BACKGROUND: The proper use of inhaler drugs is critical in the management of chronic asthma. In this study, we investigated the inhalation performance of asthmatic patients and effectiveness of the regular education of inhalation technique. METHODS: The 145 asthmatic patients who had been educated the inhaler technique for more than 3 times were enrolled. The inhalation performance of each patient was scored using a checklist form (9 items for metered dose inhaler [MDI], 4 items for dry powder inhaler [DPI]) whenever they visited the clinic. Clinical characteristics affecting inhalation performance were evaluated in the groups using each type of inhaler. RESULT: In MDI, the mean initial performance score was significantly low when the patients were female sex, aged patients (>65 years old), or had lower educational backgrounds. Some items of the checklist, which include tilting head back, placing the mouthpiece with a distance from lips, continuing deep inspiration, and holding breath after inhalation for 10 seconds, were improperly performed in about 25% of the MDI users. No significant change was observed in the final performance scores assessed after intensive repeated education for proper inhalation technique of MDI. In DPI, the mean initial performance score was significantly low in the patients with old age (>65 years old) or lower educational backgrounds. The final performance scores were significantly improved after the repeated education for proper use of DPI inhalation in contrast to MDI. CONCLUSION: For the effective management of asthma, it may be important to choose proper type of inhaler with consideration of individual characteristics of the patients. The evaluation of inhalation performance and regular education of inhalation technique could be useful to maintain and improve the effective use of inhaler, especially in DPI.
Asthma* ; Checklist ; Dry Powder Inhalers ; Education ; Female ; Head ; Humans ; Inhalation* ; Lip ; Metered Dose Inhalers ; Nebulizers and Vaporizers

PURPOSE: Asthma control in older asthmatics is often less effective, which may be attributed to small airway dysfunction and poor inhalation technique. We compared the efficacy of 2 inhalers (fluticasone propionate/formoterol treatment using a pressurized metered-dose inhaler [p-MDI group] vs. fluticasone propionate/salmeterol treatment using a dry powder inhaler [DPI group]) in older asthmatics.METHODS: We conducted a 12-week, randomized, open-label, parallel-designed trial in older patients (over 55 years old) with moderate-to-severe asthma, and compared the efficacy and safety for asthma control between the 2 groups. Subgroup analyses on disease duration and air trapping were performed. Clinical parameters, including changes in lung function parameters, inhaler technique and adherence, were compared with monitoring adverse reactions between the 2 groups.RESULTS: A total of 68 patients underwent randomization, and 63 (30 in the p-MDI group and 33 in the DPI group) completed this study. The p-MDI group was non-inferior to the DPI group with regard to the rate of well-controlled asthma (53.3% vs. 45.5%, P < 0.001; a predefined non-inferiority limit of 17%). In subgroup analyses, the proportion of patients who did not reach well-controlled asthma in the p-MDI group was non-inferior to that in the DPI group; the difference was 12.7% among those with a longer disease duration (≥ 15 years) and 17.5% among those with higher air-trapping (RV/TLC ≥ 45%), respectively (a predefined non-inferiority limit of 17%, P < 0.001). No significant differences were observed in lung function parameters, inhalation techniques, adherence and adverse reactions between the 2 groups.CONCLUSION: These results suggest that the p-MDI group may be comparable to the DPI group in the management of older asthmatics in aspects of efficacy and safety.
Airway Management ; Asthma ; Dry Powder Inhalers ; Fluticasone ; Humans ; Inhalation ; Lung ; Medication Adherence ; Metered Dose Inhalers ; Nebulizers and Vaporizers ; Random Allocation

BACKGROUND: Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management. METHODS: We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit. RESULTS: The outcomes of 127 COPD patients were analyzed. CAT scores (19.6±12.5 vs. 15.1±12.3) improved significantly after this program (p<0.05). Patients with improved CAT scores of 4 points or more had a better understanding of COPD management and the correct technique for using inhalers than those who did not have improved CAT scores (p<0.05). CONCLUSION: A comprehensive education program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management.
Animals ; Cats ; Disease Management* ; Dry Powder Inhalers ; Education* ; Humans ; Korea ; Metered Dose Inhalers ; Nebulizers and Vaporizers* ; Outpatients ; Primary Health Care ; Pulmonary Disease, Chronic Obstructive*

Administration, Inhalation ; Adolescent ; Asthma ; therapy ; Child ; Child, Preschool ; Female ; Humans ; Inhalation Spacers ; Male ; Metered Dose Inhalers ; Nebulizers and Vaporizers ; standards ; Technology Assessment, Biomedical ; Treatment Outcome

BACKGROUND: Medications for asthma can be administered either by inhaled or systemic routes. The major advantages of delivering drugs directly into the lungs via inhalation are that higher concentrations can be delivered more effectively to the airways and that systemic side effects are avoided or minimized. Inhaled medications, or aerosols, are available in a variety of devices that differ in required technique and quantity of drugs delivered to the lung. OBJECTIVE: The purpose of this study was to determine the effects of patient education on correct use of metered dose inhaler in patients with asthma. METHODS: Twenty patients with asthma were instructed three times on proper inhaler usage by a physician at two-week intervals. Practical performance and theoretical knowledge were assessed (ten-item assessment). Scoring was done by one physician using a score of 1-3 for each item. RESULTS: The practical performance and theoretical knowledge scores were higher in patients after being instructed three times compared with those who were instructed once (26.2+/-2.2 vs 18.1+/-3.6, p< 0.01). The scores were higher in patients with higher education level com- pared with those with lower education level after three lessons (27.3+/-1.94 vs 24.3+/-1.80, p< 0.05). The most common errors included inadequate actuation time and breath holding, and insufficient activations. CONCLUSION: These findings suggest that patients with asthma be instructed in inhaler use and that their technique be checked regularly and repeatedly depending on education level.
Aerosols ; Asthma* ; Breath Holding ; Education ; Humans ; Inhalation ; Lung ; Metered Dose Inhalers* ; Nebulizers and Vaporizers ; Patient Education as Topic*

PURPOSE: Asthma inhalation therapy is important for the treatment of childhood asthma. Therefore, it is necessary to educate patients on the correct inhalation techniques. The purpose of this study was to determine the effectiveness and necessity of educating patients on the correct inhalation techniques. METHODS: A total of 86 patients with bronchial asthma and who were over 7 years old were enrolled and educated on handling inhaler devices for 2 years. The inhaler devices used were the diskus (n=27), turbuhaler (n=12) and metered dose inhaler with a spacer (n=47). Trained pharmacists provided the education. Four steps (breathing out prior to inhalation, inhalation, holding the breath, exhaling slowly) that were critical for handling each device were evaluated and each step was scored as good, fair or poor. We evaluated the symptom score (daytime cough, nighttime cough, sleep disturbance and limitation of activity) and lung function before treatment and 4 weeks later. RESULTS: Over 90.0% of the diskus users performed fair to good in each step. The symptom score and lung function at 4 weeks later after education were significantly improved (P=0.000). The turbuhaler users all performed fair to good on each step. The symptom score was significantly improved (P<0.005), but the lung function was not difference. Over 95% of the users of a metered dose inhaler with a spacer performed moderate to good on each step. The symptom score and lung function were significantly improved (P<0.05). CONCLUSION: The structured, detailed education on inhaler devices by trained specialists was very important for performing correct inhalation therapy to control asthma, and repeated education might be also necessary.
Asthma ; Cough ; Exhalation ; Handling (Psychology) ; Humans ; Inhalation ; Lung ; Metered Dose Inhalers ; Nebulizers and Vaporizers ; Pharmacists ; Respiratory Therapy ; Specialization

No abstract available.
Asthma ; Nebulizers and Vaporizers

We present a case of an anesthetic gas leak through the valve of the Selectatec back bar during a surgical procedure. The Selectatec Vaporizing System is a quick-change system consisting of anesthetic vaporizers of the 'Tec models' of the Ohmeda machine that are seated on a compatibility manifold block located on the back bar of the anesthetic machine. In order to prevent a leak and a failure of vapor delivery, the "Tec models series" can only be turned 'on' when the locking lever is turned to the 'lock' position. However in this case, the control knob was rotated despite the back bar locking mechanism not being engaged, and a gas leak developed through the unlocked valves in Selectatec back bar. The Penlon Sigma Delta Anesthetic Vaporizer (sevoflurane) in a Datex-Ohmeda Aestiva/5 anesthesia machine can be turned 'on' when the locking lever is maintained at the 'unlock' position.
Anesthesia ; Nebulizers and Vaporizers*

Max was treated with SABA using an MDI and spacer with facemask and responded well to the initial treatment. You explained to the parents that nebulisers are neither required nor recommended in the treatment of wheezing in their child's situation. You advised the parents on the proper technique of MDI use with spacer and facemask, as well as care of the equipment. You also gave them a clearly written action plan regarding the efficient management of the next episode of wheeze with MDI and spacer. You further explained the side effects of oral bronchodilators and nebulisers, and why you refrained from using them. Max was given a follow-up appointment to assess his progress, and his parents were advised on the situations when they should go to a doctor or the emergency department.
Asthma ; drug therapy ; Child ; Cough ; Drug Delivery Systems ; Humans ; Inhalation Spacers ; Nebulizers and Vaporizers ; Respiratory Sounds

Disodium cromoglycate(DSCG) has been widely used in the treatment of bronchial asthma and has become the prophylactic drug of choice in patients with mild-to-moderate asthma, because it has anti-allergic, anti-inflammatory and mast cell stabilizing properties. DSCG has been considered one of the safest medications among drugs for asthma treatment. The most common side effects are irritation of throat and dry mouth. Bronchospasm and chest tightness have been reported, but they were usually experienced by patients using spinhaler powdered capsules rather than metered dose inhalers (MDI). In this report, we presented a case of recurrent DSCG-induced bronchoconstriction with brief review of the literature. He had had an aspirin-induced asthma and had been well controlled with steroid inhalers and DSCG-MDI. After aspirin-bronchopro vocation test, he complained of chest discomfort and tightness immediately after inhaling DSCG-MDI. On serial monitoring of peak expiratory flow rate (PEER), there was a significant decline of PEER after two puffs inhalation of DSCG-MDI. Thus we performed DSCG-inhalation broncho provocation test with the nebulizer solution, which was pure DSCG without any addition of ingradients or propellants. This produced an early asthmatic reaction with more than 40% decline of FEV,. He was diagnosed as DSCG-induced bronchoconstriction and his clinical conditions were improved after avoidance of DSCG-MDI.
Asthma* ; Asthma, Aspirin-Induced ; Bronchial Spasm ; Bronchoconstriction* ; Capsules ; Humans ; Inhalation ; Mast Cells ; Metered Dose Inhalers ; Mouth ; Nebulizers and Vaporizers ; Occupations ; Peak Expiratory Flow Rate ; Pharynx ; Thorax