Effect of DPI's training-device on inhalation technique and clinical efficacy in asthmatics

Nicola, Mina; Elberry, Ahmed A.; Sayed, Ossama M.; Hussein, Raghda R. S.; Abdelrahim, Mohamed E. A.

doi:10.1016/j.bjbas.2017.10.005

Cited by 19 publications

(17 citation statements)

References 37 publications

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“…Similar to earlier studies, 5,42,43 the results showed that a high number of subjects using MDI did not achieve MDI inhalation technique correct in the visit 1 but they significantly got better in the visit 2 ( P < .001) and improved more in the visit 3 ( P < .001) 14,24,26‐28,32 . Therefore, continuous counselling of the asthmatic subjects significantly correlates with the proper MDI inhalation technique ( P < .001) 24,29,44‐46 . Additional care should be given to this counselling after observing the results of the first group which did not improve at all with 95 subjects dropping out of the study 34 .…”

Section: Discussionsupporting

confidence: 77%

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The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

et al. 2020

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Background Subjects’ improper usage of their metered‐dose inhalers (MDI) is considered a chief cause of poor asthma control. The work presented here aims to evaluate the effect of MDI verbal counselling on subjects’ lung function and inhalation technique. Method A total number of 900 asthmatic subjects (450 female) were gathered from University hospital outpatient clinics from January 2017 to May 2019 with a mean (SD) age 45.2 (17.1) years old. They were divided into two groups. The first was monthly asthma follow‐up, for three visits, (450 (266 females) subjects). The other group was monthly asthma follow‐up, for three visits plus MDI inhalation technique verbal counselling (450 (184 female) subjects). At the beginning of studying group 2 and at every monthly visit (three visits), each subject was asked to show the investigator his MDI inhalation technique and the number of mistakes was noticed and adjusted. Additionally, at each visit, their forced expiratory volume in one second (FEV1) as a percentage of the forced vital capacity (FVC) and peak expiratory flow (PEF) were measured. Results No subject dropped out from group 2; however, 95 subjects dropped out from group 1 with no improvement in the lung function tests. The mean number of accurate steps of the MDI inhalation technique observed in group 2 was improved significantly (P < .001) as the number of visits increased particularly in children. “Start to inhale slowly, through the mouth and at the same time press the canister to actuate a dose and maintain a slow and deep inhalation, through the mouth, until the lungs are full of air (This should take an adult 4‐5 seconds)” was the common repetitive mistake. There was a significant improvement (P < .05) in the lung function test scores after the counselling in group 2, especially in old subjects. Conclusions MDI’s counselling must be continually offered to the asthmatic subject at any possible chance to improve and sustain the optimal MDI inhalation technique and probably improve subjects’ lung function score.

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Section: Discussionsupporting

confidence: 77%

“…Continuous counselling of asthmatics improves their long‐term asthma control and has vital role in the proper managing of various limitations of airflow 16‐18 . It also may increase the pulmonary function tests score, quality of life and asthmatic subjects’ illness 19‐32 …”

Section: Introductionmentioning

confidence: 99%

The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

et al. 2020

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“…Although systemic delivered therapy is available for asthma and chronic obstructive pulmonary disease (COPD), inhaled therapy is the most widely used option [1][2][3]. The reason behind that is the better safety index for the inhaled way [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

et al. 2020

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Add-on devices that are attached to metered-dose inhalers (MDIs) were introduced to improve aerosol delivery. The objective of this study was to determine the efficacy of drug delivery from an MDI when attached to different add-on devices at different inhalation volumes.The total emitted dose (TED) of salbutamol was estimated for the MDI alone and the MDI connected to five different add-on devices (Able valved holding chamber, Tips-haler valved holding chamber, Aerochamber plus flow Vu valved holding chamber, Dolphin chamber, and a handmade water bottle spacer), at inhalation flow of 28.3 L·min−1 with flow volume of 1, 2 and 4 L, assuming young child (aged <6 years), old child (>6 years) and adult inhalation volumes, respectively.The TED% ranged between 84.1% and 87.2% at all inhalation volumes from the MDI alone, which was significantly greater than all MDI add-on device combinations (p<0.05). The TED% delivered to MDI sampling apparatus by a homemade water bottle spacer and Dolphin chamber, as non-antistatic add-on devices, ranged between 30.5% and 35.3%. However, washing these non-antistatic add-on devices with a light detergent before use improved their TED to range between 47.6% and 51.2%. Non-antistatic add-on devices had significantly lower TED (p<0.05) than that delivered by most antistatic add-on devices, which ranged from 51.3% to 71.6%.This study suggests that antistatic add-on devices delivered much more aerosol than non-antistatic add-on devices. However, it may be advised to still use a non-antistatic add-on device, for the sake of solving the coordination problem, and wash it with light detergent before use to improve TED.

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“…they were easy and logical to perform (eg, step 1 is to remove the pMDI protective cap, and step 11 is to replace the cap). 5,8,17,18 Errors in technique that patients exhibited have been investigated extensively and support the role of verbal training in improving overall technique, especially if the counseling is performed frequently. 10,21,22 However, the effect of using the training device and smartphone application in conjunction with verbal counseling, as in our study, on reducing the number of errors committed by the subjects reflect their importance for improving inhalation technique.…”

Section: Discussionmentioning

confidence: 97%

“…15 It is estimated that up to 94% of such patients fail to use their pMDI correctly, compared to 84% of patients who fail to use dry powder inhalers correctly. 5,[16][17][18] Previous research has highlighted the need for training and education to improve aerosol therapy in patients. 3,4 Training subjects to use a pMDI correctly through verbal counseling had a significant effect on asthma control; however, a large percentage of subjects failed to maintain the correct inhalation technique and could forget their training days after counseling.…”

Section: Discussionmentioning

confidence: 99%

Impact of Advanced Patient Counseling Using a Training Device and Smartphone Application on Asthma Control

et al. 2019

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BACKGROUND: Pressurized metered-dose inhalers (pMDIs) are among the most commonly used aerosol delivery devices. Poor lung deposition from a pMDI is often a result of incorrect inhalation technique. The aim of this study was to compare the impact of combining a newly released training device with a smartphone application (advanced counseling) in asthma control to the impact of traditional verbal training. METHODS: A total of 371 subjects with asthma were divided into 2 groups: advanced counseling (n ‫؍‬ 187) and verbal counseling (n ‫؍‬ 184). Both groups had 3 visits, each meeting being a month apart. At each visit, lung function (ie, FEV 1 , ratio of FEV 1 to forced vital capacity [FEV 1 /FVC], and peak expiratory flow) were measured, an asthma control test was given, and subjects were trained in the correct inhalation technique. Inhalation flow through the pMDI was also recorded at each visit because the correct pMDI technique requires an inspiratory flow of < 60 L/min. RESULTS: In the advanced counseling group, lung function significantly improved after both the first and the second visit (P < .001), whereas in the verbal group, lung function improved significantly only after the second visit (P < .001). Although the inspiratory flow through the pMDI improved significantly in both groups, it was closest to the target range in the advanced counseling group. In addition, more subjects in the advanced counseling group had monthly increases of > 3 points in their asthma control test scores compared to the verbal counseling group. CONCLUSIONS: The use of a training device with a smartphone application in conjunction with traditional verbal counseling in pMDI technique resulted in significant improvements in asthma control compared to traditional verbal counseling in pMDI technique alone.

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Effect of DPI's training-device on inhalation technique and clinical efficacy in asthmatics

Cited by 19 publications

References 37 publications

The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

Impact of Advanced Patient Counseling Using a Training Device and Smartphone Application on Asthma Control

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