Titolo del documento

Novel spacer device does not improve adherence in childhood asthma

Autori e Nazionalità

Burgess SW, Sly PD, Cooper DM, Devadason SG. Australia 

Fonte bibliografica

Pediatr Pulmonol 2007 Jun 22;(Epub ahead of print) 

Lingua

Inglese

Abstract

The Funhaler (FH) is a novel spacer device (holding chamber) that has been designed to improve adherence and aerosol delivery in young asthmatic children using a metered dose inhaler. A pilot study reported a 38% increase in parent-reported adherence over 2 weeks compared with the child's normal spacer. The aim of this study was to investigate whether the FH would be associated with superior adherence in the medium term (3 months) using an objective assessment. Forty-seven children aged 18 months to 7 years were randomised to a FH or control small volume spacer. Participants were reviewed monthly for 3 months. Adherence was measured using an electronic monitoring device (Smartinhaler). Disease control was based on symptom scores and exacerbation rates. Twenty-six children were randomised to the FH and 21 to the control spacer. Three children withdrew (FH = 2). Median adherence each month for the 3 months was 74%, 54%, and 46% for the FH and 70%, 73%, and 54% for the control spacer. The difference in adherence was not statistically significant (P = 0.47, 0.37, and 0.23, respectively). There was also no significant difference in exacerbation rates or symptom scores. Seven of the FHs broke during the study. The FH was preferred by 21/24 parents randomised to the FH compared with their child's normal spacer. Despite the FH being popular with children and parents its use was not associated with improved adherence or disease control

PMID

17588243 [PubMed - as supplied by publisher]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

L'utilizzo del nuovo distanziatore Funhaler non si associa ad una migliore compliance rispetto all'utilizzo di uno spacer di controllo

Titolo del documento

Determinants of patient adherence to an aerosol regimen.

Autori e Nazionalità

Rau JL 

Fonte bibliografica

Respir Care 2005; 50:1346-1356

Lingua

Inglese

Abstract

Patient adherence with prescribed inhaled therapy is related to morbidity and mortality. The terms "compliance" and "adherence" are used in the literature to describe agreement between prescribed medication and patient practice, with "adherence" implying active patient participation. Patient adherence with inhaled medication can be perfect, good, adequate, poor, or nonexistent, although criteria for such levels are not standardized and may vary from one study to another. Generally, nonadherence can be classified into unintentional (not understood) or intentional (understood but not followed). Failing to understand correct use of an inhaler exemplifies unintentional nonadherence, while refusing to take medication for fear of adverse effects constitutes intentional nonadherence. There are various measures of adherence, including biochemical monitoring of subjects, electronic or mechanical device monitors, direct observation of patients, medical/pharmacy records, counting remaining doses, clinician judgment, and patient self-report or diaries. The methods cited are in order of more to less objective, although even electronic monitoring can be prone to patient deception. Adherence is notoriously higher when determined by patient self-report, compared to electronic monitors. A general lack of adherence with inhaled medications has been documented in studies, and adherence declines over time, even with return clinic visits. Lack of correct aerosol-device use is a particular type of nonadherence, and clinician knowledge of correct use has been shown to be imperfect. Other factors related to patient adherence include the complexity of the inhalation regimen (dosing frequency, number of drugs), route of administration (oral vs inhaled), type of inhaled agent (corticosteroid adherence is worse than with short-acting beta2 agonists), patient awareness of monitoring, as well as a variety of patient beliefs and sociocultural and psychological factors. Good communication skills among clinicians and patient education about inhaled medications are central to improving adherence.

 

PMID

16185370 [PubMed - indexed for MEDLINE

Tipo di studio

Esposizione narrativa

Livello di evidenza

4

Commento

Che differenza c'è fra compliance e aderenza alla terapia.  Quali sono i fattori che influenzano l'aderenza della terapia inalatoria 

Titolo del documento

True device compliance: the need to consider both comptence and contrivance.

Autori e Nazionalità

Brennan VK, Osman LM, Graham H, Critchlow A, Everard ML.

Fonte bibliografica

Respir Medicine 2005;99:97-102

Lingua

Inglese

Abstract

Inability to use inhalers effectively is known to adversely affect the delivery of drug. It is assumed that increasing competence to use inhalers will lead to improved drug delivery. However many subjects appear competent (are able to use a device effectively) but contrive to use the device in a sub-optimal way in routine use. This study aimed to explore levels of True device compliance, that is the extent to which devices are used effectively in routine use, and to explore the influences of age and device on this parameter. The ability of 53 asthmatic patients aged 1-88 years to use their corticosteroid inhaler was assessed by a single investigator. In addition information regarding patient behaviour in routine practice was explored in a structured interview. True device compliance was defined to occur when a subject was rated competent and did not report contrivance. Competence was related to device type. All subjects using a holding chamber [pMDI + HC] (N = 21) or breath activated inhaler (N = 5) could demonstrate an adequate technique compared with only 9 (47%) of those prescribed a pMDI. However only 4 (19%) prescribed a pMDI + HC were true device compliant with the majority regularly using the pMDI alone while (42%) of those prescribed a pMDI were True device compliant. Since 82% of patients over 65 were prescribed pMDI alone, and 92% of patients up to 5 years were prescribed pMDI + HC, True device compliance was low among both groups. Only 33% of patients over 65 prescribed pMDIs were able to use them competently. Lack of competence, particularly in the elderly, and contrivance, particularly common amongst those using holding chambers, are two important but independent impediments to effective inhaled therapy.

PMID

15672856 [PubMed - indexed for MEDLINE]

Tipo di studio

osservazionale

Livello di evidenza

3

Commento

Mancanza di competenze e rifiuto sono comuni tra i pazienti che utilizzano i distanziatori

Titolo del documento

Inhalers in asthma management: is demonstration the key to compliance ?

Autori e Nazionalità

Fink JB. USA

Fonte bibliografica

Respir Care 2005;50(5):598-600

Lingua

Inglese

Abstract

Vengono riportati alcuni principi generali per aumentare la compliance all'uso dei device nell'asma

PMID

PMID: 15871751 [PubMed - indexed for MEDLINE]

Tipo di studio

Editoriale

Livello di evidenza

4

Commento

Il medico deve consigliare al paziente di portare con sè il device durante le visite di controllo e controllare con una dimostrazione pratica la sua competenza

Titolo del documento

Inhaler therapy. What it means for children with asthma.

Autori e Nazionalità

Parsons K, Worrall G, Knight J, Hewitt D. Canada

Fonte bibliografica

Can Fam Physician 2004;50:1102-8.

Lingua

Inglese

Abstract

OBJECTIVE: To investigate what inhaler therapy means for children with asthma and to identify problems and concerns children experience with inhalers. DESIGN: Qualitative research design. SETTING: A community-based family practice in rural Newfoundland. PARTICIPANTS: Seventeen children, aged 5 to 16, who had been diagnosed with mild or moderate asthma and were being prescribed inhaled steroids or bronchodilators. METHOD: Two in-depth interviews with each of a purposive sample of participants were analyzed by the selective or highlighting approach. MAIN FINDINGS: Common positive themes were identified: inhalers were easy to use, and medication was necessary for good quality of life. Common negative themes were simply forgetting, inconvenient and annoying, only-as-needed approach, medication does not work well anyway, and side effects. CONCLUSION: Inhaler therapy had both positive and negative meaning for children. Although inhaled medications were seen as very important for good quality of life when taken regularly, most children wanted to use them only as needed for symptom control. Children knew the importance of inhaler therapy but still complied poorly.

PMID

15455809 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

I bambini riconoscono l'importanza della terapia inalatoria, ma hanno una scarsa compliance

Titolo del documento

A new asthma spacer device to improve compliance in children: a pilot study 

Autori e Nazionalità

Chaney G, Clements B, Landau L, Bulsara M, Watt P.  Australia

Fonte bibliografica

Respirology 2004;9:499-506

Lingua

Inglese

Abstract

OBJECTIVE: This pilot study was designed to compare the acceptance, ease of use, and effects on compliance between currently used spacer devices and the Funhaler--a new small volume spacer device designed to improve adherence to asthma medication in children. METHODOLOGY: A matched questionnaire-based survey was conducted by two interviews of each caregiver by the same person. A total of 32 children were randomly recruited from seven clinics spanning widely differing socioeconomic and geographical areas of Perth, Western Australia. Preschool children taking regular inhaled asthma medication using an existing low volume spacer device and aged between 1.5 and 6 years, took part in the pilot study. Parents completed two matched questionnaires. The first questionnaire was completed at the beginning of the study and the second after 2 weeks' use of the Funhaler spacer. Data collected related primarily to ease of use of the devices, child and parental compliance, and treatment attitudes. During the study, parents were also called at random on one occasion to ascertain whether they had attempted to medicate their child the previous day. RESULTS: Using the Funhaler incentive spacer device, parents reported significantly more success at medicating their children (22/30 always successful) in comparison to using their existing spacer device (3/30). Parental adherence to prescribed frequency and the delivery technique of children were also improved. The children also showed improved satisfaction and willingness to use the device and parents' attitude towards medicating their children was improved with the Funhaler spacer device. CONCLUSIONS: Use of a novel, incentive spacer device (Funhaler) appeared to be associated with increased success and fewer problems in medicating children, improved child and parental adherence, and a more positive attitude towards treatment, suggesting that more extensive long-term efficacy trials with the device are warranted.

PMID

15612962 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Un'indagine eseguita tramite un questionario per valutare il gradimento di un nuovo distanziatore (Funhaler) dotato di un meccanismo di incentivazione

Titolo del documento

Funhaler spacer:improving adherence without compromising delivery

Autori e Nazionalità

Watt PM, Clements B, Devadason SG, Chaney GM. Australia 

Fonte bibliografica

Arch Dis Child 2003;88:579-581 

Lingua

Inglese

Abstract

A novel asthma spacer device, the "Funhaler", incorporates incentive toys which are isolated from the main inspiratory circuit by a valve. Here we show that its use does not compromise drug delivery. Improved adherence combined with satisfactory delivery characteristics suggest that the Funhaler may be useful for management of young asthmatics

PMID

12818901 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

L'output aerosolico dopo erogazione di beclometasone e di salbutamolo spray con il nuovo distanziatore Funhaler non è diverso di quello che si ottiene con un distanziatore di controllo. Il Funhaler è associato con un miglior grado di aderenza

Titolo del documento

Spacer compliance after discharge following a mild to moderate asthma attack

Autori e Nazionalità

Cheng NG, Browne GJ, Lam LT, Yeoh R, Oomens M. Australia

Fonte bibliografica

Arch Dis Child 2002;87:302-305

Lingua

Inglese

Abstract

AIM: To assess MDIS usage in patients discharged from a children's hospital emergency department following a mild to moderate asthma attack. METHODS: Prospective observational study of 73 consecutive patients presenting to a children's hospital emergency department with a mild to moderate asthma attack. Demographic data, whether asthma literature/written MDIS instructions were provided, and who provided MDIS instructions (either a discharge coordinator or other emergency department staff) were noted. Parents of patients were telephoned after the first week following discharge and questioned about patient improvement, MDIS use/reasons for not using MDIS, and unscheduled presentations to their local doctor or hospital. RESULTS: Following discharge, 50/73 (68.5%) patients used MDIS exclusively (compliers), while 23/73 used nebulisers some or all of the time (non-compliers). There was no difference in patient improvement or unscheduled presentations between compliers and non-compliers. Most non-compliers 14/23 (60.9%) changed because of parental preference; ease of nocturnal nebuliser use was a possible factor. Compliance was associated with the age of the patient, spacer usage at hospital, the size of device used at hospital, and whether an information fact sheet was given. CONCLUSIONS: Most children discharged from the emergency department following a mild to moderate asthma attack continue MDIS use exclusively in the first week. MDIS compliance may be associated with knowledge, experience, and ease of spacer usage. The study shows that education for parents is crucial for MDIS compliance.

 

PMID

12244002 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

L'educazione per il paziente è cruciale:dimessi dal Pronto Soccorso la maggior parte dei bambini con attacco d'asma lieve-moderato continuano ad utilizzare lo spray con il distanziatore per non più di una settimana

Titolo del documento

Structured discharge procedure for children admitted to hospital with acute asthma: a randomised controlled trial of nursing practice

Autori e Nazionalità

Wesseldine LJ, McCarthy P, Silverman M. Gran Bretagna

Fonte bibliografica

Arch Dis Child 1999;80:110-114

Lingua

Inglese

Abstract

BACKGROUND: Discharge planning is becoming an important part of the management of childhood asthma in hospital. Readmission to hospital, although often inevitable, might represent a failure of the opportunity for intervention presented by a brief period of supervised care in hospital. AIM: To examine the impact of a structured, nurse-led discharge package for children admitted to hospital with acute asthma on readmission to hospital, reattendance at the accident and emergency (A&E) department, and general practitioner consultations for asthma. METHODS: A structured nurse-led discharge package, consisting of a 20 minute patient education programme and self management plan for children with asthma was developed on the wards of a busy children's hospital. A randomised controlled trial was conducted involving 160 children aged 2-16 years admitted for asthma over a 12 month period. Readmission and A&E reattendance's over the six months after discharge from hospital were obtained from the hospital computerised information system and general practitioner consultations from practice records. RESULTS: Children in the intervention group were significantly less likely to be readmitted to hospital in the next six months than those in the control group (12 of 80 v 30 of 80 patients), and significantly less likely to attend the A&E department (6 of 80 v 31 of 80). Significantly fewer children in the intervention group had visits to their general practitioner for problematic asthma (31 of 78 v 72 of 77 for whom data were available). CONCLUSION: By delivering the simplest form of education and support during a child's stay in hospital, readmissions over a six month period were reduced. The programme was designed to be suitable for administration by nursing staff on the children's wards after a brief period of training.

 

PMID

10325723 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

2+

Commento

Un pacchetto educazionale fornito da un'infermiera della durata di 20' riduce la frequenza del ricovero per asma nei successivi 6 mesi.