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Commentary: How to Improve Inhalation Technique in Our Patients With Asthma
Comentario: Cómo mejorar la técnica inhalatoria de los pacientes asmáticos
F. Deulofeu i Fontanillasa
a Cap de Servei Medicina Interna, Fundació Hospital de Sant Celoni, Barcelona, Spain.
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    "textoCompleto" => "<p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><img src="27v32n05-13052052tab01.gif"></img></p><p class="elsevierStylePara">Drug delivery by inhalation to administer bronchodilators and antiinflammatory medication has contributed significantly to improvements in care for patients with asthma&#46; Inhalation therapy has been known and used for about 4000 years&#44;<span class="elsevierStyleSup">1</span> although it was not until 1829 that the first device for producing particle suspensions was developed&#46;<span class="elsevierStyleSup">2</span> In subsequent years a number of systems were perfected&#44; and the first pressurized canister system was marketed in 1956&#46;<span class="elsevierStyleSup">3</span> Spacers first appeared in the 1970s&#44; and dry powder inhalers made their appearance soon after&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Inhalation devices have made it possible to deliver very small doses of drugs directly to the target organ&#44; thus achieving rapid&#44; effective action with a minimum of side effects&#46; Thanks to these systems&#44; asthma can be controlled with highly effective treatments and minimal side effects&#44; and patients can lead a completely normal life&#46;</p><p class="elsevierStylePara">As shown in a number of studies<span class="elsevierStyleSup">4-6</span> and confirmed in this issue by Flor Escriche et al&#44; patients use inhalation systems incorrectly&#44; and this probably diminishes the efficacy of treatment&#46; The authors found that 53&#46;9&#37; of their patients performed inhalation techniques incorrectly&#44; the steps with the highest percentage error rates were exhaling completely before inhaling the dose&#44; holding the breath after inhaling&#44; and exhaling slowly afterwards&#46;</p><p class="elsevierStylePara">Since the appearance of pressurized canisters&#44; many other systems have appeared that aim to facilitate compliance with treatment&#44; and that have been shown to increase the amount of drug that reaches the lungs&#46; But this variety of products&#44; each of which requires a different technique for correct use&#44; confuses our patients and make compliance difficult&#46; Flor Escriche et al document this in their study&#59; moreover&#44; they note that at any given time a patient may be using two or three different inhalation devices&#46;</p><p class="elsevierStylePara">How can we improve our patients&#39; inhalation technique&#63; Do the kinds of errors in technique identified thus far have a clinically significant effect on the control of asthma&#63; As I understand the issue&#44; these are the questions that need to be answered&#44; and the lines of research that could be undertaken&#58;</p><p class="elsevierStylePara">To improve inhalation techniques&#44; health education is needed both for health care professionals and for patients&#46; Workshops should train health care professionals in the techniques used for different devices&#44; the advantages of each&#44; and in how to choose the most appropriate type of inhaler for different patients&#46; These workshops should be held periodically&#59; training the trainers is fundamental&#46; As for the patients&#44; their inhalation technique should be checked when they come to the health center&#44; and errors in technique should be corrected&#46; It is also important to use only one inhalation device for each patient&#46;</p><p class="elsevierStylePara">Continuing quality improvement is based on a cycle consisting of several stages&#46; First the problem must be detected &#40;incorrect inhalation technique&#41;&#44; then its possible causes analyzed &#40;inadequate information about the correct technique&#44; use of different devices&#44; etc&#46;&#41;&#46; The next step is to plan corrective measures &#40;workshops for professionals&#44; checking inhalation technique at each visit&#44; etc&#46;&#41;&#44; and this should be followed by further studies to determine whether the problem has been dealt with effectively&#46;</p><p class="elsevierStylePara">With the technology currently available&#44; health care professionals have access to a great deal of information in the form of guidelines&#44; protocols&#44; scientific journals&#44; and other sources that help us to keep our knowledge up to date&#46; These resources also help us to make the best diagnostic and therapeutic decisions for our patients&#46; Articles such as that by Flor Escriche et al warn us that the recommendations in guidelines are not always followed&#46; Therefore we should examine the possibility of incorporating in our daily work processes a system of practice audits as part of a continuing quality improvement program&#46;</p>"
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ISSN: 02126567
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos