Effect of Mishandling of Inhalers on Management of Subjects with COPD

吸入器的處理不當對慢性阻塞性肺病患者的效果

吳玉珍(Yu-Chen Wu) ； 王貞云(Yu Sophie Wang) ； 王正信(Jeng-Shing Wang)

《南臺灣醫學雜誌》 10卷2期 (2014/12) Pp. 61-66

https://doi.org/10.6726/MJST.201412_10(2).0001

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慢性阻塞性肺病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® 21%，Accuhaler® 21%，到Turbuhale® 32%。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），口服類固醇療程（P＜0.001）和抗菌劑療程（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常就診患者常見的問題，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

慢性阻塞性肺病評估測試 ； 慢性阻塞性肺病 ； 吸入器

並列摘要

Objective: Incorrect usage of inhaler devices might have a major influence on the clinical effectiveness of the delivered drug. The objective of this study was to assess the incorrect technique with established inhalers in subjects with chronic obstructive pulmonary disease (COPD), to highlight the common errors observed in inhalation technique and to discuss implications for clinical efficacy. Methods: First, recruited subjects completed a standardized questionnaire; each questionnaire consisted of a general section and specific parts, each related to a specific inhaler. Then, each patient demonstrated the inhalation technique with all used devices to the investigator in a quiet area using a placebo device. Results: We have collected 100 records of inhaler technique. At least one critical mistake was distributed among users, ranging from 21% for Evohaler®, 21% for Accuhaler®, and 32% for Turbuhaler®. There were significant differences between inhaler misuse and older age (p=0.01), lower schooling (p=0.01) and lack of instruction or check-up received for inhaler technique by health caregivers (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 evaluated as an COPD Assessment Test (CAT) score for the COPD (p＜0.001). Conclusions: Inhaler mishandling continues to be common in experienced outpatients referring to chest clinics and associated with increased unscheduled health-care resource use and poor clinical control. Instruction by health caregivers maybe the modifiable factor useful for reducing inhaler mishandling.

並列關鍵字

CAT ； COPD ； inhaler