BeclometasoneCome i cortisonici in genere, il budesonide presenta efficacia nel trattamento di manifestazioni infiammatoriespecie di origine allergica. Viene utilizzato nella profilassi e per il trattamento di cortucosteroidi allergica, forme di asma e corticosteroidi inalatori e asma nasale. Dispositivi di erogazione per via inalatoria: Corticosteroidi inalatori e asma sospensione da nebulizzare richiede l'utilizzo di un nebulizzatore: Nei bambini si consiglia di impiegare una maschera facciale per equipoise vs dbol budesonide sospensione da nebulizzare per ridurre la perdita di farmaco durante l'erogazione.
Factors related to the incorrect use of inhalers by asthma patients
Graduate Program in Pulmonology. To evaluate inhaler technique in outpatients with asthma and to determine associations between the correctness of that technique and the level of asthma control. The patients completed two questionnaires a general questionnaire and an asthma control questionnaire based on the Global Initiative for Asthma guidelines , demonstrated their inhaler technique, and performed pulmonary function tests.
Incorrect inhaler technique was defined as the incorrect execution of at least two of the predefined steps. We included patients. Of those, 81 Logistic regression analysis identified the following factors associated with incorrect inhaler technique: In the sample studied, incorrect inhaler technique was associated with poor asthma control. Asthma is one of the most common chronic conditions. Although the results of clinical findings have shown that asthma control can be achieved in most patients, epidemiological evidence suggests that there is a significant gap between treatment goals and the actual level of control achieved with treatment in the general population.
Inhaled drugs are the primary treatment for asthma. The objective of the present article was to assess inhaler technique in outpatients with asthma and to determine associations between the correctness of that technique and the level of asthma control.
This was a cross-sectional study. Written informed consent was obtained from all patients or their legal guardians, in the case of those under 18 years of age. The study population consisted of patients treated at the HCPA outpatient clinics specializing in asthma. Individuals aged 18 years or older who had a previous diagnosis of asthma were sequentially recruited. A physician who was a member of the research team confirmed the diagnosis on the basis of the following criteria , 6: Patients should have made two prior visits to one of the outpatient clinics mentioned above, and the pharmacological treatment regimen should have already been adjusted to the level of asthma severity.
The exclusion criteria were declining to participate in the study, having another chronic lung disease emphysema, chronic bronchitis, or bronchiectasis , not using inhaled drugs, and failing to complete all of the evaluations required by the study protocol. The questionnaire used to interview patients included a checklist for assessing patient handling of the device used to inhale the corticosteroid.
Prior to the study outset, the principal investigator trained all members of the research team on the correct use of each device and on how to score each stage of the evaluation process. Patients were asked to demonstrate their inhaler technique, using placebo. For metered dose inhalers, patients were assessed for their performance of the following steps: For dry powder inhalers, patients were assessed for their performance of the following steps: Asthma severity was categorized on the basis of the daily medication regimen in use, as proposed in the Global Initiative for Asthma GINA guidelines.
The level of asthma control was assessed in accordance with the classification proposed in the GINA guidelines Chart 1. Pulmonary function was assessed with a computerized spirometer MasterScreen v4. All parameters are expressed as a percentage of the predicted value for age, gender, and height. The results are expressed as a percentage of the predicted value for age, gender, and height. For the statistical analysis, we used the Statistical Package for the Social Sciences, version For each patient, the number of inhaler technique errors was recorded.
In the present sample, the association between the number of errors dichotomized into one or more errors and two or more errors and the level of asthma control controlled, partially controlled, and uncontrolled was analyzed by the chi-square test.
Therefore, correct inhaler technique was defined as making less than two inhaler technique errors, whereas incorrect inhaler technique was defined as making two or more errors.
Patients with correct inhaler technique and patients with incorrect inhaler technique were compared for categorical variables using the chi-square test with adjusted standardized residuals and, when necessary, Yates' correction or Fisher's exact test.
Continuous variables were compared by the independent sample t-test or the Mann-Whitney U test. A binary logistic regression model enter method was used to identify characteristics predictive of incorrect inhaler technique. Variables with a significance level less than 0. All statistical tests were two-tailed. A total of eligible patients were examined.
Thirty patients declined to participate, 27 patients were excluded because they had another chronic lung disease, 7 patients were excluded because they did not use the prescribed inhaled drug, and 2 patients were excluded because they failed to complete all of the evaluations required by the study protocol. Therefore, individuals completed the study. Of those, patients showed correct inhaler technique and 81 Table 1 shows the general characteristics of the study patients.
One hundred and ninety-nine patients The mean age was Asthma severity was classified as mild persistent in 37 Asthma was classified as controlled in 47 Table 2 shows the comparison between groups formed on the basis of inhaler technique assessment. Statistically significant differences were found for the following variables: In contrast, we found a higher proportion of patients with incorrect technique among those using metered dose inhalers without spacers.
Table 4 shows the logistic regression for factors related to incorrect inhaler technique. The following variables were independently associated with incorrect inhaler technique: The present study showed that the number of inhaler technique errors has a significant impact on the level of asthma control. The variables that were associated with incorrect inhaler technique were being widowed, using metered dose inhalers, having a monthly family income of less than three times the national minimum wage, and having two or more comorbidities.
Incorrect inhaler technique in asthma treatment can substantially reduce lung deposition of the drug, undermining the effectiveness of asthma treatment.
In the present study, incorrect inhaler technique i. It is of note that a previous study, , 9 in which incorrect inhaler technique was defined as making one or more errors, found no association between the correctness of inhaler technique and the level of asthma control. In contrast to these findings, in a study conducted in Brazil, Coelho et al. Performing the inhaler technique correctly depends on the type of inhaler.
A systematic review , 11 has shown that patients using dry powder inhalers had lower rates of inhaler technique errors than did those using metered dose inhalers. The present study adds to the evidence that the proportion of patients with inappropriate inhaler technique is higher among patients using metered dose inhalers than among those using dry powder inhalers.
This difference is even greater when patients using metered dose inhalers without spacers are considered. Metered dose inhalers are more difficult to use, because they require greater motor coordination. The use of a spacer reduces the need for greater motor coordination, but, despite that, metered dose inhalers remain more difficult to use than dry powder inhalers, which leads to a higher proportion of inhaler technique errors.
This may indicate a bias in the present study, with the requirement for classifying the technique as correct being more stringent for individuals using metered dose inhalers. However, this is more likely to represent the greater complexity of performing the inhaler technique with metered dose inhalers than with dry powder inhalers. In the present study, a higher proportion of patients with inappropriate technique were found among those with a monthly family income of less than three times the national minimum wage.
A previous study has shown that, to ensure appropriate treatment and reduce asthma morbidity, it is necessary that socioeconomically disadvantaged patients receive a more intense educational approach. The level of support provided by family members or caregivers can also contribute to the appropriate performance of the inhaler technique.
Widowhood can contribute to a varying degree of social isolation and loneliness that can negatively impact the treatment of chronic diseases. The physical or mental impairment induced by the presence of other diseases can negatively impact the use of inhalers. Conditions such as tremors, vision impairment, hearing impairment, arthritis, mood disorders, and cognitive disorders can impair learning of the inhaler technique or its appropriate performance.
However, we did not specifically address which diseases were more prevalent in this association. Since the present study found a large proportion of patients with uncontrolled asthma Therefore, since our study was carried out at a public tertiary care center, it is natural that cases that are more difficult to control will be referred there for treatment and that, in contrast, controlled asthma cases will be sent back for treatment at public primary care clinics.
The present study has some limitations to consider. First, it was a cross-sectional study and, therefore, it does not allow the establishment of a temporal sequence between the quality of the patients' performance of the inhaler technique and their level of asthma control. Second, the study was carried out at a single center that provides care within the public health system. Consequently, the study population consisted of individuals who had a low monthly family income and a low educational level, and this may limit the generalization of results.
The clinical implications of this study lie primarily in the demonstration of the fact that two or more inhaler technique errors affect the level of asthma control, with In addition, our findings indicate that target group patients such as widowed patients, patients using metered dose inhalers, patients with a monthly family income of less than three times the national minimum wage, and patients with two or more comorbidities require special attention in terms of inhaler technique education.
Therefore, it is important that educational strategies for asthma patients be developed to improve their performance of the inhaler technique and increase their level of asthma control. O delineamento constituiu-se em um estudo transversal. Para o uso do inalador pressurizado, as seguintes etapas eram avaliadas: O resultado foi expresso em percentagem do previsto para idade, sexo e altura. Em contraste a esses achados, em um estudo brasileiro, Coelho et al. National Center for Biotechnology Information , U.
Journal List J Bras Pneumol v. Received May 8; Accepted Oct This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Introduction Asthma is one of the most common chronic conditions.
Methods This was a cross-sectional study. Open in a separate window. Criteria for assessing the level of asthma control. Results A total of eligible patients were examined. General characteristics of the study patients.
Comparison between groups formed on the basis of inhaler technique assessment. Binary logistic regression for factors related to incorrect inhaler technique.