期刊
RESPIRATORY MEDICINE
卷 105, 期 6, 页码 930-938出版社
W B SAUNDERS CO LTD
DOI: 10.1016/j.rmed.2011.01.005
关键词
Asthma; COPD; MDI; DPI; Inhaler technique; Patient education
资金
- Chiesi
- Artsana
- AstraZeneca
- GSK
- Menarini
- Novartis
- Pfizer
- Abbott
Proper inhaler technique is crucial for effective management of asthma and COPD. This multi-centre, cross-sectional, observational study investigates the prevalence of inhaler mishandling in a large population of experienced patients referring to chest clinics; to analyze the variables associated with misuse and the relationship between inhaler handling and health-care resources use and disease control. We enrolled 1664 adult subjects (mean age 62 years) affected mostly by COPD (52%) and asthma (42%). Respectively, 843 and 1113 patients were using MDIs and DP's at home; of the latter, the users of Aerolizer (R), Diskus (R), HandiHaler (R) and Turbuhaler (R) were 82, 467, 505 and 361. We have a total of 2288 records of inhaler technique. Critical mistakes were widely distributed among users of all the inhalers, ranging from 12% for MDIs, 35% for Diskus (R) and HandiHaler (R) and 44% for Turbuhaler (R). Independently of the inhaler, we found the strongest association between inhaler misuse and older age (p = 0.008), lower schooling (p = 0.001) and lack of instruction received for inhaler technique by health caregivers (p < 0.001). Inhaler misuse was associated with increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), courses of oral steroids (p < 0.001) and antimicrobials (p < 0.001) and poor disease control evaluated as an ACT score for the asthmatics (p < 0.0001) and the whole population (p < 0.0001). We conclude that inhaler mishandling continues to be common in experienced outpatients referring to chest clinics and associated with increased unscheduled health-care resource use and poor clinical control. Instruction by health caregivers is the only modifiable factor useful for reducing inhaler mishandling (C) 2011 Elsevier Ltd. All rights reserved.
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