BackgroundThe burden of asthma and COPD among patients is high and people affected are frequently hospitalized due to exacerbations. There are numerous reasons for the lack of disease control in asthma and COPD patients. It is associated with non-adherence to guidelines on the part of the health care provider and with poor inhalation technique and/or non-adherence to the prescribed treatment plan by the patient. This study aims to present data on inhaler technique and its impact on quality of life (QoL) and symptom control in a typical population of patients with chronic lung disease from a randomized controlled trial on medication adherence.MethodsFor this cross-sectional analysis, 165 asthma and COPD patients were analyzed. Correct application of inhaler devices was tested using pre-defined checklists for each inhaler type. QoL and symptom control were investigated using COPD Assessment Test (CAT) and Asthma Control Test (ACT). Spirometry was used to measure forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).ResultsOverall, incorrect inhalation technique ranged from 0 to 53% depending on the type of inhaler. COPD patients with incorrect device application had a higher CAT sum score compared to those with a correct device application (P = .02). Moreover, COPD patients with incorrect device application were more likely to suffer from cough (P = .03) and were more breathless while walking uphill or a flight of stairs (P = .02). While there was no significance found in asthma patients, COPD patients who used their devices correctly had a significantly better mean FEV1% predicted at baseline compared to those who applied their devices incorrectly (P = .04).ConclusionsCorrect inhalation of prescribed medication is associated with improved health status and lung function. These findings should encourage health professionals to provide instructions on correct inhalation technique and to regularly re-evaluate the patients’ inhalation technique.Trial registrationClinicalTrials.gov: NCT0238672, Registered 14 February 2014.

BackgroundPoor medication-adherence is common in chronic lung patients, resulting in reduced health-outcomes and increased healthcare-costs. This study aimed to investigate the impact of an acoustic reminder and support calls on adherence to inhaled therapy in asthma and COPD patients and to determine their effect on exacerbations.MethodsThis single-blinded randomized controlled trial investigated asthma and COPD patients during 6 months in an ambulatory setting. The intervention consisted of daily alarm clock and support phone calls, whenever use of rescue medication doubled or inhaled medication was not taken as prescribed. Primary outcome was time to next exacerbation. Frequency of exacerbations, adherence to inhaled medication and quality of life scores were secondary outcomes. Cox and Poisson regression were used to determine intervention effect on time to exacerbation and frequency of exacerbations, respectively.ResultsSeventy-five participants were assigned to the intervention group and 74 to usual follow-up care. During a median follow-up of 6.2 months, 22 and 28% in the intervention and control groups respectively, experienced at least one exacerbation. Intervention had no effect on time to first exacerbation (HR 0.65, 95% CI 0.21 to 2.07, P = .24), but showed a trend toward a 39% decreased frequency of exacerbations (RR = 0.61, 95% CI 0.35 to 1.03, P = .070) for the adjusted models, respectively. The intervention group had significantly more days with 80–100% taking adherence regarding puff inhalers (82 ± 14% vs. 60 ± 30%, P < .001) and dry powder capsules (90 ± .10% vs. 80 ± 21%, P = .01). Timing adherence in participants using puff inhalers was higher in the intervention group (69 ± 25% vs. 51 ± 33%, P < .001). No significant differences in QoL were found between the two groups.ConclusionParticipants assigned to the intervention group had significantly better taking and timing adherence of inhaled medication resulting in a trend towards a decreased frequency of exacerbations. However, no effect on time to next exacerbation was observed.Trial registrationClinicalTrials.gov: NCT02386722, Registered 14 February 2014.

While the evidence for impoverished emotional reactions of bilinguals in their weaker second language (L2) accumulates, the underlying mechanisms of this effect remain poorly understood. Here, we investigate how unbalanced bilinguals' language-specific emotions vary depending on differences in language processing automaticity versus in language learning and use contexts. We analyzed behavioral emotional reactions in a hypothetical decision-making task with low emotional appeal, the Asian disease problem (Study 1) and pupil and valence responses to authentic narrative video advertising with high emotional appeal (Study 2). Both studies replicated the L2 emotion disadvantage. In decision-making, L2 reactions paralleled first language reactions under perceptual load. During the L2 narrative, the pupil dilated less because of reduced lexical access automaticity rather than in response to language-context factors. The findings suggest that bilinguals have language-independent emotional representations. Yet, they process emotional information conveyed in L2 less automatically, which triggers weaker emotional reactions. (PsycINFO Database Record

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Background: In Swiss adults, prevalence of asthma and COPD is around 7%. To date, asthma and COPD are not curable but treatable respiratory diseases. The burden of each disease among patients is high and people affected are frequently hospitalised due to exacerbations. This is associated with accelerated lung function decline, increased mortality and reduced health-related quality of life (HRQoL). However, there are numerous reasons for the lack of disease control in asthma and COPD patients. It is repeatedly associated with non-adherence to guidelines regarding treatment recommendation on the part of the health care provider and with poor inhalation technique and/or non-adherence to the prescribed treatment plan by the patient.