scholarly journals Respimat as the new standard for inhalation therapy devices

2021 ◽  
pp. 32-37
Author(s):  
V. V. Arkhipov
Keyword(s):  
Patient Education ◽  
Inspiratory Flow ◽  
Inhalation Therapy ◽  
Inhalation Technique ◽  
Chronic Obstructive ◽  
Active Device ◽  
Obstructive Pulmonary Disease ◽  
Technical Errors ◽  
Number Of Patients ◽  
Therapy Effectiveness

The effectiveness of inhalation therapy can be significantly reduced by a number of problems. For example, inhalation technique errors can reduce the dose delivered by 22-95% compared to the optimal value in patients with technical errors in the use of the inhaler. Sub-optimal inspiratory flow rates in a number of patients with chronic obstructive pulmonary disease and asthma are often the cause of technical errors during inhalation. Patient education does not produce the expected results, as the underlying cause of reduced flow is high hyperinflation and weakening of the respiratory musculature. The use of technologically outdated inhalers is another significant cause of reduced therapy effectiveness. Patient education and even conversion to a different inhaler do not always increase the effectiveness of therapy. Respimat, a brand new delivery agent introduced in 2004, allows 39% to 67% of the nominal dose to be delivered to the airways, while the degree of pulmonary deposit is independent of inspiratory flow and pulmonary drug deposit does not decrease with increasing obstruction. Compared to powder inhalers, Respimat creates less resistance to airflow on inhalation. In addition, Respimat is an active device that requires no effort on the part of the patient to move the aerosol particles. These features make Respimat the new standard for inhalation therapy. This review aims to familiarise readers with the main features of the Respimat and the latest research findings

scholarly journals Role of educational intervention with practical demonstration in improving inhaler technique

2019 ◽  
Vol 6 (3) ◽  
pp. 840
Author(s):  
Bharat Bhushan ◽  
Kulbir Singh ◽  
Jebin Abraham ◽  
Deepak Goyal ◽  
Arjun Bhatnager ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Inhalation Therapy ◽  
Inhalation Technique ◽  
Chronic Obstructive ◽  
Inhaler Technique ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases ◽  
Therapy Technique ◽  
Practical Demonstration

Background: Chronic respiratory diseases are among the leading causes of morbidity and mortality worldwide with chronic obstructive pulmonary disease (COPD) and asthma being the most common. There is under-utilization of the basic tools of inhalation therapy technique(s) in their management. Implementation of a personalized educational and demonstrational intervention by the attending physician during regular follow-up visits of these patients will substantially improve the treatment outcome.Methods: This prospective interventional study was conducted on 239 diagnosed cases of asthma and COPD. Inhaler technique was assessed in accordance to standard checklist and errors were corrected by a practical demonstration. A follow-up assessment was conducted for the same after 2 weeks. Data thus collected was evaluated.Results: Out of 239 patients, 47.6% (n=114) reported for follow-up assessment. Average reporting time for follow-up assessment was 27.4 days. Amongst them, an improvement of at least one step was found in 86.8% (n= 99) and about 28% (n=32) patients performed all steps correctly. Average number of steps improved was 2.1.Conclusions: Majority of the patients showed an improvement in the inhaler technique during follow-up assessment after an educational intervention and practical demonstration. Near perfection was achieved by about more than quarter of the patients. Regular practical demonstration of the inhalation technique during subsequent follow-up sessions unequivocally improves results.

Comparison of plasmapheresis efficacy and complex antioxidant therapy in patients with comorbid course of chronic pancreatitis and chronic obstructive pulmonary disease

2014 ◽  
Vol 18 (4 (72)) ◽  
Author(s):  
O. S. Khukhlina ◽  
O. O. Ursul ◽  
V. S. Smandych
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Pancreatitis ◽  
Pulmonary Disease ◽  
Underlying Disease ◽  
Pancreatic Tissue ◽  
Inhalation Therapy ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Complex Therapy ◽  
Reduced Intensity

60 patients with chronic obstructive pulmonary disease (COPD) and chronic pancreatitis (CP) were examined in the dynamics of treatment. The complex therapy of patients with COPD and CP including inhalation therapy with Thiotropium bromide, Serrathiopeptidase and Emoxypin promoted reduced intensity of oxidative stress, restoration of antioxidant protective components activity and natural detoxication system, intensified the activity of enzymatic, Hagemmandependant fibrinolysis and collagenosis, improving the processes of microcirculation, elimination of ischemia and swelling of the pancreatic tissue, quick removal of clinical exacerbation signs of the underlying disease and comorbid diseases. According to the correction degree of enzyme deviation syndrome in the blood, intensity of nitrositic stress and endogenic intoxication in patients with COPD and CP, the effect of 30-day intake of Serrathiopeptidase and 15-day intake of Emoxypin is equal to the efficacy of five plasmapheresis sessions.

scholarly journals Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

Pneumologia ◽  
2019 ◽  
Vol 68 (1) ◽  
pp. 31-36
Author(s):  
Ioana Cojocaru ◽  
Livia Luculescu ◽  
Daniela Negoescu ◽  
Irina Strâmbu
Keyword(s):  
Clostridium Difficile ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Respiratory Infections ◽  
Demographic Data ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Male Predominance ◽  
Number Of Patients ◽  
Lower Intestine

Abstract Clostridium difficile is an anaerobic bacterium than can colonise the lower intestine and cause enterocolitis in susceptible patients. Clostridium difficile infection (CDI) is typically a nosocomial infection, favoured by treatment with antibiotics (especially with broad-spectrum drugs), proton pump inhibitors, but also comorbidities, old age and prolonged hospitalisation. Based on the observation that in the past years, the frequency of nosocomial CDI has increased in the Institute of Pulmonology, Bucharest, this retrospective observational study aimed to analyse the characteristics of admitted patients who develop CDI, in order to identify possible particular features and risk factors. Accordingly, medical files from 80 patients admitted from January 2015 to August 2017 were analysed for demographic data, respiratory diagnosis, comorbidities, blood tests, treatments prescribed, time of CDI onset, evolution and outcome. The number of patients studied was 29 in 2015, 16 in 2016 and 35 in 2017, with slight male predominance. Totally, 54 patients (67.5%) had tuberculosis (pulmonary or pleural), 12 had lung cancer, five had respiratory infections, two had chronic obstructive pulmonary disease and seven had other diseases. All patients but nine were receiving antibiotics: tuberculosis drugs, cephalosporins, fluoroquinolones and beta-lactams. About half of the patients received proton pump inhibitors. Most patients had several comorbidities. Mean time since admittance to onset of diarrhoea was 20 days. CDI was treated with metronidazole or vancomycin. The evolution was favourable in 90% of patients, but eight patients (10%) died This study highlights a high frequency of CDI in patients treated for tuberculosis. Due to insufficient data, no epidemiological consideration could be made. Further studies are needed to assess the relationship among tuberculosis, tuberculosis treatment and CDI.

scholarly journals Management of chronic obstructive pulmonary disease: A review focusing on exacerbations

2020 ◽  
Vol 77 (4) ◽  
pp. 259-268
Author(s):  
Suzanne G Bollmeier ◽  
Aaron P Hartmann
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Patient Education ◽  
Disease Management ◽  
Pulmonary Disease ◽  
The United States ◽  
Chronic Obstructive ◽  
Severe Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
The Impact

Abstract Purpose Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in the United States. Exacerbations— acute worsening of COPD symptoms—can be mild to severe in nature. Increased healthcare resource use is common among patients with frequent exacerbations, and exacerbations are a major cause of the high 30-day hospital readmission rates associated with COPD. Summary This review provides a concise overview of the literature regarding the impact of COPD exacerbations on both the patient and the healthcare system, the recommendations for pharmacologic management of COPD, and the strategies employed to improve patient care and reduce hospitalizations and readmissions. COPD exacerbations significantly impact patients’ health-related quality of life and disease progression; healthcare costs associated with severe exacerbation-related hospitalization range from $7,000 to $39,200. Timely and appropriate maintenance pharmacotherapy, particularly dual bronchodilators for maximizing bronchodilation, can significantly reduce exacerbations in patients with COPD. Additionally, multidisciplinary disease-management programs include pulmonary rehabilitation, follow-up appointments, aftercare, inhaler training, and patient education that can reduce hospitalizations and readmissions for patients with COPD. Conclusion Maximizing bronchodilation by the appropriate use of maintenance therapy, together with multidisciplinary disease-management and patient education programs, offers opportunities to reduce exacerbations, hospitalizations, and readmissions for patients with COPD.

scholarly journals Assessment of rotahaler inhalation technique among patients with chronic obstructive pulmonary disease in a teaching hospital of Nepal

2017 ◽  
Vol 5 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Diksha Sapkota ◽  
Yogesh Raj Amatya
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Teaching Hospital ◽  
Dry Powder Inhaler ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Inhalation Technique ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease

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

Therapeutic strategy in acute or chronic airflow limitation

2016 ◽  
Author(s):  
Francesco Macagno ◽  
Massimo Antonelli
Keyword(s):  
Bacterial Infections ◽  
Blood Gases ◽  
Airflow Limitation ◽  
Inhalation Therapy ◽  
Chronic Obstructive ◽  
Therapeutic Success ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Established Role

The fragility of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accounts for their frequent hospitalization and their high intensive care unit risk. Therapy for AECOPD is varied and the need for hospitalization must be always carefully evaluated, considering the risk factors related to the presence of multi-resistant pathogens or the need of invasive procedures. The prolonged use of oxygen therapy requires an accurate monitoring of blood gases and continuous oximetry. Inhalation therapy can be performed using nebulizers, predosed aerosols or powders for inhalation. Corticosteroids for oral and systemic use now play an established role in AECOPD, because bacterial infections account for 50% of exacerbations. Non-invasive ventilation (NIV) must be considered the first option in AECOPD patients and acute respiratory failure if there are no contraindications. The careful monitoring of the patient and the response to NIV are indispensable elements for therapeutic success.

Clinical Profile of Critically Ill Patients Presenting to Emergency Department of Tertiary Level Hospital of Nepal

2019 ◽  
Vol 41 (1) ◽  
pp. 67-74
Author(s):  
Shubha K Shrestha ◽  
Bishwas Pradhan ◽  
Yogendra M Shakya ◽  
Hem R Paneru
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
University Teaching ◽  
Chronic Obstructive ◽  
Optimal Care ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Common Diagnosis ◽  
The Common ◽  
A Prospective Study

Introduction: Among critically ill patients presenting to Emergency Room (ER) of Tribhuwan University Teaching Hospital (TUTH), a number of patients have to either remain in ER or have to be referred outside due to unavailability of critical care beds. Studies have shown significant association between delayed admission and mortality rates along with increased length of stay and higher cost. This study aimed to present an audit of critically ill patients presenting to ER of TUTH. Methods: This was a prospective study conducted over a period of one month. All patients presenting to ER of TUTH were triaged and critically ill patients were shifted to Red area of the ER. All patients ≥16 years of age shifted to Red area during the study period were enrolled in our study. Results: Out of 3718 patients presenting to ER during the study period, the number of critically ill patients ≥16 years of age was 526 i.e. 14.14% of total patients. Among them, the common diagnosis were Cerebrovascular Accidents (CVA) followed by Intoxication, Acute Exacerbation (AE) of Chronic Obstructive Pulmonary Disease (COPD), Pneumonia and Chronic Kidney Disease (CKD) respectively. Almost 20% of these patients were admitted, 31% were referred and 40% were shifted for observation. The median length of ER stay was 6 hours (Mean: 8.5 hrs; Range: 20 min to 70 hr 15 min). Conclusion: Among critically ill patients presenting to our ER, almost 1/5th of the patients were admitted whereas more than 2/3rd were either referred or remained in our ER. This data highlights the need for solutions to provide optimal care for the acute phase management of the critically ill patients.

scholarly journals Monitoring of inhaler use at home with a smartphone video application in a pilot study

2020 ◽  
Vol 30 (1) ◽  
Author(s):  
Nagesh Dhadge ◽  
Madhuragauri Shevade ◽  
Nisha Kale ◽  
Govinda Narke ◽  
Dhananjay Pathak ◽  
...  
Keyword(s):  
Pilot Study ◽  
Rating Scale ◽  
Video Recording ◽  
Inspiratory Flow ◽  
Inhalation Therapy ◽  
Inhalation Technique ◽  
Inhaler Technique ◽  
Flow Rates ◽  
Video Application ◽  
At Home

Abstract Inhalation therapy is the basis of the pharmacological management of asthma and COPD. Most patients are trained on the correct use of inhalers by health professionals but after that do patients continue to take them correctly at home remains largely unknown. Video recording of the inhalation technique using a smartphone can be used to evaluate the inhaler technique at home. Through this pilot study, we aimed to understand whether inhaler training given to patients in the outpatient clinic translates into good inhalation practices at home by a video application platform using a smartphone. We recruited 70 newly diagnosed asthma and COPD patients and a pulmonologist trained them to use their inhaler until they were able to use it correctly. Videos of inhaler use were captured by a relative or a friend at home and then sent to an independent reviewer via WhatsApp on Days 1, 7, 14 and 28 (±2). Each step of the inhaler technique was evaluated based on a predetermined checklist with a rating scale of 0 to 10 (10 for all steps done correctly). Out of 70 patients recruited, 30 (42%) sent all videos. We found that, although all patients performed all the steps correctly in the clinic, none of them performed all steps correctly at home even on Day 1 itself of the inhaler use. On Day 1, the steps score reduced from 10 to 6.9 with a downward trend until Day 28. The most common mistakes from Day 1 onwards were incorrect inspiratory flow rates and not gargling after the inhaler use. Also, most patients showed partially effective inhalation as per our scoring method. Remote video monitoring of inhaler use in the home environment is possible with a mobile video application that gives us a better insight into the most common inhaler mistakes performed by patients at home. Inhaler errors start appearing immediately on Day 1 after the training, and incorrect inspiratory flow rates and forgetting to do gargles are common errors. Early detection of inhaler errors at home may be possible through this method.

scholarly journals Use of inhaled devices during a hospital exacerbation of COPD: a summary of an interdisciplinary audit held at ICS Maugeri Pavia, Italy (March-June 2019)

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Michele Vitacca ◽  
Cinzia Lastoria ◽  
Monica Delmastro ◽  
Domenico Fiorenza ◽  
Pasquale De Cata ◽  
...  
Keyword(s):  
Treatment Algorithm ◽  
Real Life ◽  
Inhalation Therapy ◽  
Chronic Obstructive ◽  
Patient Needs ◽  
Treatment Protocols ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Long Acting ◽  
Exacerbation Of Copd

To date treatment protocols in Respiratory and or Internal departments across Italy for treatment of chronic obstructive pulmonary disease (COPD) patients at hospital admission with relapse due to exacerbation do not find adequate support in current guidelines. Here we describe the results of a recent clinical audit, including a systematic review of practices reported in literature and an open discussion comparing these to current real-life procedures. The process was dived into two 8-hour-audits 3 months apart in order to allow work on the field in between meeting and involved 13 participants (3 nurses, 1 physiotherapist, 2 internists and 7 pulmonologists). This document reports the opinions of the experts and their consensus, leading to a bundle of multidisciplinary statements on the use of inhaled drugs for hospitalized COPD patients. Recommendations and topics addressed include: i) monitoring and diagnosis during the first 24 h after admission; ii) treatment algorithm and options (i.e., short and long acting bronchodilators); iii) bronchodilator dosages when switching device or using spacer; iv) flow measurement systems for shifting to LABA+LAMA within 48 h; v) when nebulizers are recommended; vi) use of SMI to deliver LABA+LAMA when patient needs SABA <3 times/day independently from flow limitation; vii) use of DPI and pre-dosed MDI to deliver LABA+LAMA or TRIPLE when patient needs SABA <3 times/day, with inspiratory flow > 30 litres/min; viii) contraindication to use DPI; ix) continuation of LABA-LAMA when patient is already on therapy; x) possible LABA-LAMA dosage increase; xi) use of SABA and/or SAMA in addition to LABA+LABA; xii) use of SABA+SAMA restricted to real need; xiii) reconciliation of drugs in presence of comorbidities; xiv) check of knowledge and skills on inhalation therapy; xv) discharge bundle; xvi) use of MDI and SMI in tracheostomized patients in spontaneous and ventilated breathing.

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