Titolo del documento

Assessment of inhalation technique in children in general practice: increased risk of incorrect performance with new device

Autori e Nazionalità

ten Have WH, Van De Berg NJ, Bindels PJE, Van Aalderen WMC, Van der Palen J. Olanda

Fonte bibliografica

 Asthma 2008;45:67-71

Lingua

Inglese

Abstract

In a general practice based population 76% of 530 children inhaling asthma medication inhaled correctly. However, important differences among inhalers were found. Children with a pressurized metered-dose inhaler without a spacer device performed worst, with only 22% inhaling without essential errors. At a second evaluation of the inhaler technique, one year after the first assessment, performances with a new device were more often incorrect versus the unchanged devices (21.1% and 10.8%, respectively; p = 0.01). Providing children with a new device should be carefully controlled over time especially because these children are error prone.

 

PMID

PMID: 18259998 [PubMed - in process]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

Ancora uno studio che dimostra come gli spray non devono essere usati senza distanziatore e come sia necessario insegnare accuratamente la corretta tecnica inalatoria

testo

Titolo del documento

Retention by children of device technique for inhaled asthma drugs between visits

Autori e Nazionalità

Munzenberger PJ, Thomas R, Bahrainwala A. USA 

Fonte bibliografica

J Asthma 2007;44(9):269-273 

Lingua

Inglese

Abstract

This study determined retention by children of drug delivery device technique between visits. Patients had asthma requiring the daily use of at least one medication delivery device. Seventy-two patients completed the study; 24 used only the metered dose inhaler (MDI) (group 1), while 48 used the MDI and 1 other device (group 2). Patients or caregivers were initially instructed on and demonstrated the correct use of their medication delivery device(s). At their next visit, they demonstrated their technique for each device. At follow-up, 36% correctly performed all components of the MDI. Group 1 (50%) was higher than group 2 (29%). The percent of correct MDI components for group 1 (84) was also higher than group 2 (78) but not significantly. For both groups and devices, breathing out before inhalation and breath holding was problematic. This study reinforces the need to demonstrate and observe the correct use of inhalation devices at each clinic visit.

 

PMID

PMID: 17994409 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

Questo studio rinforza il messaggio che si deve controllare la tecnica inalatoria dei pazienti durante ogni visita

Titolo del documento

Incorrect application technique of metered dose inhalers by internal medicine residents: impact of exposure to a practical situation

Autori e Nazionalità

Stelmach R, Robles-Ribeiro PG, Ribeiro M, Oliveira JC, Scalabrini A, Cukier A. Brasile 

Fonte bibliografica

J Asthma 2007;44:765-768

Lingua

Inglese

Abstract

We evaluated residents regarding maintenance treatment of asthma and the technique for using metered dose inhalers. Methods. Residents were asked to prescribe a treatment for a patient with poorly controlled persistent asthma and to demonstrate the use of metered dose inhaler (MDI) medication. Results. 76% of 239 residents correctly identified the medication indicated for the case; only 30% of them adequately performed the inhalation technique (49% from HCFMUSP vs. 19% from other institutions; p < 0.001). Conclusions. The results demonstrate that, when seeing a typical patient with uncontrolled persistent asthma, most residents are able to correctly identify the drugs indicated for treatment but not adequately instruct the MDI technique use

PMID

PMID: 17994408 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

Solo il 30% dei medici al loro II anno di training in Medicina Interna possiede un'adeguata tecnica inalatoria con gli spray (nessuno spacer era disponibile), mentre la maggior parte di loro identifica il tipo di farmaco corretto per il paziente asmatico: questo significa che anche se i medici specializzandi hanno buone basi teoriche poi non sanno trasferire nella pratica queste loro conoscenze.

Titolo del documento

Spacer inhalation technique and deposition of extrafine aerosol in asthmatic children

Autori e Nazionalità

Roller CM, Zhang G, Troedson RG, Leach CL, Le Souef PN, Devadason SG. USA

Fonte bibliografica

Eur Respir J 2007;29:299-306

Lingua

Inglese

Abstract

The aim of the present study was to measure airway, oropharyngeal and gastrointestinal deposition of (99m)Tc-labelled hydrofluoroalkane-beclomethasone dipropionate after inhalation via a pressurised metered-dose inhaler and spacer (Aerochamber Plus) in asthmatic children. A group of 24 children (aged 5-17 yrs) with mild asthma inhaled the labelled drug. A total of 12 children took five tidal breaths after each actuation (tidal group). The other 12 children used a slow maximal inhalation followed by a 5 - 10-s breath-hold (breath-hold group). Simultaneous anterior and posterior planar gamma-scintigraphic scans (120-s acquisition) were recorded. For the tidal group, mean+/-sd lung deposition (% ex-actuator, attenuation corrected) was 35.4+/-18.3, 47.5+/-13.0 and 54.9+/-11.2 in patients aged 5-7 (n = 4), 8-10 (n = 4) and 11-17 yrs (n = 4), respectively. Oropharyngeal and gastrointestinal deposition was 24.0+/-10.5, 10.3+/-4.4 and 10.1+/-6.2. With the breath-hold technique, lung deposition was 58.1+/-6.7, 56.6+/-5.2 and 58.4+/-9.2. Oropharyngeal and gastrointestinal deposition was 12.9+/-3.2, 20.1+/-9.5 and 20.8+/-8.8. Inhalation of the extrafine formulation with the breath-hold technique showed significantly improved lung deposition compared with tidal breathing across all ages. Oropharyngeal and gastrointestinal deposition was markedly decreased, regardless of which inhalation technique was applied, compared with a previous paediatric study using the same formulation delivered via a breath-actuated metered-dose inhaler.

 

PMID

17005581 [PubMed - indexed for MEDLINE]

 

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Misurata l’entità della deposizione polmonare e gastro-intestinale del beclometasone dipropionato HFA, che nella confezione spray   utilizza i nuovi propellenti Idrofluoroalcani: 25 bambini di età 5-17 anni con asma lieve, in fase stabile,   sono stati invitati ad assumere lo steroide inalatorio radiomarcato   con la tecnica del respiro corrente o con quella dell’inspirio profondo seguito da una pausa: coloro che utilizzavano la seconda modalità di inalazione presentavano una maggior deposizione polmonare del farmaco (58.1%   a 5-7 anni, 56.6% a 8-10 anni e 58.4 % a 11-7 anni) rispetto quelli che   eseguivano 5 atti respiratori a volume corrente (35,4% a 5-7 anni, 47,5% a 8-10 anni, 54,9% a 11-17 anni), con una differenza particolarmente evidente dunque nei pazienti più piccoli. Inoltre con l’inspirio profondo nei bambini di età 5-7 anni si aveva una minor deposizione oro-faringea e gastro-intestinale e una minor variabilità della dose che arrivava ai polmoni. Gli autori concludono il loro studio con l’invito ad utilizzare preferenzialmente la tecnica dell’inspirio profondo seguita da una pausa   nei bambini di età ≥ 5 anni.

Titolo del documento

Skills amongst parents of children with asthma: a pilot intereventional study in primary care setting.  

Autori e Nazionalità

Aziz NA, Norzila MZ, Hamid NG, Noorlaili MT 

Fonte bibliografica

Med J Malaysia 2006;61:534-9

Lingua

Inglese

Abstract

The increasing prevalence of childhood asthma has become a concern among health practitioners. Effective management emphasizes long-term management and inhaled therapy has become the mainstay home management for children. However, proper utilization of medication is pertinent in improving control. Proper asthma education is mandatory in improving skills and confidence amongst parents. To assess the skills of using the metered-dose inhaler (MDI) with a spacer among asthmatic children before and after educational intervention and to analyse any difficulties which may occur amongst the participants in executing the assessment steps. A cross-sectional clinic based study involving 85 parents and children with asthma. A standardized metered-dose inhaler-spacer checklist of eight steps of medication usage and five steps of cleaning the spacer were used as the assessment tools for pre and post intervention. The performance on using the inhaler-spacer and spacer cleaning knowledge pre and two months post intervention was evaluated. One point was given for each correct step and zero points for incorrect answers/steps. The mean score for skills of inhaler technique improved significantly after educational intervention (3.51 to 6.01, p < 0.0001) as did the mean score for parental knowledge of spacer cleaning technique (1.35 to 3.16, p 0.001). Analysis showed only a limited improvement even after an educational session in three steps of inhalation technique: step 5 (23.5%/69.4%), step 6 (28.2%/68.2%) and step 7 (25.9%/61.2%). Parents with asthmatic children had poor skills in utilizing their children's medication. A short-term educational intervention was able to improve overall knowledge and skill but certain skills need more emphasizing and training.

PMID

17623952 [PubMed - in process]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

Un programma educazionale basato sulla dimostrazione migliora la tecnica inalatoria dei bambini che usano il distanziatore, ma alcuni step vanno particolarmente ricontrollati , perchè sono più difficili da ricordare.

Titolo del documento

Assessment oh inhalation technique and detrminants of incorrect performance among children with asthma

Autori e Nazionalità

Walia M, Paul L, Satyavani A, Lodha R, Kalaivani M, Kabra SK. India

Fonte bibliografica

Pediatr Pulmonol 2006; 11:1082-7.

Lingua

Inglese

Abstract

The objective of our study was to evaluate the pressurized metered dose inhaler (pMDI) with holding chamber technique of asthmatic children attending out patient pediatric chest clinic and determine factors associated with incorrect technique. All patients had previously received instructions regarding inhalation technique. The inhalation technique was assessed on a five-point checklist, four of which were considered essential. Two hundred and thirteen children (mean +/- SD age, 7.3 +/- 3.8 years; 151 boys) completed the study. Children were using their inhaler for a median duration of 6 months (range 1-96 months). One hundred and eighty-eight patients (88.3%) performed all essential steps correctly. The commonest mistake among the essential steps was not shaking the inhaler (n = 21, 9.9%) followed by inability to make a tight seal around the mouthpiece of the holding chamber (n = 12, 5.6%). Correct technique was not affected by gender, asthma severity and socio-economic indices: education level of parents, percapita monthly income, rural or urban background. Our study indicates that a large majority of children from a developing country setting, irrespective of lower education and income levels can be successfully educated to appropriately use inhalation device. Inhalation performance is not affected by socio-economic background of the patients. Comprehensive inhalation instructions and monitoring at each visit are however critical to ensure reliable and consistent performance of correct technique among asthmatic children.

PMID

16989001 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

In India la maggior parte dei bambini che sono stati educati nella tecnica dello spray con il distanziatore esegue correttamente l'inalazione. Gli errori più comuni: dimenticarsi di scuotere lo spray, non buona adesione del boccaglio in bocca

Titolo del documento

Concurrent use of metered-dose and dry powder inhalers by children with persistent asthma does not adversely affect spacer/inhaler technique

Autori e Nazionalità

Chan DS, Callahan CW, hatch-Pigott VB, Lawless A, Proffitt Hl, Manning NE, Schweikert  MP

Fonte bibliografica

Ann Pharmacother 2006;40:1743-6

Lingua

Inglese

Abstract

BACKGROUND: Studies conducted in adults have suggested that patients who use a metered-dose inhaler/holding chamber spacer (MDI/S) and dry powder inhaler (DPI) concurrently will have poorer MDI/S technique than that of patients who use MDI/S exclusively. To our knowledge, as of August 31, 2006, no studies have been performed in pediatric patients. OBJECTIVE: To compare MDI/S technique scores of children using only MDI/S with scores of those using both MDI/S and DPIs. METHODS: The MDI/S technique of children aged 6-17 years, with persistent asthma, recruited from a general pediatric practice population for an asthma intervention study project was scored using a standardized checklist. MDI/S scores of children who were being treated with maintenance and rescue medication delivered only by MDI/S were compared with those treated with both MDI/S (rescue) and DPI (maintenance). Scores lower than 70% were considered to be inadequate. RESULTS: A total of 117 patients (73 male, 44 female), aged 9.70 +/- 3.1 years (mean +/- SD), with persistent asthma, participated in the study. There were 83 children (54 male, 29 female, age 9.4 +/- 3.2 y) in the MDI/S only group and 34 (19 male, 15 female, age 10.3 +/- 2.9 y) in the MDI/S + DPI group. In the MDI/S + DPI group, Diskus was the DPI used for 32 patients, and Turbuhaler was used by 2 children. Sixteen patients had severe persistent asthma, 80 had moderate persistent asthma, and 21 had mild persistent asthma as classified by National Heart Lung and Blood Institute guidelines. No difference in sex and age demographics existed; however, there was a difference in the distribution of asthma severity between groups (ie, no patients with mild persistent asthma in the MDI/S + DPI group; p < or = 0.01). Mean score for the MDI/S only group was 86 +/- 17% and, for the MDI/S + DPI group, 90.1 +/- 12% (p = 0.15). More patients in the MDI/S group had inadequate scores (18%) compared with those in the MDI/S + DPI group (3%; p < 0.05). CONCLUSIONS: While DPI and MDI/S techniques are markedly different in several significant ways, concurrent use of these inhalers did not adversely affect MDI/S technique scores of pediatric patients with persistent asthma, compared with those using MDI/S alone. Patients in the MDI/S only group had an inadequate MDI/S score (<70%) more often than did patients in the MDI/S + DPI group.

PMID

16968822 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

testo

Respir Med 2006;100:1479-1494

Inglese

Although the principles of asthma management are well established in Europe, the available data indicate that asthma in patients is not well controlled. Many patients derive incomplete benefit from their inhaled medication because they do not use inhaler devices correctly and this may compromise asthma control. The Aerosol Drug Management Improvement Team (ADMIT), incorporating clinicians from the UK, Germany, France, Italy, Spain and The Netherlands, reviewed published evidence to examine ways to improve the treatment of reversible airways disease in Europe. Data indicate that there is a clear need for specific training of patients in correct inhalation technique for the various devices currently available, and this should be repeated frequently to maintain correct inhalation technique. Devices which provide reassurance to patients and their physicians that inhalation is performed correctly should help to improve patient compliance and asthma control. Educational efforts should also focus on primary prescribers of inhaler devices. ADMIT recommends dissemination of information on the correct inhalation technique for each model of device by the use of an accessible dedicated literature base or website which would enable to match the appropriate inhaler to the individual patient. There is also a need for standardisation of prescribing practices throughout Europe. Regular checking of inhalation technique by prescribers is crucial as correct inhalation is one of the keystones of successful asthma management.

16495040 [PubMed - indexed for MEDLINE]

Revisione narrativa

4

Titolo del documento

Key issues in inhalation technique in children. Curr Med Res Opinion 2005; Suppl 4:S27-S32

Autori e Nazionalità

Brand PL. Olanda

Fonte bibliografica

Curr Med Res Opinion 2005; Suppl 4 :S27-S32

Lingua

Inglese

Abstract

In order to achieve asthma control it is essential that children receive the appropriate education and training pertaining to the management of their disease, are prescribed the correct medication according to severity, and most importantly, are prescribed the correct inhaler to ensure medication is deposited in their lungs. There are three major misconceptions which physicians and patients have regarding the use of inhalers in children. Firstly, that the nebulizer is more effective than a pressurised metered dose inhaler (pMDI) plus spacer in treating acute asthma in children. Secondly that using an inhaler correctly is easy, and lastly that correct use of the inhaler, once taught, persists over time. However, recent studies have shown that these conceptions are false. Firstly, comparable efficacy is achieved by treatment with inhaled corticosteroids or bronchodilators delivered through a nebulizer and a pMDI plus spacer, both when used to treat acute asthma and for maintenance therapy. Secondly, contrary to general opinion, using an inhaler correctly is difficult for children. Many children with asthma use their inhaler devices incorrectly, even after instruction for correct use of the inhaler. Thirdly, correct inhalation technique deteriorates over time; and inhalation instructions, therefore, should be given repeatedly to achieve and maintain correct inhalation technique in asthmatic children. The profile of the ideal inhaler comprises good drug deposition in the lower airways, deliverance of a consistent dose, being easy to teach and to use correctly, and being small in size and convenient to handle. It should also be multidose, require a low inspiratory airflow for activation, provide feedback to patients on correct use of the inhaler, be re-usable, have an appealing design and feel, and have a reliable dose counter which may help to monitor the patient's compliance. The Novolizer device, a new multidose dry powder inhaler (DPI), shows many of these characteristics making it potentially very suitable for children with asthma.

PMID

16138942 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione narrativa

Livello di evidenza

4

Commento

Quali sono le chiavi per una corretta tecnica inalatoria ?

Titolo del documento

An evaluation of children's metered-dose inhaler technique for asthma medications.

Autori e Nazionalità

Burkhart PV, Rayens MK, Bowman RK. Usa

Fonte bibliografica

Nurse Clin North Am 2005;40:167-182. 

Lingua

Inglese

Abstract

Regardless of the medication delivery system, health care providers need to teach accurate medication administration techniques to their patients, educate them about the particular nuances of the prescribed delivery system (eg, proper storage), and reinforce these issues at each health encounter. A single instruction session is not sufficient to maintain appropriate inhaler techniques for patients who require continued use. Providing written steps for the administration technique is helpful so that the patient can refer to them later when using the medication. The National Heart, Lung, and Blood Institute's "Practical Guide for the Diagnosis and Management of Asthma" recommends that practitioners follow these steps for effective inhaler technique training when first prescribing an inhaler: 1. Teach patients the steps and give written instruction handouts. 2. Demonstrate how to use the inhaler step-by-step. 3. Ask patients to demonstrate how to use the inhaler. Let the patient refer to the handout on the first training. Then use the handout asa checklist to assess the patient's future technique. 4. Provide feedback to patients about what they did right and what they need to improve. Have patients demonstrate their technique again, if necessary.The last two steps should be performed (ie, demonstration and providing feedback on what patients did right and what they need to improve) at every subsequent visit. If the patient makes multiple errors, it is advisable to focus on improving one or two key steps at a time. With improvements in drug delivery come challenges, necessitating that practitioners stay current with new medication administration techniques. Teaching and reinforcing accurate technique at each health care encounter are critical to help ensure medication efficacy for patients with asthma. Since one fifth of children in the study performed incorrect medication technique even after education, checklists of steps for the correct use of inhalation devices, such as those provided in this article, should be given to patients for home use and for use by clinicians to evaluate patient technique at each health encounter.

PMID

15733954 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

In quale modo insegnare ai pazienti la tecnica d'uso corretta dei distanziatori ?  Per la risposta vedi la sezione FAQ

Titolo del documento

Demonstrated use of metered-dose inhalers and peak flow meters by children and adolescents with acute asthma exacerbations

Autori e Nazionalità

Scarfone RJ, Capraro GA, Zorc JJ, Zhao H. USA

Fonte bibliografica

Arch Pediatr Adolesc Med 2002;156:378-383

Lingua

Inglese

Abstract

OBJECTIVES: To determine the ability of children and adolescents with acute asthma exacerbations to adhere to national guidelines for proper metered-dose inhaler (MDI) and peak flow meter (PFM) technique and to define characteristics associated with improper use. DESIGN: A prospective study in which the patients were instructed to use a placebo MDI or a PFM in the emergency department exactly as at home. Technique was graded on the basis of performance of specific steps recommended by national guidelines. SETTING AND PARTICIPANTS: Children and adolescents (aged 2-18 years) with acute asthma exacerbations in the emergency department of an urban children's hospital with acute asthma. RESULTS: Thirty-three (45.2%) of 73 patients using an MDI (MDI group) demonstrated multiple steps improperly compared with 60 (44.4%) of 135 using an MDI with a holding chamber (MDI-HC group; P =.92). In the MDI group, young ages of the patients (P<.008) and the parents (P<.003) were associated with improper use. In the MDI-HC group, factors independently and significantly associated with improper use were no hospitalizations within the past year, parent assistance of the patient with MDI-HC use, and nondaily use of the MDI-HC. Also, 165 (82.9%) of 199 children who, per national guidelines, should be using a PFM at home, did not. Eighty-two (73.9%) of 111 patients demonstrated perfect performance of all PFM steps. CONCLUSIONS: Among children with acute asthma, we found high rates of improper MDI use and PFM underuse. A greater emphasis must be placed on teaching methods to optimize drug delivery and to instruct patients about the importance of self-monitoring of disease severity.

PMID

PMID: 11929373 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

Tra i bambini che arrivano al PS per asma acuto (e che usano abitualmente lo spacer) è elevata la percentuale di coloro che utilizzano in modo improprio lo spray con il distanziatore: solo il 24% non compie alcun errore... 

Titolo del documento

Drug delivery

Autori e Nazionalità

Le Souef. Australia 

Fonte bibliografica

Med J Aus 2002;177 Suppl:S69-S71 

Lingua

Inglese

Abstract

What we know: In preschool children, small-volume spacers perform better than large-volume spacers. Detergent is the best antistatic agent for spacers, increasing lung delivery two- to threefold, but it must not be rinsed off. A mouthpiece should be used in children aged 2-3 years or older, as lung delivery is two- to threefold higher for oral inhalation than nasal inhalation (ie, by mask). Inhaled drug doses do not generally need to be reduced in infants and young children owing to inefficiencies of delivery in younger patients. Nebulisers are "dinosaurs" and not needed for most children with asthma. What we need to know: What is the best inhalation technique for spacers? How long should children breathe, how many breaths should they take, and at what age should they breath-hold? How should children, parents and doctors be instructed to achieve optimal levels of electrostatic charge reduction for spacers? How much should inhaled steroid dose be reduced when a spacer is used optimally? What dosing instructions should be given for beta(2)-agonists delivered by spacer?

PMID

12225266 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione narrativa

Livello di evidenza

4

Commento

Risposte a domande di importanza pratica sull'uso dei distanziatori

testo

Titolo del documento

An exploration of the skilss needed for inhalation therapy in schoolchildren wit asthma in Taiwan 

Autori e Nazionalità

Chen SH, Yin TJ, Huang JL. Taiwan

Fonte bibliografica 

Ann Allergy Asthma Immunol 2002;89(3):311-315

Lingua

Inglese

Abstract

BACKGROUND: Clinical observation has shown that many asthma-affected children and their parents are not familiar with appropriate techniques for inhaler use. This may result in misuse, overdose, or diminished response of the administered therapeutic drugs, or may even result in unnecessary, repeated hospitalization. Inappropriate inhalation technique is hazardous to the safety of children with asthma and unnecessarily increases costs resulting from unnecessary rehospitalization. OBJECTIVE: We designed a study to evaluate the skills needed for inhaler use among children with asthma in Taiwan. SUBJECTS AND METHODS: Schoolchildren with asthma, aged 8 to 13 years, were asked to demonstrate their inhalation technique. The inhalers used in this study were either metered-dose inhalers or dry-power inhalers. Assessment of the inhalation technique was made using a standardized inhaler checklist. A higher score indicates greater skill using the inhaler. RESULTS: This study surveyed 132 schoolchildren with asthma. Of those, only 23 (17.4%) asthmatic children who received inhalation therapy revealed good compliance with their medication regimens. No child was observed to have completed all inhaler techniques correctly. Those family members who participated in educational programs and who received instruction from health teams had higher scores for the inhaler checklist (P < 0.05). It was found that children who inhaled medication unaided had a better knowledge of asthma, and their drug inhalation technique was also more skillful (P < 0.03). By multiple regression analysis, we found that determinants of a child's skill at performing the inhalation maneuver included: number of asthma attacks within the preceding year, unaided application of inhaler therapy, older subject age, potential for subjects to receive instructions from parents regarding inhaler use, subjects reading related publications, and the family's degree of satisfaction with the physician's educational program. These variables contributed a total of 23% to variance in the subjects' inhalation technique. CONCLUSION: This study revealed that most asthmatic children being treated with inhaler medication do not use such devices appropriately. More aggressive asthma education is necessary in Taiwan.

PMID

12269653 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

La maggior parte dei bambini trattati con terapia inalatoria non dimostra una tecnica appropriata. A Taiwan sono pertanto necessari programmi educazionali più aggressivi

Titolo del documento

Determinants  of correct inhalation technique in children attending an hospital-based asthma clinic.

Autori e Nazionalità

Kamps Aw, Brand PL, Roorda RJ. Olanda 

Fonte bibliografica

Acta Paediatr 2002;1:159-62.

Lingua

Inglese

Abstract

Many children with asthma use their inhaler device incorrectly even after comprehensive inhalation instruction. The aim of this study was to identify factors associated with correct inhalation technique. Two hundred children with asthma demonstrated their inhalation technique. Patient characteristics and the components of inhalation instructions they had received were compared for children demonstrating a correct or incorrect inhalation technique. In addition, the inhalation technique of 47 newly referred patients was followed-up prospectively after repeated comprehensive instruction sessions. Seventy-eight percent of all patients demonstrated a correct inhalation technique. Patients who had received repeated instruction sessions and patients who had previously been asked to demonstrate the use of their inhaler during an instruction session were more likely than other children to demonstrate a correct inhalation technique (p < 0.001 and p = 0.03, respectively). Multiple logistic regression analysis showed that repetition of instructions was significantly associated with a correct inhalation technique (odds ratio (OR) 8.2, 95% CI 3.2-21.5; p < 0.0001) irrespective of type of inhaler used. Demonstration of the inhaler use by the patient was significantly associated with a correct inhalation technique for patients using a metered dose inhaler plus spacer device (OR 3.5, 95% CI 1.0-12.6; p = 0.05). but not for patients using a dry powder inhaler (OR 1.6, 95% CI 0.4-6.4; p = 0.54). The number of newly referred patients demonstrating a correct inhalation technique improved from 57.4% to 97.9% after three comprehensive instruction sessions. CONCLUSION: Inhalation instruction should be given repeatedly to achieve and maintain correct inhalation technique in asthmatic children.

PMID

11952002 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

Quei bambini che  sono stati controllati con ripetute sessioni educazionali sull'uso corretto dei distanziatori sono quelli che compiono poi meno errori

Titolo del documento

Inhalation treatment: errors in application and difficulties in acceptance of the devices are frequent in wheezy infants and young children

Autori e Nazionalità

Marguet C, Couderc L, Le Roux P, Jeannot E, Lefay V, Mallet E. Francia

Fonte bibliografica

Pediatr Allergy Immunol 2001;12;224-230

Lingua

Inglese

Abstract

The recent availability of small-volume spacers has facilitated the general use of inhaled treatment in infants. The purpose of this study was to evaluate any errors made by parents when using this new inhalation technique and the child's behavior during the inhalation. Ninety-four young children (61% boys) under 5 years of age were enrolled in the study. Inhalation treatment was recommended either by a general practitioner or by a pediatrician. Data concerning treatment regimens, the ability of parents to use the spacer and metered-dose inhalers (MDIs), and the acceptance of the devices, were collected by means of a demonstration and questionnaire. Unexpectedly, the doses, administration times, and duration of the treatments varied from one child to the next. No explanation or training in administering the treatment via the spacers was given to 12% and 47% of the parents, respectively. Fourteen per cent of parents did not shake the MDIs, 12% did not monitor the valves, and 22% allowed too short a time for inhalation. The lack of explanation increased the occurrence of errors in manipulation of the devices. The procedure was judged to be easy to follow by 78% of the parents, but the face mask was accepted with difficulty by 22% of the children. Repeated crying during administration of the treatment was observed in 38% of the patients, particularly the youngest. Crying influenced the acceptance of the face mask, reduced parental compliance, and made the use of the devices more difficult. Errors altering the efficiency of inhalation treatment in infants are frequent. Most of these errors could be avoided by spending more time to inform the parents about correct usage. Furthermore, repeated crying during inhalation is common in young children and this problem should to be taken into consideration in the evaluation of treatment.

PMID

11555320 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Nei bambini piccoli, al di sotto dei 5 anni di età, che utilizzano il distanziatore gli errori di tecnica inalatoria sono comuni. Più di 1/3 piange durante la procedura

Inglese

The aim of this study was to evaluate the effect of instructions to children with asthma (given by general practitioners or by pharmacy assistants) on how to inhale from metered dose inhalers with spacers (MDI/s) or dry powder inhalers (DPI). We scored inhalation technique of asthmatic children according to criteria defined by the Netherlands Asthma Foundation, and related the performance to the inhalation instructions given. For each inhaler, a number of steps were considered essential for reliable drug delivery. Patients newly referred for asthma were asked to demonstrate their inhalation technique and to fill out a questionnaire on the inhalation instruction received prior to referral. Children participating in a clinical trial, who had received repeated comprehensive inhalation instructions, served as a control group. Sixty-six newly referred patients (1-14 years of age, median age 5 years; 37 boys) and 29 control patients (5-10 years of age, median age 7 years; 21 boys) completed the study. Sixty patients (91%) had received inhalation instruction prior to referral. Only 29% of these patients, using a dry powder inhaler, performed all essential steps correctly, compared to 67% of children using a metered dose inhaler/spacer combination (P < 0.01). Children who had received comprehensive inhalation instructions with repeated checks of proper inhalation technique at the pharmacy or in the clinical trial setting were more likely to perform all essential steps correctly (79% and 93%, respectively) than children who had received a single instruction by a general practitioner (39%, P < 0.01). Many asthmatic children use their inhalers devices too poorly to result in reliable drug delivery, even after inhalation instruction. Comprehensive inhalation instruction and repeated check-ups are needed to assure reliable inhalation technique.

 10613785 [PubMed - indexed for MEDLINE]

Osservazionale

3

Molti bambini asmatici continuano a presentare errori nella tecnica inalatoria, nonostante abbiano ricevuto le istruzioni

Randomizzato, singolo cieco

2+

Titolo del documento

What do pedaitricians in training know about the correct use of inhalers and spacer devices ?

Autori e Nazionalità

Amirav I, Goren A, Pawlowski NA. Israele

Fonte bibliografica

J Allergy Clin Immunol 1994;94:669-675

Lingua

Inglese

Abstract

Most patients with asthma in the United States are cared for by nonspecialist physicians. Because inhaled medications are the mainstay of asthma therapy and their successful use requires both practical skills and theoretic knowledge, we wondered how much nonspecialist physicians know about the use of metered-dose inhalers and spacer devices. Fifty pediatricians in training were interviewed individually. Practical knowledge was assessed by asking each to demonstrate correct use of a placebo inhaler and a spacer device (Inspirease [Key Pharmaceuticals, Inc., Miami, Fla.] and Aerochamber with mask [Monaghan Medical Corp., Plattsburgh, N.Y.]). Of the seven recommended steps for use of metered-dose inhalers, the residents demonstrated an average of 3.8 steps correctly. The most common errors included not shaking the metered-dose inhaler before use (18% of residents correct) and insufficient breath holding (28% correct). In testing spacer use, the most common errors included not shaking the canister (16% correct) and incorrect number of activations and inhalations (12% correct). Many residents were not familiar with correct assembly of the spacer (48% correct). Theoretic knowledge of metered-dose inhaler and spacer use was evaluated by a written questionnaire. The most common deficiencies in theoretic knowledge related to the purpose of slow inspiration and breath holding. Most of the participants had been treating children with asthma and had prescribed metered-dose inhalers (45 of 50, 90%) and spacer devices (76%) in the past

PMID

7930299 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Anche gli specializzandi di pediatria non conoscono bene la tecnica dei distanziatori.....

Titolo del documento

Single breathversus panting technique in salbutamol delivery through a 750 ml spacing device

Autori e Nazionalità

James RW, Masters IB. Australia

Fonte bibliografica

Pediatr Pulmonol 1990;8(4):263-7

Lingua

Inglese

Abstract

Spacing devices have been widely advocated for asthmatic patients having difficulty actuating metered aerosols and co-ordinating inspiration. Studies have generally supported the slow inspiration/breath hold technique. This requires conscious respiratory control. Such control is often not possible in young children; consequently panting techniques are widely recommended. The panting technique has not been studied. The aim of this study was to compare the bronchodilator effectiveness of panting and the single breath maneuver, each followed by a breath hold, and each at functional residual capacity (FRC), using a Volumatic Space. The study design was a randomly allocated cross-over assessment of bronchodilator response for each technique. The drug dosage was controlled by limiting the inspired volumes of gas (single and cumulative) to the pretested inspiratory capacity. Two hundred micrograms of salbutamol was delivered into the spacer. Twenty-one patients were entered in the study and 15 (mean age +/- SD = 10.9 +/- 3.3 years) completed the protocol. There was no significant difference in bronchodilator response between the two groups. We conclude that the panting and the single breath techniques are equally effective in children of this age group.

PMID

2196513 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato, cross over

Livello di evidenza

2+

Commento

Utilzzando il Volumatic non c'è differenza nella risposta broncodilatatrice al salbutamolo utilizzando la tecnica del respiro singolo con inspirio profondo o quella di più atti respiratori tranquilli

Titolo del documento

Nebuhaler technique

Autori e Nazionalità

Gleeson JG, Price JF.Gran Bretagna

Fonte bibliografica

Br J Dis Chest 1988;82(2):172-4

Lingua

Inglese

Abstract

Two Nebuhaler techniques were compared by measuring the response to terbutaline 0.25 mg in 13 asthmatic children. Five breaths each sufficient to operate the Nebuhaler valve resulted in greater bronchodilatation after 10 minutes (P less than 0.05) than two deep inspirations from residual volume each held for 5 seconds. The peak responses were similar and both methods produced significant bronchodilatation compared with placebo. Either method is satisfactory in children but the former is easier to perform.

PMID

3166930 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Scarso numero di partecipanti

Titolo del documento

Errors in inhalation technique and efficiency in inhaler use in asthmatic children 

Autori e Nazionalità

Pedersen S, Frost L, Arnfred T. Danimarca 

Fonte bibliografica

Allergy 1986;41:118-124

Lingua

Inglese

Abstract

256 asthmatic children receiving regular inhalation therapy demonstrated how they used their inhalers. Pulmonary function measurements (PFM) were made before and after the demonstrations, and errors in technique were recorded. 242 children had reversible airway obstruction on the day of study. In only 109 (45%) did the inhalation result in an increase in FEV1 greater than or equal to 15% (efficient technique). An efficient inhalation technique was found in 46% of children who demonstrated a pressurized aerosol, 59% who demonstrated a tube spacer aerosol and 46% who demonstrated a rotahaler, and the frequency of efficient technique varied from 17% to 84% between six different groups of instructors. 87% of children controlled and 25% not controlled with PFM at the time of prescription had an efficient technique. Children under 6 years had a more inefficient and a more faulty technique than older children, but otherwise age did not influence the result. Neither was time since instruction of any importance for efficiency or number of errors. The errors recorded that seem to influence efficiency most were: coordination problems, rapid inspirations, ceasing to inspire when the aerosol was fired, and inhalation through the nose. The results emphasize the paramount importance of clear instructions and control of inhalation technique at the time the treatment is prescribed

PMID

3706674 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

Molti errori vengono compiuti dai pazienti che usano la tecnica dello spray con il distanziatore: i più comuni sono quelli di non ricordarsi di scuotere lo spray e di non eseguire la pausa respiratoria