An Investigation into the Factors Associated with Incorrect Use of a Pressurized Metered-Dose Inhaler in Japanese Patients.

IF 2 4区 医学 Q3 RESPIRATORY SYSTEM Journal of Aerosol Medicine and Pulmonary Drug Delivery Pub Date : 2023-02-01 DOI:10.1089/jamp.2022.0018
Hiroshi Ohnishi, Masafumi Okazaki, Kazuki Anabuki, Shin Akita, Shigeo Kawase, Kimiko Sakai Tsuji, Mitsuhiko Miyamura, Akihito Yokoyama
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引用次数: 1

Abstract

Rationale: Inhalation of the correct dose of a short-acting beta 2 agonist (SABA) from a pressurized metered-dose inhaler (pMDI) is essential for the relief of symptoms in patients with asthma and/or chronic obstructive pulmonary disease. The aim of this study was to evaluate the prevalence and factors associated with the incorrect use of a pMDI. Methods: This study retrospectively assessed the electronic medical records of 161 patients with various respiratory diseases. The patients had never used a pMDI and underwent training by pharmacists educated in the use of a pMDI followed by bronchodilator reversibility testing at our hospital. The patients' characteristics and various lung capacity parameters were evaluated for association with the incorrect use of a pMDI. Results: Thirty-nine of the 161 (24.2%) patients, including 46% of 28 patients older than 80 years, used the pMDI incorrectly, mainly because of incoordination between activation of the device and inhalation (n = 11), inadequate strength to manipulate the device (n = 9), too short duration of inhalation (n = 6), and difficulty in breath holding (n = 3). Advanced age; lower height; and decreased lung volumes, including vital capacity (VC), inspiratory capacity, inspiratory reserve volume (IRV), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate, were associated with the incorrect use of a pMDI. Neither the body weight, tidal volume, expiratory reserve volume, %FVC predicted, %FEV1 predicted, nor FEV1% was associated with the incorrect use of a pMDI. Multivariate binomial logistic regression analysis identified decreased IRV as the only independent predictor associated with the incorrect use of a pMDI. Conclusions: Physicians should be aware that elderly patients or patients with decreased IRV might be unable to obtain the correct SABA dose from a pMDI. A large-scale prospective study is required to confirm these findings from our retrospective study with a small group of patients.

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日本患者不正确使用加压计量吸入器相关因素的调查。
理由:从加压计量吸入器(pMDI)吸入正确剂量的短效β 2激动剂(SABA)对于缓解哮喘和/或慢性阻塞性肺疾病患者的症状至关重要。本研究的目的是评估不正确使用pMDI的患病率和相关因素。方法:对161例呼吸系统疾病患者的电子病历进行回顾性分析。患者从未使用过pMDI,并接受了在我院接受过pMDI使用培训的药剂师的培训,随后进行了支气管扩张剂可逆性试验。评估患者的特征和各种肺活量参数与pMDI不正确使用的关系。结果:161例患者中有39例(24.2%)患者不正确使用pMDI,其中年龄在80岁以上的28例患者中有46%,主要原因是装置的激活与吸入不协调(n = 11),操作装置的力量不足(n = 9),吸入时间过短(n = 6),屏气困难(n = 3)。先进的年龄;降低高度;肺活量(VC)、吸气量、吸气储备量(IRV)、用力肺活量(FVC)、一秒用力呼气量(FEV1)和呼气流量峰值等肺容量的减少与pMDI的不正确使用有关。体重、潮气量、呼气储备量、预测FVC %、预测FEV1%和FEV1%均与pMDI的不正确使用无关。多变量二项逻辑回归分析确定IRV下降是与pMDI使用不正确相关的唯一独立预测因子。结论:医生应该意识到,老年患者或IRV降低的患者可能无法从pMDI中获得正确的SABA剂量。我们对一小部分患者进行回顾性研究,需要进行大规模的前瞻性研究来证实这些发现。
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来源期刊
CiteScore
6.70
自引率
2.90%
发文量
34
审稿时长
>12 weeks
期刊介绍: Journal of Aerosol Medicine and Pulmonary Drug Delivery is the only peer-reviewed journal delivering innovative, authoritative coverage of the health effects of inhaled aerosols and delivery of drugs through the pulmonary system. The Journal is a forum for leading experts, addressing novel topics such as aerosolized chemotherapy, aerosolized vaccines, methods to determine toxicities, and delivery of aerosolized drugs in the intubated patient. Journal of Aerosol Medicine and Pulmonary Drug Delivery coverage includes: Pulmonary drug delivery Airway reactivity and asthma treatment Inhalation of particles and gases in the respiratory tract Toxic effects of inhaled agents Aerosols as tools for studying basic physiologic phenomena.
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