Concurrent Use Of Metered Dose Inhalers Without Spacer And Dry Powder Inhalers By Asthmatic Children Adversely Affect Proper Inhalation Technique

摘要

Asthma is a common chronic disease of children. A good control of symptoms will improve quality of patient life. Inhalation technique is an important aspect in the management of asthma. The better the inhalation technique the better the lung deposition of asthma therapy especially inhaled corticosteroids. This will lead to better control of symptoms and improve adherence to treatment. In the following study the inhalation technique of asthma devices were compared using inhalation technique score system. The asthma devices studied were metered dose inhalers (pressurized MDI) without spacers and dry powder inhalers (DPI). The hypothesis studied was that the inhalation technique score of dry powder inhalers will be adversely affected with concurrent use of metered dose inhalers without spacers. Introduction The purpose of the current study was to examine whether asthmatic children using multiple types of inhalers demonstrate poor inhalation technique scores in comparison to those patients using only one type of inhaler. The working hypothesis is that the inhalation technique score for the dry powder inhalers (DPI) when used in combination with the metered dose inhaler (pressurized MDI without spacer) will exhibit lower inhalation technique scores than when DPI are used alone.Pediatric outpatients (n=97) at Farwania Hospital who regularly used pMDI and /or DPI (Turbuhaler or Diskus) asthma inhalers were evaluated. Methods Informed consent was obtained from caregivers of 97 outpatient asthmatic children at the Asthma Clinic in Farwania Hospital. All subjects met the inclusion criteria, i.e. asthmatics on inhaled asthma therapy and able to perform inhalation technique for the medication they were using.The DPI inhalers investigated were Turbuhaler (TH; AstraZeneca) or Diskus (DK; GlaxoWellcome). Subjects used one of these DPI inhalers alone or in combination with pMDI. All pMDI were HFA type. The old CFC inhalers contain chlorofluorocarbons, which harm the ozone layer. Replacements of CFCs have been available since 1996, and are known as HFAs (hydrofluoroalkanes). HFA inhalers provide the same level of safety and efficacy as CFC inhalers, but without harming the ozone layer (the Montreal Protocol on Substances that Deplete the Ozone Layer (15).The technique of pMDI without spacer is different than pMDI with spacer. The actuation inhalation coordination is crucial for pMDI while this is not important if using a spacer. In is a common practice for children older than 6 years to use pMDI without spacer because of portability and cost issues. Assessments were performed in the outpatient clinic. The inhalation technique was evaluated during the clinic visit and scored using a modified inhaler-specific checklist adapted from the Dutch Asthma Foundation technique score. These patients received inhalation technique instruction from the asthma clinic if they were follow-up patients, or alternatively received instruction from outside the asthma clinic if they were new patients to the clinic. All consenting patients who were taking inhaled treatments for asthma were recruited for this study. A well trained investigator, using inhaler-specific checklists adapted from the Dutch Asthma Foundation (12) assessed the patients’ inhalation technique with their prescribed asthma inhalers (tables 1-3). The total score was obtained by multiplication of all the scores then multiplying the total by 100 to get a percent score. Steps of inhalation technique were given certain score according to the importance and degree of accuracy (2-5). The investigator counted the number of correct steps in a child’s technique, with each step assigned certain point. The total points were then divided by the maximum points and further multiplied by 100 to determine a percentage score. This system incorporates the relative importance of each step in the inhalation technique. For each inhaler, items essential to the delivery of active drug into the lungs were identified. The