What determines whether an elderly patient can use a metered dose inhaler correctly?

Allen, Stephen; Prior, Alison

doi:10.1016/0007-0971(86)90008-2

Cited by 125 publications

(64 citation statements)

References 7 publications

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“…VAN DER PALEN et al [30] identified that failure to exhale prior to inhalation was the most frequently presented error in patients aged 18-65 years, implying that knowledge deficits as opposed to physical functioning may be of greater influence. This contrasted with errors identified in older adults [31][32][33][34], in which tasks dependent more on physical abilities, such as failure to breath-hold and lack of inhalation/actuation coordination [31,33] occurred more frequently. However, due to the lack of heterogeneity between studies with regard to recruitment, methodology and analysis, further study involving direct comparison within a controlled environment is required to assess result reproducibility.…”

Section: Results Validitymentioning

confidence: 58%

“…There is substantial evidence of significant inverse proportionalities between cognitive status and the ability to successfully learn technique [8,42,43]. ALLEN and PRIOR [31] identified that only individuals with full cognitive function could be trained successfully in accurate technique. Explicit abbreviated mental test score (AMT), mini-mental test score and EXIT25 score threshold levels have also been identified at which patients can be trained in the use of certain devices [8,35,[42][43][44], providing support for such an association.…”

Section: Results Validitymentioning

confidence: 99%

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Inhaler technique: does age matter? A systematic review

2017

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Poor inhaler technique and inferior asthma outcomes are evident in older adults. Reviews comparing metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques across older adults and younger cohorts are scarce. This systematic review aimed to determine whether differences exist between such cohorts with regards to the number and type of MDI and DPI errors made. A systematic literature search was conducted in Embase, Medline and PubMed from July 1 to December 31, 2016. Studies were selected in accordance with preset inclusion criteria, relevant data were extracted, and quality was assessed with validated checklists. 14 studies were identified. Evidence suggests a negative correlation between advancing age and correct technique across MDI and varying DPI devices when examined collectively. Differences appear to exist between older adult and younger cohorts prescribed MDIs in error types. There is evidence of age-associated differences in the number and type of inhaler technique errors. Further research is required to assess outcomes in individual DPIs, reproducibility and the effects of confounders.

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Section: Results Validitymentioning

confidence: 58%

Section: Results Validitymentioning

confidence: 99%

Inhaler technique: does age matter? A systematic review

2017

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“…In a UK based study of people over the age of 70 years living at home, 15.8% of subjects were using an inhaler, of whom 42.8% were using a metered-dose inhaler (MDI) [16]. Despite their wide prescription many patients cannot use pMDIs correctly, even with education and training [13,18,19]. Lenney et al demonstrated that only 79% of patients could use a pMDI correctly after expert training [15].…”

Section: Pressurized Metered-dose Inhalersmentioning

confidence: 99%

Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma

Capstick

Clifton²

2012

Expert Review of Respiratory Medicine

119

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“…It is now well established that lung deposition and clinical response to pharmaceutical aerosols packaged in MOls is greatly influenced by the technique used to inhale the aerosol (4)(5)(6)(7)(8)(9)(10)(11). Although it is a common belief that many patients do not use their MOts properly (3,(12)(13)(14)(15)(16)(17), there are no objective data directly comparing different groups of patients to determine whether there are specific characteristics, such as age, gender or diagnosis, associated with the risk of incorrect MOl technique. The absence of objective comparisons of MOl technique among different groups of patients represents a potentially important gap in the understanding of asthma morbidity.…”

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confidence: 99%

The influence of age, diagnosis, and gender on proper use of metered-dose inhalers.

Goodman¹,

Israel²,

Rosenberg³

et al. 1994

Am J Respir Crit Care Med

195

111

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Metered dose inhalers (MOls) are widely used in clinical practice for administering pharmaceuticals targeted to the lung. It is well known that the inhalation technique used with MOls can substantially influence the clinical response to inhaled medications. Todetermine the acceptability of MOl maneuvers, we studied 59 subjects (26 females and 33 males; age, 20 to 81 yr; mean age, 38 yr) to determine whether the MOl technique used by these individuals complied with published recommendations for acceptable inhalation technique. Measurements were made with an MOl adapter that contained an unobtrusive, lightweight, miniature sensing system. Inspiratory flow at the moment of MOl actuation (Va), the volume (integrated from airflow) at actuation as a fraction of total inspiratory volume 0/aM), breath-holding time (tBH), and inspiratory volume as a fraction of FVC 0/I/FVC) were determined from 59 uncoached inhalations. We defined an acceptable maneuver, based on published data, by four components: (1) inspiratory flow at actuation (Va) between 25 and 90 Umin; (2) actuation during early inspiration (0 < VaM~0.20); (3) adequate breathholding time (tBH >4 s), and (4) a deep inhalation (VIIFVC >0.50). For all subjects, only 25% of inhalation maneuvers met all four criteria for acceptability. We found that a significantly higher proportion of male than female subjects performed an acceptable MOl maneuver (43% versus 4%, p < 0.001). There were no significant differences in technique between younger and older subjects or between patients with a diagnosis of asthma or chronic obstructive pulmonary disease (COPO). We conclude that most patients use their MOls incorrectly; females of all ages are much more likely to have improper MOl technique than are males. Goodman DE, Israel E, Rosenberg M, Johnston R, Weiss ST, Drazen JM. The influence of age, diagnosis, and gender on proper use of metered-dose inhalers. Am J Respir Crit Care Med 1994;150:1256-61.

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What determines whether an elderly patient can use a metered dose inhaler correctly?

Cited by 125 publications

References 7 publications

Inhaler technique: does age matter? A systematic review

Inhaler technique: does age matter? A systematic review

Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma

The influence of age, diagnosis, and gender on proper use of metered-dose inhalers.

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