Characterization of elderly and non-elderly patients with Bronchial Asthma

• Main Author: Ferreira, Eduardo Manuel Freitas
• Publication Date: 2016
• Format: Master thesis
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: http://hdl.handle.net/10400.6/5338
• topic: Asma; Idosos; Inaladores; Não-Idosos; Técnica Inalatória.

Introduction: Asthma therapy requires, together with appropriate medication, a correct inhalational technique. However, incorrect inhaler usage is frequent. Thus, the physician has a major role in accomplishing a therapeutic effect, both in terms of achieving an initial correct technique but also in maintaining correct use. This study aims to compare inhaler technique error frequency and type between elderly and non-elderly asthmatics; to compare inhaler technique self-perception with real performance and to evaluate inhaler technique determinants. Methods: Cross-sectional assessment of 92 elderly and 100 non-elderly asthmatic patients followed up at Centro Hospitalar Cova da Beira, Portugal. A standardized questionnaire was applied and inhaler technique demonstration was requested, with a total 130 non-elderly and 118 elderly inhaler demonstrations. Errors were accessed using checklists based on manufacturers’ instructions and Inhaler technique was graded as correct, acceptable or incorrect based upon previously published criteria. Data was analysed using Chi-Square Test or Fischer’s Exact Test, using the Software Package for Social Sciences®, version 23.0, regarding a p-value less than or equal to 0.05 as significant. Results: Technique was correct in 13.6%, acceptable in 61.0% and incorrect in 25.4% of the elderly asthmatics, compared to 15.4%, 55.4% and 29.2% of the non-elderly asthmatics, respectively. Metered dose inhaler (MDI) showed the worst performance with only 7.7% of the elderly and 19.6% of the non-elderly showing no errors. In contrast, Diskus® showed the best performance in both groups. No difference between study groups was found for inhaler technique. The most common mistake was failure to tilt the head back when inhaling, a minor error. Only 11.1% of the elderly who classified their inhaler as easy and 12.7% who stated their technique as correct had no errors. Although almost all patients had initial training, only 49.2% of the elderly and 55.4% of the non-elderly had frequent training. Frequent assessment was associated with a better technique in the non-elderly but not in the elderly. No association was found between technique and gender, education, social class or inhaler number. Discussion: Incorrect inhaler technique remains common. MDI was found to have a higher proportion of errors when compared to Dry Powder Inhalers, suggesting it as less user friendly. However, all devices showed a large proportion of errors, consistent with guidelines stating devices as equivalent if handled correctly. Patients tend to overestimate their technique as correct. Thus, it is not sufficient to ask about their perception in device handling. Rather, frequent assessment is necessary because they tend to forget instructions over time.