Effectiveness of Inhalation Technique Assessment Service for Patients with Respimat® inhaler

Background: Inhalation mode of drug delivery is the mainstay treatment for chronic obstructive pulmonary disease, however; incorrect technique prevents patients from receiving maximal therapeutic benefi ts.Objectives: To assess usage technique of rotahaler among patients with chronic obstructive pulmonary disease and identify factors affecting its performance.Methods: Descriptive cross sectional study was conducted to assess rotahaler (single unit dose dry powder inhaler) inhalation technique among patients with chronic obstructive pulmonary disease in Kathmandu University Teaching Hospital. The study population consisted of 100 respondents using rotahaler for at least one year. Data collection was done by standard checklist, semi structured questionnaire via observation and interview methods respectively.Results: Correct inhalation technique was found in 37% of total respondents. Nearly two out of three respondents (61%) failed to breathe out deeply before inhaling. Majority of the respondents (59%) failed to hold breath for at least 10 second and 25% were unable to breathe in deeply. Age, occupation, source of inhalation instruction and re-demonstration of the technique were found to be signifi cantly associated with the correct inhalation technique (p <0.05).Conclusion: More than half of the respondents had incorrect inhalation technique, so health education program targeting the common identifi ed errors should be carried out. Arrangements should be made for regular involvement of pharmacist in teaching and re-demonstration to ensure good inhaler technique. This would ultimately lead to a greater clinical response and improved patient compliance.Journal of Kathmandu Medical CollegeVol. 5, No. 1, Issue 15, Jan.-Mar., 2016, Page: 11-17

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Decreases in Frontal and Parietal Lobe Regional Cerebral Blood Flow Related to Habituation

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.1992.78 ◽

1992 ◽

Vol 12 (4) ◽

pp. 546-553 ◽

Cited By ~ 39

Author(s):

Steven Warach ◽

Ruben C. Gur ◽

Raquel E. Gur ◽

Brett E. Skolnick ◽

Walter D. Obrist ◽

...

Keyword(s):

Right Hemisphere ◽

Parietal Lobe ◽

Brain Activity ◽

Inhalation Technique ◽

Attentional Processes ◽

Left Handed ◽

Verbal Tasks ◽

Spatial Tasks ◽

Regional Specificity ◽

The Right

We previously reported decreased mean CBF between consecutive resting conditions, ascribed to habituation. Here we address the regional specificity of habituation over three consecutive flow studies. Regional CBF (rCBF) was measured in 55 adults (12 right-handed men, 12 right-handed women, 14 left-handed men, 17 left-handed women), with the 133Xe inhalation technique, during three conditions: Resting, verbal tasks (analogies), and spatial tasks (line orientation). Changes in rCBF attributable to the cognitive tasks were eliminated by correcting these values to a resting equivalent. There was a progressive decrease in mean rCBF over time, reflecting habituation. This effect differed by region, with specificity at frontal (prefrontal, inferior frontal, midfrontal, superior frontal) and inferior parietal regions. In the inferior parietal region, habituation was more marked in the left than the right hemisphere. Right-handers showed greater habituation than did left-handers. There was no sex difference in global habituation, but males showed greater left whereas females showed greater right hemispheric habituation. The results suggest that habituation to the experimental setting has measurable effects on rCBF, which are differently lateralized for men and women. These effects are superimposed on task activation and are most pronounced in regions that have been implicated in attentional processes. Thus, regional decrement in brain activity related to habituation seems to complement attentional effects, suggesting a neural network for habituation reciprocating that for attention.

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