Reviewing inhaler technique for older people with COPD can improve disease control

2019 ◽  
Author(s):  
Keyword(s):  
Older People ◽  
Disease Control ◽  
Inhaler Technique ◽  
Improve Disease Control

scholarly journals Urinary Excretion Post Inhalation Method to Correlate Inhaler Technique with Disease Control in Patients with Obstructive Pulmonary Diseases Using Own Metered Dose Inhaler (MDI)

2021 ◽  
Author(s):  
ethirajan nandagopal ◽  
Sumithra M ◽  
N Meenakshi
Keyword(s):  
Disease Control ◽  
Statistical Significance ◽  
Pulmonary Diseases ◽  
Dose Inhaler ◽  
Urinary Concentration ◽  
Inhaler Technique ◽  
Metered Dose ◽  
The Mean ◽  
Multiple Drugs ◽  
Inhaler Devices

Objectives: Correct use of inhaler devices is critical in ensuring the optimal lung bioavailability of the inhaled drug. The study aimed to assess inhaler technique used in patients with using metered-dose inhalers (MDI) by correlating with urinary salbutamol excretion post inhalation and its correlation with disease control. Methods: Thirty patients with obstructive pulmonary diseases attending outpatients’ services inhaled two doses of salbutamol 100 µg and urine samples were collected after 30 min. Inhaler technique scores were assessed using a standardized 8-point checklist. The 30-minute concentration of urinary salbutamol is then correlated with inhaler technique scores and control status of the disease. Key findings: The mean age of the subjects was 60.8 (SD ± 9.338). The mean (SD) 30 min urinary salbutamol concentration was 3.6±1.6 µg/ml. The mean concentration of salbutamol was found to be 2.3 µg/ml (n=1), 2.3 µg/ml (n=5), 3.1 µg/ml (n=7), 3.9 µg/ml (n=8), 4.7 µg/ml (n=5), 5.3 µg/ml (n=3), and 5.0 µg/ml (n=1) among patients performing 1, 2, 3, 4, 5, 6, 7, 8 steps correctly, respectively. There was a statistically significant correlation (p=0.028) witnessed between the mean 30 min urinary salbutamol concentration and total correct steps. The frequency of exacerbation, use of antibiotics, and oral corticosteroids (OCS) were more in patients with poor inhaler technique scores, although statistical significance was achieved only for frequency of antibiotics use (p=0.032). Conclusions: The 30 min salbutamol urinary concentration evaluation may help to identify patients who were underdosed due to poor handling of inhaler devices. Being a complex procedure, it can at least be initiated in patients reporting frequent exacerbations, hospitalization, and those who need multiple drugs for disease control.

Survival of patients (pts) treated with high-dose radiotherapy (RT) and concurrent chemotherapy for unresectable non-small cell lung cancer (NSCLC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7544-7544
Author(s):  
S. Schild ◽  
D. Graham ◽  
S. Hillman ◽  
S. Vora ◽  
G. Yolanda ◽  
...  
Keyword(s):  
Disease Control ◽  
Standard Dose ◽  
Secondary Analysis ◽  
Concurrent Chemotherapy ◽  
Phase Iii ◽  
High Dose ◽  
Entire Cohort ◽  
Prior Therapy ◽  
Technological Improvements ◽  
Improve Disease Control

7544 Background: NCCTG N0028 was a trial that determined the MTD of RT that could be given with carboplatin & paclitaxel was 74 Gy/34 fractions. This secondary analysis was performed to determine the survival of pts treated on this trial. Methods: Eligible pts had medically or surgically unresectable NSCLC, PS=0–1, weight loss <10% in the prior 3 months(mo), no prior therapy, adequate laboratory & pulmonary functions. Included were 25 pts with clinical stages I (4pts), II (1 pt), IIIa (12 pts), & IIIb (8 pts). Treatment included: weekly I.V. paclitaxel (50mg/m2) & carboplatin (AUC=2) during RT. The RT included 2 Gy daily to an initial dose of 70 Gy. The total dose was increased in 4 Gy increments until the MTD was determined. RT was delivered with 3-D treatment planning but no elective nodal RT. Three pts received 70 Gy, 18 pts received 74 Gy, & 4 pts received 78Gy. Results: Pts were followed until death or from 10–67 mo (median: 28mo) in those alive at last evaluation. The median survival (MS) of the entire cohort was 42mo. The 5 stages I-II pts had a MS of 53 mo & the 20 stage III pts had MS of 42mo. Conclusions: Standard dose RT is unable to sterilize disease in the majority of pts with unresectable NSCLC. While the addition of chemotherapy has significantly improved survival of these pts, the MS is generally 15–24 mo. These preliminary results suggest higher than standard doses of RT may improve disease control & prolong survival. A phase III trial comparing standard-dose RT(60Gy) to high-dose RT (74Gy) is open and should more definitively address the issue of RT dose with concurrent chemotherapy for unresectable NSCLC. Future technological improvements in imaging & targeting will provide methods to safely administer even greater RT doses which will likely further improve disease control. No significant financial relationships to disclose.

scholarly journals Inappropriate inhaler use: assessment of use and patient preference of seven inhalation devices

2005 ◽  
pp. 80-84
Author(s):  
J. Lenney ◽  
J. A. Innes ◽  
G. K. Crompton
Keyword(s):  
Disease Control ◽  
Patient Preference ◽  
Cost Effective ◽  
Ease Of Use ◽  
Dose Inhaler ◽  
Inhaler Technique ◽  
Metered Dose ◽  
Good Technique ◽  
Inhaler Devices

Inefficient inhaler technique is a common problem resulting in decreased disease control and increased inhaler use. The aim of this study was to assess patients' use of different inhaler devices and to ascertain whether patient preference is indicative of ease of use and whether current inhaler use has any influence on either technique or preference. We also wished to define the most appropriate method of selecting an inhaler for a patient, taking into account observed technique and device cost. One hundred patients received instruction, in randomized order, in the use of seven different inhaler devices. After instruction they were graded (using predetermined criteria) in their inhaler technique. After assessment patients were asked which three inhalers they most preferred and which, if any, they currently used. Technique was best using the breath-actuated inhalers; the Easi-Breathe and Autohaler, with 91 % seen to have good technique. The pressurized metered dose inhaler (pMDI) fared poorly, in last position with only 79 % of patients showing good technique, despite being the most commonly prescribed. The Easi-Breathe was by far the most popular device with the patients. The Autohaler came in second position closely followed by the Clickhaler and Accuhaler. The majority of patients (55 %) currently used the pMDI but the pMDI did not score highly for preference or achieve better grades than the other devices. Only 79 % of patients tested could use the pMDI effectively even after expert instruction yet it continues to be commonly prescribed. This has important repercussions for drug delivery and hence disease control. Prescribing a patient's preferred device increases cost but can improve efficiency and therefore be cost effective in the long term. Using an inexpensive device (pMDI) when technique is good and the patient's preferred inhaler device when not is one way to optimize delivery and may even reduce cost.

scholarly journals Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study

2018 ◽  
Vol 3 (1) ◽  
pp. e000566 ◽  
Author(s):  
Patrick M Newman ◽  
Molly F Franke ◽  
Jafet Arrieta ◽  
Hector Carrasco ◽  
Patrick Elliott ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Disease Control ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Haemoglobin A1c ◽  
Stepped Wedge ◽  
Patients With Diabetes ◽  
The Impact ◽  
Improve Disease Control

BackgroundNon-communicable diseases (NCDs) contribute greatly to morbidity and mortality in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, but data are lacking. We assessed the impact of a CHW-led intervention on disease control and adherence among patients with diabetes and/or hypertension in Chiapas, Mexico.MethodsWe conducted a prospective observational study among adult patients with diabetes and/or hypertension, in the context of a stepped-wedge roll-out of a CHW-led intervention. We measured self-reported adherence to medications, blood pressure and haemoglobin A1c at baseline and every 3 months, timed just prior to expansion of the intervention to a new community. We conducted individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community.FindingsWe analysed 108 patients. The CHW-led intervention was associated with a twofold increase in the odds of disease control (OR 2.04, 95% CI 1.15 to 3.62). It was also associated with optimal adherence assessed by 30-day recall (OR 1.86; 95% CI 1.15 to 3.02) and a positive self-assessment of adherence behaviour (OR 2.29; 95% CI 1.26 to 4.15), but not by 5-day recall.InterpretationA CHW-led adherence intervention was associated with disease control and adherence among adults with diabetes and/or hypertension. This study supports a role of CHWs in supplementing comprehensive primary care for patients with NCDs in LMICs.Trial registration numberNCT02549495.

scholarly journals Toxicity of two groups of pesticides against the mosquito Aedes aegypti

2020 ◽  
Vol 13 (1) ◽  
pp. 148-155
Author(s):  
Mohammed Rashed Al Zahrani ◽  
Fatehia Nasser Gharsan ◽  
Khalid Mohammed Al-Ghamdi ◽  
Jazem Abdullah Mahyoub ◽  
Tariq Saeed Alghamdi
Keyword(s):  
Saudi Arabia ◽  
Aedes Aegypti ◽  
Disease Control ◽  
Human Health ◽  
Mosquito Control ◽  
Disease Outbreaks ◽  
Control Programs ◽  
Chemical Pesticides ◽  
Improve Disease Control

The mosquito Aedes aegypti (Linnaeus) (Diptera: Culicidae) is a vector for several pathogens that affect human health worldwide. Therefore, mosquito control is the best approach to prevent disease outbreaks. In this milieu, it is preferable to evaluate the effectiveness of chemical pesticides at regular intervals to identify the most effective ones and use them during the outbreaks of diseases and spread of pests. Here, we aimed to study the toxicity of six pesticides, which are classified under two groups, namely pyrethroids and organophosphates, against A. aegypti mosquitoes to improve disease control in Saudi Arabia. Hortak was the most effective in larval mosquito control (LC50 = 0.0031 ppm), followed by Aquapal Super 20 EW (LC50 = 0.0389 ppm), whereas Solfac was the least effective (LC50 = 0.1119 ppm). In addition, the sensitivity of the tested larvae to Safrotin and Keen 600 EC was 8.1 and 58.9 times higher than that to Resfin-5, which was the least effective, respectively. Hortak and Safrotin exhibited the highest toxicity against the larvae of A. aegypti. Our findings confirm that the tested pesticides can be used in mosquito-control programs during epidemic outbreaks and emergency.

scholarly journals Inhaler technique in older people in the community

2004 ◽  
Vol 33 (2) ◽  
pp. 185-188 ◽  
Author(s):  
S. F. Ho
Keyword(s):  
Older People ◽  
Inhaler Technique
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