Evaluation and Impact of Education on the Inhalation Technique in Adults who Use a Metered Dose Inhaler
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Abstract
Introduction: metered dose inhalers (MDI) are fundamental in treating obstructive diseases. However, there is evidence of its incorrect use and therefore limited benefits. This work aims to evaluate the use of MDIs and to know the impact of education on the correct inhalation technique. Method: prospective, before-after study, carried out in hospitalized and outpatients. Demographic data and data on the use of the MDI are recorded. Subsequently, the patient was asked to take 2 inhalations with his MDI and valved-holding chamber, a score was given according to the ESTI score and he was educated orally, visually, and with an explanatory brochure. The patients were reassessed within 1 month of the first evaluation. Results: 119 patients were included, 53.8% male, with a mean age of 60.6 (±16) years. 60.5% always used an aero chamber and 19.3% almost always. 65% had the perception that their inhalation technique was good or very good. 32% did not know how to identify their rescue inhaler. The score on the baseline ESTI scale was 6.8 (± 2.3) points, which improved in the reassessment, 8.7 (± 1.5) points; p<0.0001. The inhalation technique rated as very good or good improved from 24.4% to 63%; p<0.0001. Conclusion: our results show that the inhalation technique with MDI is deficient and active education demonstrates a significant impact on the correct use of these devices.
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References
-. Stein SW, Thiel CG. The history of therapeutic aerosol: A chronological review. J Aerosol Med Pulm Drug Deliv 2017;30(1):20-41. Doi: 10.1089/jamp.2016.1297.
-. Burgos F. Terapia inhalada sin educación, un fracaso anunciado. Arch Bronconeumol 2002:38(7):297-9. Doi: 10.1016/S0300-2896(02)75221-6
-. Fernandez Tena A, Casán Clarà P. Deposition of inhaled particles in the lungs. Arch Bronconeumol 2012:48(7):240-246. Doi: 10.1016/j.arbres.2012.02.003
-. Consenso SEPAR-ALAT sobre terapia inhalada. Arch Bronconeumol. 2013;49(Supl 1):2-14. Doi: 10.1016/S0300-2896(13)70068-1
-. Sanchis j, Corrigan C, Levy MI, Viejo JR. Inhaler devices: from theory to practice. Respid Med 2013;107 (4):495-502.
-. Cho-Reyes S, Celli BR, Dembek C, Yeh K, Navaie M. Inhalation technique errors with metered-dose inhalers among patients with obstructive lung diseases: a systematic review and meta-analysis of U.S. studies. Chronic Obstr Pulm Dis 2019;6(3):267-280. Doi: 10.15326/jcopdf.6.3.2018.0168
-. Forero JC. Terapia broncodilatadora ¿Qué responsabilidad tenemos los médicos y los pacientes en su uso inadecuado? Acta Med Colomb 2015; 40(3): 191.
-. Roggeri A, Micheletto C, Roggeri DP. Inhalation errors due to device switch in patients with chronic obstructive pulmonary disease and asthma: Critical health and economic issues. Int J Chron Obstruct Pulmon Dis 2016; 11: 597–602. Doi: 10.2147/COPD.S103335
-. Fink JB, Rubin BK. Problems with inhaler use: a call for improved clinician and patient education. Respir Care 2005; 50: 1360-1374.
-. Lareau SC, Yawn BP. Improving adherence with inhaler therapy in COPD. Int J Chron Obstruct Pulmon Dis 2010; 5: 401–406. Doi: 10.2147/COPD.S14715
-. Sanchis J, Gich I, Pedersen S. On behalf of the Aerosol Drug Management Improvement Team (ADMIT). Systematic Review of Errors in Inhaler Use. Has Patient Technique Improved Over Time? Chest 2016; 150(2):394-406. Doi: 10.1016/j.chest.2016.03.041.
-. Pessôa CL, Mattos MJ, Alho AR et al. Most frequent errors in inhalation technique of patients with asthma treated at a tertiary care hospital. Einstein (São Paulo) 2019;17(2):eAO4397. Doi: 10.31744/einstein_journal/2019AO4397
-. Rajah R, Yi Woei T, Shien Chee H, Jo Lyn T, Muhamad Shuhaimi MS, Lee Hwang O. Critical Inhaler Administration Errors of Patients on Pressurized Meter Dose Inhaler (pMDI): A Hospital-Based Cross-Sectional Study in Malaysia. Hosp Pharm 2022; 57(2): 217–222. Doi: 10.1177/00185787211010164
-. Cho-Reyes S, Celli BR, Dembek C, Yeh K, Navaie M. Inhalation Technique Errors with Metered-Dose Inhalers Among Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of U.S. Studies. Chronic Obstr Pulm Dis 2019; 24;6(3):267-280. Doi: 10.15326/jcopdf.6.3.2018.0168.
-. Plaza V, Sanchis J, Roura P et al. Physicians’ knowledge of inhaler devices and inhalation techniques remains poor in Spain. J Aerosol Med Pulm Drug Deliv 2012; 25(1):16-22. Doi: 10.1089/jamp.2011.0895.
-. Plaza V, Giner J, Rodrigo GJ, Dolovich MB, Sanchis J. Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. J Allergy Clin Immunol Pract 2018;6(3):987-995. Doi: 10.1016/j.jaip.2017.12.032.
-. Barbara S, Kritikos V, Bosnic-Anticevich S. Inhaler technique: does age matter? A systematic review. Eur Respir Rev 2017;26(146):170055. Doi: 10.1183/16000617.0055-2017.
-. Aydemir Y. Assessment of the factors affecting the failure to use inhaler devices before and after training. Respir Med 2015;109(4):451-8. Doi: 10.1016/j.rmed.2015.02.011.
-. Haro M, Lázaro C, Marín-Barnuevo C, Andicoberry MJ, Martínez MD. Utilidad de la enseñanza de manejo del cartucho presurizado y el sistema turbuhaler en los pacientes hospitalizados. Arch Bronconeumol 2002; 38:306-10. Doi: 10.1016/S0300-2896(02)75223-X
-. Dolovich M, Ahren R, Hess D et al. Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest 2005;127;335-371. Doi: 10.1378/chest.127.1.335.
-. Giner J, Macián V, Hernández C y grupo Eden. Estudio multicéntrico y prospectivo de “educación y enseñanza” del procedimiento de inhalación en pacientes respiratorios (estudio EDEN). Arch Bronconeumol 2002; 38:300-05. Doi: 10.1016/S0300-2896(02)75222-8
-. Melani AS, Bonavia M, Cilenti V et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med 2011; 105:930-8.
-. Viejo-Bañuelos JL, Sanchis J. Nuevos inhaladores o mejora en el manejo de los actuales. La parabola de los ciegos (Brueghel) Arch Bronconeumol 2017;54(5):245-246. Doi: 10.1016/j.arbres.2017.07.003
-. Rodríguez C, González-Barcala FJ, Facal D. Dificultades en terapia inhalada: la complejidad de lo sencillo. Arch Bronconeumol 2020;56(7):416–417. Doi: 10.1016/j.arbres.2019.08.004
-. Nikander K, Nicholls C, Denyer J ,Pritchard J. The evolution of spacers and valved holding chambers. J Aerosol Med Pulm Drug Deliv 2014;27 (1):S4-23. Doi: 10.1089/jamp.2013.1076.
-. Mendoza L, Contreras C, Espinoza A, Jover E, Cavada G. El sistema de bolsa es útil como espaciador para la administración de los aerosoles presurizados. Rev Chil Enf Respir 2005;21:33-38.
- Vincken W, Levy ML, Scullion J et al. Spacer devices for inhaled therapy: why use them, and how? ERJ Open Res 2018; 4: 00065-2018. DOI: 10.1183/23120541.00065-2018
- Ministerio de Salud. Gobierno de Chile. Circular N°3/27 febrero 2013 [Internet]. [Consultado 3 abr 2023]. Disponible en: https://www.ispch.cl > files > circular > 2013/03