smoking on the tooth-supporting alveolar bone. Thus, the aim of this study was to histometrically evaluate the influence of cigarette smoke inhalation and its cessation on tooth-supporting alveolar bone. METHODS: Sixty male Wistar rats were randomly assigned to one of the following groups: group 1 - control (n = 15), group 2 - 2 months of cigarette smoke inhalation (n = 13), group 3 - 3 months of cigarette smoke inhalation and 2 months without exposure to cigarette smoke inhalation (n = 16) and group 4 - 5 months of cigarette smoke inhalation (n = 16). Five months after the beginning of cigarette smoke inhalation regime (2 months for group 2), the animals were killed and the mandible was removed and prepared for histological sections. The proportion of mineralized tissue in the furcation area (i.e. a 1000 microm zone under the furcation and between the roots) was obtained. RESULTS: Data analysis demonstrated that the animals continuously exposed to cigarette smoke inhalation presented a decreased proportion of mineralized tissue (groups 2 and 4), when compared to control and cessation groups (groups 1 and 3) (p < 0.05). Similar levels of proportion of mineralized tissue were observed in groups 1 and 3, showing a beneficial effect of cigarette smoke inhalation cessation on proportion of mineralized tissue. CONCLUSION: Within the limits of the present study, it can be concluded that cigarette smoke inhalation may affect the tooth-supporting bone as early as 2 months after the initial exposure, and that smoke exposure cessation may revert its negative impact on the alveolar bone.

Alveolar Bone Loss↗
PubMed2002

Anti-leukotrienes as add-on therapy to inhaled glucocorticoids in patients with asthma: systematic review of current evidence.

OBJECTIVES: To examine the evidence for the efficacy and glucocorticoid sparing effect of oral anti-leukotrienes taken daily as add-on therapy to inhaled glucocorticoids in patients with asthma. DESIGN: Systematic review of randomised controlled trials of children and adults with asthma comparing the addition of anti-leukotrienes or placebo to inhaled glucocorticoids. MAIN OUTCOME MEASURES: The rate of exacerbations of asthma requiring rescue systemic glucocorticoids when the intervention was compared to the same or double dose of inhaled glucocorticoids, and the glucocorticoid sparing effect when the intervention was aimed at tapering the glucocorticoid. RESULTS: Of 376 citations, 13 were included: 12 in adult patients and one in children. The addition of licensed doses of anti-leukotrienes to inhaled glucocorticoids resulted in a non-significant reduction in the risk of exacerbations requiring systemic steroids (two trials; relative risk 0.61, 95% confidence interval 0.36 to 1.05). No trials comparing the use of anti-leukotrienes with double the dose of inhaled glucocorticoids could be pooled. The use of anti-leukotrienes resulted in no overall group difference in the lowest achieved dose of inhaled glucocorticoids (three trials; weighted mean difference -44.43 microg/day, -147.87 to 59.02: random effect model) but was associated with a reduction in withdrawals owing to poor asthma control (four trials; relative risk 0.56, 0.35 to 0.89). CONCLUSIONS: The addition of anti-leukotrienes to inhaled glucocorticoids may modestly improve asthma control compared with inhaled glucocorticoids alone but this strategy cannot be recommended as a substitute for increasing the dose of inhaled glucocorticoids. The addition of anti-leukotrienes is possibly associated with superior asthma control after tapering of glucocorticoids, but the glucocorticoids sparing effect cannot be quantified at present.

Adult↗
PubMed2002

Ability to learn inhaler technique in relation to cognitive scores and tests of praxis in old age.

Clinical observations have shown that some older patients are unable to learn to use a metered dose inhaler (MDI) despite having a normal abbreviated mental test (AMT) score, possibly because of dyspraxia or unrecognised cognitive impairment. Thirty inhaler-naive inpatients (age 76-94) with an AMT score of 8-10 (normal) were studied. Standard MDI training was given and the level of competence reached was scored (inhalation score). A separate observer performed the minimental test (MMT), Barthel index, geriatric depression score (GDS), ideational dyspraxia test (IDT), and ideomotor dyspraxia test (IMD). No correlative or threshold relationship was found between inhalation score and Barthel index, GDS, or IDT. However, a significant correlation was found between inhalation score and IMD (r = 0.45, p = 0.039) and MMT (r = 0.48, p = 0.032) and threshold effects emerged in that no subject with a MMT score of less than 23/30 had an inhalation score of 5/10 or more (adequate technique requires 6/10 or more), and all 17/18 with an inhalation score of 6/10 or more had an IMD of 14/20 or more. The three patients with a MMT >22 and inhalation score <6 had abnormal IMD scores. Inability to learn an adequate inhaler technique in subjects with a normal AMT score appears to be due to unrecognised cognitive impairment or dyspraxia. The MMT is probably a more useful screening test than the AMT score in this context.

Aged↗
PubMedDate not supplied

Inhaled corticosteroid therapy does not control asthma.

BACKGROUND: Randomized clinical trials demonstrate efficacy and show that inhaled corticosteroid therapy can control asthma, but details concerning their effectiveness in achieving this goal in the community are lacking. OBJECTIVES: To determine whether inhaled corticosteroid therapy is effective in controlling asthma and to examine the rates of asthma control in relation to inhaled corticosteroid use outside the realm of randomized controlled trials. METHODS: Different populations were examined cross-sectionally to determine whether self-reported use of inhaled corticosteroids was associated with control of asthma. Subjects with asthma in the community and those attending a university-based asthma program were studied. The definition of asthma control was based on the recommendations of the Canadian Consensus Report. The elements of asthma control were examined in the context of the subject's stated use and dose of the inhaled corticosteroid. RESULTS: Asthma was controlled in 20% (95% CI 18.7% to 21.3%) of the 3427 subjects included in the present study. Only 15% (95% CI 13.5% to 16.5%) of the 2437 subjects using inhaled corticosteroids exhibited asthma control compared with 33% (95% CI 31.1% to 35.9%) of the 990 subjects not using inhaled corticosteroids (P<0.000001). CONCLUSIONS: Although it is known that inhaled corticosteroid therapy can result in asthma control in most individuals with asthma, the present study has shown that this result may not be attained outside the realm of randomized clinical trials. Inhaled corticosteroid use for asthma in a 'real world' setting appears to reflect disease severity.

Adolescent↗
PubMed1992

Comparative assessment of a new breath-actuated inhaler in patients with reversible airways obstruction.

Twenty-five patients with reversible airways obstruction inhaled salbutamol (200 micrograms) from the standard press and breathe-metered dose inhaler or a new breath-actuated metered dose inhaler (Aerolin in the Autohaler inhalation device; 3M Health Care Ltd.) in a single dose, double-blind, double-dummy, 2-period, cross-over study. Forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow rate were measured in the 4-hour period after inhalation. The equivalence of the two inhaler devices was determined by analysis of the peak change and time to peak, with reference to the initial recorded baselines of the measured parameters. The efficacy of the two devices was very similar. The breath-actuated device is likely to benefit inhaler users who suffer from poor co-ordination of actuation and inhalation with a standard inhaler.

Adult↗
PubMed1991

Inhalation of an alkaline aerosol by subjects with mild asthma does not result in bronchoconstriction.

Although it is recognized that inhalation of acid aerosols by subjects with asthma can cause bronchoconstriction, the effects of the inhalation of an alkaline aerosol are unknown. When supplemental inflatable restraints (automobile air bags) are deployed an alkaline aerosol is released. This aerosol is composed of particles of sodium carbonate and sodium bicarbonate with some sodium hydroxide. The mass median aerodynamic diameter (MMAD) of the aerosol is approximately 1 micron, and the pH of the aerosol is 9.8 to 10.3. A group of 14 volunteer male subjects with mild asthma inhaled increasing concentrations of this aerosol for 20-min periods of mouth-only tidal ventilation. Pulmonary function tests were performed at baseline (preexposure), after inhalation of room air alone (control), and after each period of inhalation of the aerosol. A total of 5 subjects inhaled aerosols at nominal concentrations of 10, 20, and 40 mg/m3, whereas 11 subjects inhaled aerosols concentrations of approximately 30, 60, and 120 mg/m3. The mean changes in FEV1 and specific airways resistance (SRaw) for the 11 subjects who inhaled the higher concentrations (average highest concentration 126.6 +/- 7.5 mg/m3, mean +/- SEM) were -1.4 +/- 1.9 and +17.5 +/- 8.5%, respectively. Neither change in lung function was clinically or statistically significant. We conclude that the inhalation of relatively high concentrations of this alkaline aerosol by subjects with mild asthma does not result in bronchoconstriction.

Adolescent↗
PubMedDate not supplied

Cost implications of using inhaled nitric oxide compared with epoprostenol for pulmonary hypertension.

OBJECTIVE: To compare the cost of using intravenous epoprostenol with that of inhaled nitric oxide (NO) for treating episodes of pulmonary hypertension in children with congenital heart disease. DESIGN: An analysis of the cost of epoprostenol and NO use over the previous 18 months was performed. Three 6-month periods were identified, two in which epoprostenol was used and the third in which inhaled NO was introduced for the treatment of pulmonary hypertension. SETTING: A 10-bed pediatric cardiac intensive care unit, Royal Liverpool Children's Hospital, Alder Hey, Liverpool, England. SUBJECTS: Children with congenital heart disease and persistently elevated pulmonary artery pressure following cardiac surgery. MAIN OUTCOME MEASURES: The total duration of use of epoprostenol and inhaled NO was documented. The costs per hour for epoprostenol and inhaled NO were calculated and the annual cost of each agent was estimated. RESULTS: In the two 6-month periods prior to the introduction of inhaled NO, epoprostenol was used on 14 occasions (5 in the first period, 3 in the second). In the last 6-month period, nine children required pulmonary vasodilator therapy on 14 occasions. All nine children were treated successfully with inhaled NO; none were given or needed epoprostenol, as NO always was effective in providing pulmonary vasodilatation. For resistant pulmonary hypertension, increasing the concentration of NO would have been the next therapeutic option. The cost for the two 6-month periods using epoprostenol was $19,483.48 for the drug and $283.25 for equipment costs (total cost $19,766.73). There was no expenditure on epoprostenol in the final 6-month period. The cost of NO was $465. However, the total expenditure, including the delivery and monitoring system, was $4,722.85. CONCLUSIONS: Using inhaled NO in our pediatric cardiac intensive care unit abolished the use of epoprostenol during the reported monitoring period. The cost savings were significant, amounting to 12% of the annual drug budget for the unit. The cost of setting up the inhaled NO delivery system is recouped rapidly. The ease of delivery and measurement of inhaled NO also may have contributed to its increased clinical use.

Child↗
PubMed1993

A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma.

BACKGROUND: Comparative studies of albuterol by wet nebulizer or metered dose inhaler have tested fixed doses of medications. We compared the dose-response relationship to albuterol by wet nebulization or metered dose inhaler in acute asthma. METHODS: Randomized, double-blind, placebo-controlled trial. Patients with acute asthma received either albuterol, 0.4 mg, by metered dose inhaler (and holding chamber) or albuterol, 2.5 mg, by wet nebulizer every 30 min until maximal bronchodilation. Forty patients (forced expiratory volume in 1 s [FEV1]: 1.15 +/- 0.43 L; 36 +/- 12 percent predicted) received metered dose inhaler and 40 others (FEV1: 1.08 +/- 0.52 L; 35 +/- 16 percent predicted) received wet nebulization. RESULTS: Twenty-six patients (65 percent) receiving metered dose inhaler and 30 (75 percent) receiving wet nebulization achieved maximal bronchodilation after two doses. Almost all reached maximal bronchodilation by four doses. The FEV1 improved by 0.72 +/- 0.49 L for metered dose inhaler and 0.68 +/- 0.61 L for wet nebulizer (p = 0.71). A significant linear relationship was seen in both groups (metered dose inhaler r = 0.94; wet nebulizer r = 0.98) between the log dose of albuterol and change in FEV1. About 1/6 the wet nebulizer dose of albuterol was needed to achieve similar response to the metered dose inhaler. CONCLUSIONS: Albuterol by metered dose inhaler provided similar bronchodilation to that achieved by wet nebulization in patients with acute asthma. The cumulative dose-response technique is applicable in the emergency department setting and is helpful in comparing the relative utility of various bronchodilator regimens.

Acute Disease↗
PubMed1995

Efficacy of inhaled nitric oxide in patients with severe ARDS.

STUDY OBJECTIVE: To investigate the initial and long-term effect of nitric oxide (NO) inhalation in patients with severe acute respiratory distress syndrome (ARDS). DESIGN: Retrospective, clinical study. SETTING: University surgical ICU. PATIENTS: Eighty-seven patients with severe ARDS. INTERVENTIONS AND MEASUREMENTS: Thirty of 87 patients with ARDS inhaled low concentrations of NO for more than 48 h in addition to the standard treatment. Initial and long-term effects of NO inhalation on hemodynamics, gas exchange, and methemoglobin formation were determined. Survival of patients treated with inhaled NO was compared with survival in similar patients without NO inhalation. RESULTS: In 83% of the patients, NO increased the ratio of arterial PO2 to the fraction of inspired O2 (PaO2/FIO2) by > or = 10 mm Hg; in 87%, NO reduced venous admixture (QVA/QT) by > or = 10%, and in 63%, NO decreased mean pulmonary artery pressure (PAP) by > or = 3 mm Hg. Daily short interruption of continuous inhalation of NO for a duration of 17 +/- 2.4 days was consistently associated with a decrease in PaO2/FIO2 by 81 +/- 4 mm Hg (p < 0.001). QVA/QT increased by 8.3 +/- 0.4% (p < 0.001) and PAP by 5.3 +/- 0.3 mm Hg (p < 0.001). Over time, we observed neither tachyphylaxis nor a more pronounced effect of inhaled NO. Methemoglobin increased from 0.74 +/- 0.56% to 0.98 +/- 0.02% (p < 0.001). Survival rates in patients treated with NO did not differ from survival rates in patients not treated with NO. CONCLUSION: Beneficial effects of NO inhalation can be observed in most patients with severe ARDS; in some cases, however, it may fail to improve pulmonary gas exchange or to reduce pulmonary hypertension without obvious explanation. To demonstrate a possible increase in survival associated with NO inhalation, large randomized prospective trials are required.

Adolescent↗
PubMed2002

Fatal work-related inhalation of harmful substances in the United States.

STUDY OBJECTIVES: Inhalation of harmful substances is common in the workplace. The purpose of this study was to describe the epidemiology of fatal occupational inhalations in the United States. DESIGN: Data from the Census of Fatal Occupational Injuries from 1992 to 1998 were analyzed. Information on demographic characteristics, occupation, and industry was used to calculate specific mortality rates, and the inhaled substances were identified. RESULTS: Nationwide, there were 523 cases of fatal occupational inhalation, with a mortality rate of 0.56 deaths per 1,000,000 worker-years. The rate of death was greater for men (1.01/1,000,000) than for women (0.03/1,000,000), and workers > or = 65 years of age had the highest mortality. Mining was the industry with the highest mortality rate (6.64/1,000,000). The occupations with the highest rate were firefighters (3.54/1,000,000) and farming, forestry, and fishing occupations (2.84/1,000,000). Nearly half of the inhalation victims were constructing, repairing, cleaning, inspecting, or painting when the injury occurred. Overall, carbon monoxide was the most frequently inhaled substance (33.5%). The incidence of fatal carbon monoxide inhalations was twice as high in the winter as in the summer. The proportion of workers killed by carbon monoxide poisoning increased with increasing age. CONCLUSIONS: Work-related inhalations cause more deaths than any other mode of exposure to harmful substances. Recognizing those circumstances that pose a higher risk for maintenance and repair workers, as well as upgrading carbon monoxide poisoning prevention programs, could have a major impact in reducing fatal work-related inhalation injuries.

Accidents, Occupational↗
PubMed2005

Hemodynamic effects of sildenafil in patients with congestive heart failure and pulmonary hypertension: combined administration with inhaled nitric oxide.

STUDY OBJECTIVES: In patients with pulmonary hypertension (PH) secondary to congestive heart failure, inhaled nitric oxide (NO) increases pulmonary vascular smooth-muscle intracellular cyclic guanosine monophosphate (cGMP) concentration, thereby decreasing pulmonary vascular resistance (PVR) and increasing cardiac index (CI). However, these beneficial effects of inhaled NO are limited in magnitude and duration, at least in part due to cGMP hydrolysis by the type 5 isoform of phosphodiesterase (PDE5). The goal of this study was to determine the acute pulmonary and systemic hemodynamic effects of the selective PDE5 inhibitor, sildenafil, administered alone or in combination with inhaled NO in patients with congestive heart failure and PH. DESIGN: Single center, case series, pharmacohemodynamic study. SETTING: Cardiac catheterization laboratory of a tertiary care academic teaching hospital. PATIENTS: We studied 11 patients with left ventricular systolic dysfunction due to coronary artery disease or idiopathic dilated cardiomyopathy who had PH. INTERVENTIONS: We administered oral sildenafil (50 mg), inhaled NO (80 ppm), and the combination of sildenafil and inhaled NO during right-heart and micromanometer left-heart catheterization. MEASUREMENTS AND RESULTS: Sildenafil administered alone decreased mean pulmonary artery pressure by 12 +/- 5%, PVR by 12 +/- 5%, systemic vascular resistance (SVR) by 13 +/- 6%, and pulmonary capillary wedge pressure by 12 +/- 7%, and increased CI by 14 +/- 5% (all p < 0.05) [+/- SEM]. The combination of inhaled NO and sildenafil decreased PVR by 50 +/- 4%, decreased SVR by 24 +/- 3%, and increased CI by 30 +/- 4% (all p < 0.01). These effects were greater than those observed with either agent alone (p < 0.05). In addition, sildenafil prolonged the pulmonary vasodilator effect of inhaled NO. Administration of sildenafil alone or in combination with inhaled NO did not change systemic arterial pressure or indexes of myocardial systolic or diastolic function. CONCLUSIONS: PDE5 inhibition with sildenafil improves cardiac output by balanced pulmonary and systemic vasodilation, and augments and prolongs the hemodynamic effects of inhaled NO in patients with chronic congestive heart failure and PH.

Adult↗
PubMedDate not supplied

[Inhalation of nitric oxide - dependence: case report]

OBJECTIVE: Describe the hemodynamic response with rebound of pulmonary hypertension after withdrawal of inhaled nitric oxide (NO) in a pediatric patient with acute respiratory distress syndrome (ARDS). METHODS: Case report of a child with ARDS and pulmonary hypertension evaluated through ecocardiografic with dopller, receiving inhaled NO for a period of 21 days. RESULTS: There was a decrease of the pulmonary artery pressure (PAP) from 52 mmHg to 44 mmHg after the initial titulation of NO inhalation dose. After the withdrawal of inhaled NO an elevation of PAP was observed (55 mmHg). It was necessary to reinstall the inhaled NO to obtain a more appropriate value (34 mmHg). A new attempt of interruption of the inhaled NO after prolonged inhalation (20 days) resulted in a new clinic worsening and increase of PAP, with the indication to reinstall the inhaled NO. In the 24th day of permanence in the intensive care unit the patient died due to multiple organ dysfunction. CONCLUSIONS: The possibility of pulmonary hypertension rebound after withdrawal of inhaled NO is a complication that may have important clinical implications for patients who need a prolonged treatment with NO. This case report emphasizes these implications.

Journal Article↗
PubMed2004

Efficacy and safety of inhaled insulin (Exubera) compared with subcutaneous insulin therapy in patients with type 1 diabetes: results of a 6-month, randomized, comparative trial.

OBJECTIVE: The aim of this study was to determine whether premeal pulmonary delivery of rapid-acting, dry-powder insulin (Exubera) plus Ultralente could provide glycemic control comparable to a conventional insulin regimen in type 1 diabetes. RESEARCH DESIGN AND METHODS: Three hundred thirty-five subjects were randomly assigned to receive either premeal inhaled insulin plus bedtime Ultralente or two to three injections of regular and NPH insulin for 24 weeks. The primary end point was a change in HbA(1c). RESULTS: Mean decreases in HbA(1c) values were comparable for inhaled (8.1-7.9%) and conventional groups (8.1-7.7%) (adjusted treatment group difference 0.16% [95% CI -0.01 to 0.32]). There were greater reductions for inhaled versus conventional regimen in fasting and postprandial plasma glucose (adjusted mean change differences -25.17 and -30.28 mg/dl, respectively [95% CI -43.39 to -6.95 and -54.58 to -5.97, respectively]). Hypoglycemia (events/subject month) was lower for the inhaled (8.6) versus the conventional (9.0) group (risk ratio, 0.96 [95% CI 0.93-0.99]). In subjects receiving inhaled insulin, increased insulin antibody levels were observed, but there were no associated clinical or laboratory changes. Adverse events were comparable between groups. Mild to moderate cough was more frequent in the inhaled insulin group (27 vs. 5%) but decreased during the treatment. Pulmonary function tests were not different between the groups except for a greater decrease in carbon monoxide diffusing capacity in the inhaled insulin group. Treatment satisfaction was greater in the inhaled than in the conventional group. CONCLUSIONS: Inhaled insulin is effective, well tolerated, and well accepted in patients with type 1 diabetes and provides glycemic control comparable to that with a conventional insulin regimen.

Adolescent↗
PubMed1994

The evolution of inhaler technology.

Historically, the evolution of inhalation therapy can be traced to India 4000 years ago. The antecedents of contemporary inhalation therapy, however, began in the nineteenth-century industrial age with the invention of the glass bulb nebulizer. From there, inhaler technology evolved along two pathways characterized by refinements in existent nebulizer technology and the invention of a portable inhalation device, the metered-dose inhaler (MDI). More recently, growing recognition of problems associated with MDI use (chiefly, its reliance on coordinated patient inhalation and actuation technique) led to modifications in the MDI itself with auxiliary devices (spacers) and the development of new inhaler systems--dry powdered inhalers (DPIs) and the breath-actuated metered-dose inhaler (BAI-MDI).

Asthma↗
PubMed1996

The effect of structured versus conventional inhaler education in medical housestaff.

Despite the importance of adequate inhaler technique in the care of asthma and chronic obstructive pulmonary disease, physicians have often been shown to have poor knowledge of correct inhaler use. At present, postgraduate teaching programs appear to leave physicians to acquire inhaler handling skills informally in the context of day-to-day patient care. We undertook the present study to determine if one brief structured educational intervention would be adequate to teach postgraduate physicians inhaler skills that would be retained over long periods of time. We also compared the efficacy of this intervention to traditional education methods. We recruited 52 postgraduate trainees in internal medicine at a large university hospital; 26 were in the educational intervention group and 26 were in the control group. Physicians in the intervention group were asked to respond to a questionnaire on inhaler use and to demonstrate the correct use of a metered-dose inhaler (MDI), an MDI with a pacing chamber and a multidose dry-powder inhaler. These intervention subjects were then instructed on proper inhaler usage by a qualified nurse educator. Eight months later, testing was repeated in the intervention group and was undertaken in the control group. Questionnaire scores were significantly higher in the intervention group at the 8-month follow-up than at baseline (59% vs. 42%; p < 0.05). Similarly, the scores of the intervention group at follow-up were significantly higher than those of the control group (59% vs. 39%; p < 0.05). There was no significant difference between the baseline scores of the intervention group and those of the control group. The mean demonstration score was significantly higher in the intervention group at follow-up than at baseline (68% vs. 39%; p < 0.001) and was also higher than that of the control group (68% vs. 44%; p < 0.001). There was no significant difference between the scores for all devices between the intervention group before education and the control group. Our data show that one brief teaching session is sufficient to produce a sustained improvement in knowledge and handling of inhalers by postgraduate physicians. The knowledge and skills of the physicians educated in our study were not only better than before they had received instruction, but were better than the knowledge and skills of postgraduate trainees from the same institution who had received no formal training. This latter observation suggests a failure of traditional unstructured postgraduate training programs to teach this practical patient care skill.

Asthma↗
PubMedDate not supplied

Comparative study of different inhaler devices in asthmatic children.

BACKGROUND: The inhaler is an important drug delivery system in the treatment of asthma, but inhaler technique is often inadequate. We assessed technique in children diagnosed with asthma, comparing the performance of three devices. PATIENTS AND METHODS: In a cross-sectional survey, 523 children (271 boys, 252 girls, ages 5 to 12 years; mean+/-SD 7.53+/-1.79 years) demonstrated inhalation technique according to Netherlands Asthma Foundation criteria during a first visit to a primary care clinic in Abha, Saudi Arabia. Patients used the device with which they were most familiar (either pMDI, Turbuhaler or Diskus). RESULTS: Two hundred children (38% of total population) used a pMDI, while 323 (62% of total population) used one of the dry powder inhalers 173 (58%) the Turbuhaler and 150 (47%) the Diskus. Only 49 children (25% of the total population) completed the assessment without making a mistake. The remaining 474 (75% of the total population) performed one or more manuevers poorly. Only 80 children who used an MDI (40% of those using the device) completed 50% or more of the maneuvers correctly compared with 111 (69% of those using the device) and 100 (67% of those using the device) of those using the Turbuhaler and Diskus, respectively (P=0.001 for comparison of MDI with dry powder inhalers). Children whose mothers had intermediate school or higher education performed better than those whose mothers had less education (P=0.001). The father's education had no bearing on performance with the inhaler. CONCLUSION: The inhaler technique of most asthmatic children is poor, but technique is better in children who use a dry powder compared a metered-dose inhaler. The level of the mother's education is positively associated with better inhalation technique in the child.

Journal Article↗