- 學位論文
老年慢性阻塞性肺疾病病人使用吸入器之正確性及相關因素探討
Accuracy and Associated Factors of Inhaler Use in Older Patients with Chronic Obstructive Pulmonary Disease: A Cross-sectional Study
摘要
研究背景 慢性阻塞性肺疾病的主要治療方式，是使用吸入器將藥物吸入肺部達到治療效果。吸入器分為三類：加壓定量吸入器、乾粉吸入器、軟霧吸入器，操作方式各不同。相較口服藥物治療，使用吸入器需要較多記憶及技術面操作，對老年病人而言更是困難。醫療人員需先了解老年慢性阻塞性肺疾病病人使用吸入器的正確性及相關因素，才能進一步照護，以提升老年病人使用吸入器的治療效益。 研究目的 探討老年慢性阻塞性肺疾病病人使用吸入器之正確性及相關因素。 研究方法 本研究採橫斷調查性研究設計。以台灣高雄市某一醫學中心為研究場所。於2020年8月29日至2020年11月20日，採方便取樣方式，納入（1）65歲以上確診慢性阻塞性肺疾病的病人；（2）已使用吸入器治療；（3）意識清醒，可國、台語溝通，並同意參與研究者。排除失明、失聰、無法表達、重聽無法理解研究說明或無法獨立操作吸入器之病人。收集性別、年齡、教育程度、目前使用吸入器之種類、使用吸入器正確性（自擬各類吸入器操作查檢表）、對於吸入器之滿意度、手握力、指捏力、最近一次接受吸入器指導的間隔時間及醫療人員的指導方式。採用描述性統計分析吸入器正確性。採用卡方檢定與獨立樣本t檢定分析吸入器操作正確性的相關因素。採用二元邏輯斯迴歸分析吸入器操作正確性的重要影響因素。 研究結果 本研究納入的150位老年慢性阻塞性肺疾病病人，其中以男性居多（87.3%），平均年齡74.98 ± 7.52歲，教育程度以國小、國中居多（49.3%）。129位受試者（86%）使用一種吸入器，21位受試者同時使用兩種吸入器（14%）。 若同時使用兩種吸入器的受試者，將分別調查操作兩種吸入器的正確性。故本研究共納入171人次使用吸入器調查，使用吸入器正確的人數比率為39.2%（僅67位受試者完全正確），其中使用DPI類吸入器正確的人數比率最高（45.4%），其次為SMI類（44%）及pMDI類（4.2%）。 以150位受試者使用一種吸入器之操作結果進行分析。吸入器種類、只使用一種吸入器與對吸入器滿意度高是吸入器正確性的相關因素，亦為重要影響因素。性別、年齡層、教育程度、手握力、指捏力、最近一次接受衛教指導時間、接受衛教指導方式皆非吸入器正確性的相關因素。 結論 老年慢性阻塞性肺疾病病人使用乾粉吸入器之操作正確性較高。選擇吸入器時，若能考量病人對吸入器的滿意度、避免同時使用多種吸入器，有助於增進病人吸入器操作正確性。建議醫療人員可主動與病人討論吸入器治療方案，介紹各吸入器間差異，透過醫病共享決策，依病人滿意度選擇吸入器，不僅幫助病人正確操作吸入器，也提高治療效果，進而達到良好的疾病控制。
並列摘要
Background The main treatment for chronic obstructive pulmonary disease (COPD) is to use inhale drugs inhaled into the lungs to achieve therapeutic effect. There are three types of inhalers: pressurized metered-dose inhalers (pMDI), dry powder inhalers (DPI), and soft mist inhalers (SMI), all with different operating skills. Compared to administration of oral medication, using inhalers requires more memorized skills and technical operations, which make the process even more difficult for elderly patients. If healthcare professionals can understand the accuracy and related factors of using inhalers for elderly people with COPD, they can take further care and improve the therapeutic benefit of elderly patients self-use of inhalers. Purpose To explore the accuracy and related factors of using inhalers in elderly people with COPD. Method This cross-sectional study was conducted the using convenient sampling method, with participants recruited from a medical center in the south Taiwan. The inclusion criteria of participants included (1) patients over 65 years of age who had been diagnosed with COPD; (2) having previous use of inhaler therapy; (3) having clear consciousness, able to communicate in Chinese or Taiwanese, and agreeing to participate in the research. The exclusion criteria were patients who were blind, deaf, unable to express themselves, hard of hearing, unable to understand the research instructions, or unable to operate the inhaler independently. From August 29, 2020 to November 20, 2020, 150 elderly patients who were diagnosed with COPD and using inhalers were recruited. Basic information of the patient, the accuracy of using inhalers, the type of using inhalers and preference of inhalers, the grip strength, finger pinch strength, the last time of inhaler instruction learning and the instruction method from the healthcare professionals were all collected. Descriptive statistics were used to analyze the accuracy of using inhalers. Chi-square test and independent t-test were used to analyze the factors related to the accuracy of using inhalers, while binary logistic regression was applied to analyze the important factors affecting the correctness of inhaler operation. Result Among the 150 elderly patients with COPD in this study, the majority were male (87.3%), mean age were 74.98 ± 7.52 years old, and had elementary or middle schools of education levels (49.3%), with 129 subjects (86%) using one type of inhaler, and 21 subjects using two types of inhalers (14%). If the subjects used two inhalers, the accuracy of each inhalers was analyzed separately. The percentage of accuracy of using the inhalers among elderly people with COPD was 39.2%, with the accuracy of using DPI being the highest (45.4%), followed by SMI (44%), and pMDI (4.2%). Related factors of accuracy of using inhalers was analyzed using 150 subjectes, with the type of inhaler, the use of only one type of inhaler, and the high degree of preference for used inhaler being these related factors of accuracy of using inhalers among elderly patients with COPD. There was no significant difference in the subjects’ gender, age, education level, grip strength, pinch strength, the instruction method from the healthcare professionals, and the interval time since last instruction of ihhaler use. Conclusion The operation accuracy of DPI for elderly patients with COPD is relatively high. When choosing an inhaler, if the patient's preference with the inhaler can be considered and using multiple inhaler is avoided at the same time, this will help improve the accuracy of the patient's inhaler operation. It is recommended that healthcare professionals actively discuss the inhaler treatment plan with the patient and introduce the differences between each inhaler. By sharing decision-making between physicians and patients, choosing inhalers based on patient satisfaction will not only help patients to operate the inhalers correctly, but also improve the treatment effect and achieve good disease control as well.