Background Adherence to inhaler medication is an important contributor to optimum asthma control along with adequate pharmacotherapy. The objective of the present study was to assess self-reported adherence levels and to identify the potential factors associated with non-adherence to the inhalers among asthma patients. Methods This facility-based cross-sectional study was conducted in the medicine outpatient department of Rajshahi Medical College Hospital from November 2020 to January 2021. A total of 357 clinically confirmed adult asthma patients were interviewed. Inhaler adherence was measured using the 10-item Test of Adherence scale (TAI).. Both descriptive and inferential statistics were used to express the socio-demographic of the patients and predictors of poor adherence to inhaler. Results A substantial number of participants were non-adherent (86%) to inhaler medication. Patients non-adherent to inhaler medication are often younger (23.15, 95% CI 3.67–146.08), lived in the rural area (23.28, 95% CI 2.43–222.66), less year of schooling (5.69, 95% CI 1.27–25.44), and belonged to the middle income (aOR 9.74, 95% CI 2.11–44.9) than those adherent with the inhaler. The presence of comorbidities (12.91, 95% CI 1.41–117.61), prolonged duration of inhaler intake (5.69, 95% CI 1.22–26.49), consulting non-qualified practitioners (13.09, 95% CI 3.10–55.26) were the significant contributor of non-adherence. Conclusion Despite ongoing motivation and treatment, non-adherence to inhalation anti-asthmatic is high and several factors have been found to contribute. Regular monitoring and a guided patient-centered self-management approach might be helpful to address them in long run.

Background: Adherence to inhaler medication is an important contributor of optimum asthma control along with adequate pharmacotherapy. The objective of the present study was to assess self-reported adherence level and to identify the potential factors associated with non-adherence to the inhalers among asthma patients.Methods: This facility-based cross-sectional study was conducted in the medicine outpatient department of Rajshahi Medical College Hospital from November 2020 to January 2021. A total of 357 clinically confirmed adult asthma patients were interviewed. Inhaler adherence was measured using the 10-item Test of Adherence scale (TAI). . Both descriptive and inferential statistics was used to express the socio-demographic of the patients and predictors of poor adherence to inhaler. Results: A substantial number of participants were non-adherent (86%) to inhaler medication. Patient non-adherent to inhaler medication are often younger (23.15, 95% CI 3.67-146.08), lived in rural area ( 23.28, 95% CI 2.43-222.66), less year of schooling (5.69, 95% CI 1.27-25.44), and belonged to the middle income (aOR 9.74, 95% CI 2.11-44.9) than those adherent with inhaler. Presence of comorbidities (12.91, 95% CI 1.41-117.61), prolonged duration of inhaler intake (5.69, 95% CI 1.22-26.49), consulting non-qualified practitioners (13.09, 95% CI 3.10-55.26) were the significant contributor of non-adherence.Conclusion: Despite ongoing motivation and treatment, non-adherence to inhalation anti-asthmatic is high and several factors have been found contributed. Regular monitoring and a guided patient centered self-management approach might be helpful to address the in long run.

Inflammation is the pathophysiological process in which there is defensive response occur in the host to the tissue injury and invasion of microorganism. Acute inflammation usually self‐ limiting, when it fails to resolve that leads to chronic inflammation. Lipids are considered as important regulatory factors of inflammation. Various lipid mediators such as leukotriene, prostaglandins and other bioactive lipids are connected in various inflammatory disorders. They are formed mainly by the cells involved in inflammatory processes and engaged in the inflammatory mechanisms. The objective of this article is to summarize the involvement of bioactive lipids in chronic inflammation. Information included in this article taken from past literature reviews. Bioactive lipids are the widest family plays important role in chronic inflammation. They are considered as initiators of inflammation. Prostaglandins and eicosanoids are involved in the process. Prostaglandins are especially PGE2 and PGI2 act as cytokine amplifiers causes transition to chronic inflammation. These occurs by five major mechanisms such as pro inflammatory cytokine release cascade, amplification of innate immune response, activation of T helper cells, recruitment of chronic inflammatory cells and increase of pro inflammatory genes induced by cytokines. There are linkage between prostaglandin related genes and susceptibility to several chronic diseases such as crohn's disease, asthma and multiple sclerosis suggested by several articles. On the other hand, leukotrienes are connected to the pathogenesis of atherosclerosis, inflammatory bowel diseases, psoriasis, rheumatoid arthritis, also in asthma and multiple sclerosis. In case of lysophospholipids and sphingolipids they are asymmetrically distributed in plasma membrane and have great molecular diversity as they have molecular linkage with other molecules such as ethanolamines, choline, inositol, serine and fatty acids such as phosphoinositides, lysoglycerophospholipids and ceramides. Biochemical inter‐conversion can occur in between them and with also others bioactive lipids. Sustained activation of most biologically active lysophospholipids are related with several chronic inflammatory diseases including obesity, diabetes, cancer, atherosclerosis and rheumatoid arthritis. If we consider, sphingolipids they are mostly associated with immune dependent and vascular chronic diseases such as diabetes, chronic obstructive pulmonary disease, inflammatory bowel diseases, neuro‐inflammatory disorders. Such as, in diabetes there is adipose tissue inflammation occur and insulin resistance developed which is caused by excessive signaling of ceramides which is a sphingolipid. Also, ceramide and its metabolites are play role in regulation of vascular integrity and function. If there is any alterations of these lipids vascular dysfunction occur which is associated with chronic inflammation. In chronic inflammation, bioactive lipids and their metabolites and signaling are dysregulated. If the endogenous mechanisms invo...

Background: Inhaler using technique has influences on disease control in patients with bronchial asthma. The objective of this study was to assess the inhaler using technique and factors associated with correct technique among adult asthma patients in northern Bangladesh.Methods: A total 357 asthma patients were recruited from medicine outpatient department of Rajshahi Medical College Hospital (RMCH) from November 2020 to January 2021. All patients were stable and using either metered dose inhaler (MDI) with or without spacer or dry powder inhaler (DPI). Demographic and disease details were collected by direct interviewing of the patients and inhaler using technique were also observed. A preformed checklist was used for marking the activities of the patients. Inhaler using technique was defined as incorrect if there was one or more critical error observed during using the prescribed inhaler. Logistic regression model was used to determine the predictors of incorrect inhaler using technique. Results: Almost 77% of the MDI users, 85% of the MDI with spacer users, and 76% of the DPI users had at least one or more critical error in handling their inhaler devices. Most commonly missed critical steps were breathing in adequately during inhalation (40% in MDI and 39% in DPI users) and holding breath after inhalation (54% in MDI and 77% in DPI users). Patients with lower educational attainment (aOR 4.56, 95% CI 1.13-18.37, p<0.05), middle-income family (aOR 6.44, 95% CI 1.73-24.03, p<0.01), self-reported difficulty of inhaler technique (aOR 3.18, 95% CI 1.58-6.41, p<0.01), seeking care from non-qualified practitioners (aOR 2.86, 95% CI 1.42-5.75, p<0.01) and no demonstration of inhaler technique (aOR 2.07, 95% CI 1.71-3.01, p<0.05) or demonstration from non-qualified practitioners (aOR 2.41, 95% CI 1.79-4.36, p<0.05) had higher chance of incorrect inhaler using technique.Conclusion: Majority of the asthma patients included in our study had one or more critical error in their inhaler using technique especially in patients with lack of inhaler using training. Patient counseling and demonstration of inhaler using technique during prescription might increase the proportion of patients practicing right technique of inhaler.