Problems of elderly patients on inhalation therapy: Difference in problem recognition between patients and medical professionals

Hira, Daiki; Komase, Yuko; Koshiyama, Setsuko; Oguma, Tetsuya; Hiramatsu, Takuya; Shiraki, Akira; Nishikawa, Masanori; Nakanishi, Masayoshi; Tsuji, Takao; Matsumoto, Hisako; Ichimura, Koichi; Iwanaga, Takashi; Misawa, Miwa; Yasuba, Hirotaka; Sugaya, Fumiko; Arakawa, Yukako; Kobayashi, Yoshiki; Kato, Toshiyuki; Futamura, Yutaka; Tsuji, Fumio; Takato, Tsuyoshi

doi:10.1016/j.alit.2016.04.002

Cited by 15 publications

(10 citation statements)

References 16 publications

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“…15 It has been reported that an inhaled medicine has significantly lower adherence than a transdermal patch. 16 Similarly, this study showed that adherence was lower for inhaled agents than for oral agents or transdermal patches. In addition, erroneous operation is often a problem with inhaled medicines.…”

Section: Dovepressmentioning

confidence: 57%

Clinical Management of Asthma by Respiratory Specialists versus General Practitioners: Questionnaire Survey Results Over 6 Years

Hamaguchi

Taooka

Nakao

et al. 2021

IJGM

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and Welfare population dynamics investigation showed a decrease in the number of deaths related to asthma in recent years. In 2016, the mortality rate was 1.2 deaths per 100,000 population. There were regional differences; Shimane Prefecture had a higher mortality rate (1.6 deaths per 100,000 population in 2016) than other prefectures. In this study, to clarify problems in asthma treatment, we evaluated the status of asthma treatment in Shimane Prefecture. Methods: We performed three cross-sectional questionnaire surveys, in October 2006, February 2009, and February 2012. We received responses from 78 clinics and hospitals. Subjects were patients with bronchial asthma over 14 years of age who regularly visited an outpatient clinic. Survey items included smoking status, control status assessed using the Asthma Control Test (ACT), treatment, and medication adherence. Doctors board-certified by the Japanese Respiratory Society were defined as respiratory specialists (RSs) and other doctors were defined as general practitioners (GPs). We compared various factors between the RS and GP groups. Results: Clinical data of 2159 patients were available for analysis. The proportion of patients with ACT score ≥ 20 points increased significantly between 2006 and 2012 in the GP group. The rate of inhaled corticosteroid use increased in the GP group from 63.6% to 76.4%. Conclusion: It was suggested that asthma control and the rate of inhaled corticosteroid use were related. We should continue educating GPs about asthma treatment.

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Section: Dovepressmentioning

confidence: 57%

Clinical Management of Asthma by Respiratory Specialists versus General Practitioners: Questionnaire Survey Results Over 6 Years

Hamaguchi

Taooka

Nakao

et al. 2021

IJGM

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“…Inhalation instruction plays an important role in inhalation therapy for asthma and COPD because therapeutic efficacy of inhalation medicine is influenced by the patient’s inhalation technique [ 3 , 30 – 33 ]. Therefore, it is an urgent issue to develop inhalation instruction tools for a large variety of inhalation devices [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices

Hira¹,

Koide²,

Nakamura³

et al. 2018

PLoS ONE

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The patients’ inhalation flow pattern is one of the significant determinants for clinical performance of inhalation therapy. However, the development of inhalation flow meters for various inhalation devices has been unable to keep up with the increasing number of newly launched inhalation devices. In the present study, we developed simple attachment orifices for the inhalation flow pattern monitoring system, which are suitable for all commercial inhalers, and investigated the efficacy of the system on the clinical inhalation instruction for patients co-prescribed dry powder inhaler (DPI) and soft mist inhaler (SMI). First, we constructed simple attachment orifices that were adjusted for 13 commercial inhalers, and examined the correlation between orifice and inhalation device. Second, the inhalation flow patterns (peak inspiratory flow rate, PIFR; inhalation duration time, DT) of patients prescribed a combination of DPI and SMI were monitored before and after inhalation instruction. The inhalation resistance of commercial inhalers are listed in the following order; Twincaps® > Handihaler® > Swinghaler® = Clickhaler® > Twisthaler® > Turbuhaler® > Jenuair® > Diskus® = Ellipta® > Diskhaler® > Breezhaler® > Respimat® = pMDI. The pressure drop via orifice was significantly correlated with that via the commercial inhaler. For the confirmation, all participants achieved the DPI criterion of PIFR. On the other hand, 4 participants (6 clinical visits) of 10 experimented participants could not achieve the essential criterion of DT (> 1.5 sec) for SMI, but all participants improved their duration time after inhalation instruction by pharmacists (P<0.05). In the present study, we successfully developed simple attachment orifice suitable for 13 commercial inhalation devices. These data suggested that our simple attachment orifices for the inhalation flow pattern monitoring system can detect patients with inadequate inhalation patterns via SMI.

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“…[23,24] We decided to use 70 years as the cutoff age to determine inhalation understanding. [25] The translated (from Japanese) parameters of the guidance sheet included the following: Guidance was provided through multiple outpatient open pharmacies. At each visit, the patient received practical guidance from the pharmacists.…”

Section: Methodsmentioning

confidence: 99%

“…[ 23 , 24 ] We decided to use 70 years as the cutoff age to determine inhalation understanding. [ 25 ]…”

Section: Methodsmentioning

confidence: 99%

Improved inhaler handling after repeated inhalation guidance for elderly patients with bronchial asthma and chronic obstructive pulmonary disease

Usami

2022

Medicine

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Accurate evaluation of inhaler handling is essential for improved treatment of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). Many studies have described the correlation between age, inhalation guidance, and procedure improvement. Elderly patients should receive proper inhalation guidance. This was a retrospective open cohort study conducted at a single hospital with outpatient open pharmacies that provided inhalation guidance to patients of BA and COPD. A total of 525 cases were included in the study. The median age was 71 years with no significant difference between genders (males: 71 ± 16.0 years; females: 72 ± 16.1 years; P = .24). There were 226 males (43.0%) and 299 females (57.0%; P = .03). BA was significantly more prevalent than COPD (P < .001). There was no significant difference in dry powder inhaler (DPI) and pressurized metered-dose inhaler (pMDI) visits in those <60 years of age (P = .23). pMDI was used significantly more often than DPI in those aged 60 to 90 years of age (P < .001). In both <70 and >70 years of age, the most common error with DPI use was improper inhalation speed, which reduced (improved) at the third visit. Gargling errors were most common with DPI use at the second visit and with pMDI at the first visit in both age groups, which subsequently reduced rapidly. Continuous repeated guidance steadily and significantly decreased errors with all devices (P < .001 for DPI, pMDI, and soft mist inhaler). Elderly cases (>70 years of age) should undergo continuous repeated guidance to reduce inhalation errors like inhalation speed and gargling errors.

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Problems of elderly patients on inhalation therapy: Difference in problem recognition between patients and medical professionals

Abstract: Elderly patients are apt to assume that they "understand well", therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent) instructions on inhalation therapy.

Cited by 15 publications

References 16 publications

Clinical Management of Asthma by Respiratory Specialists versus General Practitioners: Questionnaire Survey Results Over 6 Years

Clinical Management of Asthma by Respiratory Specialists versus General Practitioners: Questionnaire Survey Results Over 6 Years

Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices

Improved inhaler handling after repeated inhalation guidance for elderly patients with bronchial asthma and chronic obstructive pulmonary disease

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