Effects of Mishandling of Inhalers on the Management of Asthmatic Patients

吸入器的處理不當對哮喘患者的效果

黃英豪(Ying-Hao Huang) ； 王貞云(Yu Sophie Wang) ； 王正信(Jeng-Shing Wang) ； 陳世民(Shih-Min Chen)

《胸腔醫學》 30卷1期 (2015/02) Pp. 1-8

摘要

目的：吸入裝置的不正確使用可能對藥物的臨床效果產生重大影響。本研究的目的是評估哮喘患者不正確的吸入技術，要突顯吸入技術觀察到的常見錯誤，並討論對臨床療效的影響。方法：首先，招募患者完成一個標準化的問卷，每份問卷包括一個常規部分和特殊部分，每部分涉及一個特定的吸入器。然後，在一個安靜的區域，每個病人使用安慰劑裝置對研究者示範吸入技術。結果：我們已經收集了100條記錄吸入器技術。至少一個關鍵的錯誤分佈在吸入器的患者，從Evohaler®19%，Accuhaler®19%，到Turbuhale®29%。吸入器使用不當和年齡大（p=0.01），受教育低（p= 0.01），缺乏健康照護者提供的吸入器技術教學或檢查（p=0.03）有顯著差異。吸入器使用不當是與住院（p＜0.001），急診（p＜0.001），口服類固醇課程（p＜0.001）和抗菌劑（p＜0.001）的風險增加，和疾病控制不佳（p＜0.001）有關。結論：吸入器處理不當仍是轉介到胸腔科門診經驗豐富的患者常見，並與計劃外增加的醫療保健資源的使用和不良臨床控制相關。由健康照護者教學或檢查也許是有利於減少吸入器處理不當的因素。

關鍵字

哮喘控制測試 ； 哮喘 ； 吸入器

並列摘要

Introduction: Incorrect usage of inhaler devices might have a major influence on the clinical effectiveness of the delivered drug. The objectives of this study were to assess the effect on patients with asthma of using an incorrect technique with established inhalers, to highlight the common errors observed in inhalation techniques and to discuss implications for clinical efficacy. Methods: First, recruited patients completed a standardized questionnaire; each questionnaire consisted of a general section and specific parts, each related to a specific inhaler. Then, each patient demonstrated for the investigator their inhalation technique with all devices in a quiet area, using a placebo device. Results: We collected 100 records of the inhaler usage technique of asthmatic patients. At least 1 critical mistake was made by users of each of the inhalers, ranging from 19% for Evohaler®, 19% for Accuhaler®, and 29% for Turbuhaler®. There were significant differences between inhaler misuse and older age (p=0.01), few years of education (p=0.01) and lack of instruction or checking up on inhaler technique by healthcare professionals (p=0.03). Inhaler misuse was associated with increased risk of hospitalization (p＜0.001), emergency room visits (p＜0.001), courses of oral steroids (p＜0.001) and antimicrobials (p＜0.001) and poor disease control as evaluated by the Asthma Control Test (ACT) score for asthma (p＜0.001). Conclusion: Inhaler mishandling continues to be common among experienced outpatients referred to chest clinics and is associated with increased unscheduled healthcare resource use and poor clinical control. Instruction by healthcare professionals may be a modifiable factor useful in reducing inhaler mishandling.

並列關鍵字

asthma control test ； asthma ； inhaler