Is there potential to use augmented reality technology to provide demonstrative inhaler technique education for asthma patients? A qualitative study (Preprint)

BACKGROUND Many people with asthma use incorrect inhaler technique resulting in sub-optimal disease management and increased health service utilisation. Novel ways of delivering appropriate instructions are needed. OBJECTIVE This study explores stakeholder perspectives on the potential use of augmented reality (AR) technology to improve asthma inhaler technique education. METHODS Based on existing evidence and resources, an information poster displaying the images of 22 asthma inhaler devices was produced. Using AR technology via a free smartphone application, the poster launched video demonstrations of correct inhaler technique for each device. Twenty‐one semi‐structured, one‐on‐one interviews with health professionals, people with asthma and key community stakeholders were conducted and data was analysed thematically using the Triandis model of interpersonal behaviour. RESULTS People with asthma believed they were competent with inhaler technique. However, health professionals and key community stakeholders identified that this perception was misguided and facilitates persistent incorrect inhaler use and sub‐optimal disease management. Delivering inhaler technique education using augmented reality was favoured by all participants, particularly around ease of use, with the ability to visually display inhaler techniques for each device. However, all participants identified some barriers, particularly for access and appropriateness of AR for older people. CONCLUSIONS Augmented reality technology may be a novel means to address poor inhaler technique among certain cohorts of asthma patients and serve as a prompt for health professionals to initiate review of inhaler devices. A randomised controlled trial design is needed to evaluate efficacy of this technology for use in the clinical care setting.

A Concise Overview on Recent Advances in Pharmaceutical Aerosols and Their Commercial Applications

Background: Localized drug delivery to the respiratory system has become an increasingly successful and essential treatment strategy for several pulmonary diseases, including asthma, chronic abstractive disease, pneumonia, bronchitis, and cystic fibrosis. The rising incidence of respiratory diseases is a significant factor driving the worldwide market for respiratory inhaler devices. Objective: The objective of this article is to present various aspects of pharmaceutical aerosols, including their types, components, fundamentals, in-process and finished product quality control tests based on pharmacopeial standards and specifications, and commercial utility considering the pharmaceutical aerosol dosage forms that have been patented from 2000 to 2020, along with a list of marketed pharmaceutical products. Method: Aerosol, collectively referred to as a pressurized device, operates by triggering an appropriate valve system with a continuous or metered dosage of tiny mist spray. It is used not only in the treatment of asthma and chronic obstructive pulmonary disease but also in the treatment of cancer, diabetes, migraine, angina pectoris, acute lung injury, bone disorders, tuberculosis, and many more. A multitude of different variables, including types and properties of propellants, active substances, containers, valves, actuators, spray patterns, valve crimping efficiency, and particle size of the aerosols, influence the therapeutic effectiveness of pharmaceutical aerosols. Conclusion: Based on the current findings, distinct characteristics such as the elimination of firstpass metabolism, quick drug absorption, ease of therapy termination, as well as a larger surface area have attributed to the success of pharmaceutical aerosols.

Nurses Lack of Knowledge On Inhaler Devices In China: A Cross-Sectional Study

Background: To know the knowledge on inhaler devices in medical staff, this study surveyed knowledge of inhaled therapy and the use of inhaler devices in nurses in China.Methods: 1831 nurses were selected to survey on a new self-designed questionnaire online. The questionnaire has 11 questions, including the storage location of the inhaler devices, steps of using the inhaler device, and the common errors when using various devices, etc. Results: Among the 1831 participants, 816(44.57%), 122(6.66%) and 893(48.77%) nurses worked in community hospital, secondary hospital and tertiary hospital respectively. Adequate knowledge of inhaler devices was demonstrated by nurses working in community hospital(20.10%)、Secondary hospital(8.2%) and Tertiary hospital(13.1%). 27.70% nurses in community hospital knew operational key points in using inhaler compared to in secondary hospital (15.57%) and tertiary hospital (23.18%) P<0.01. Only 9.5%-26.00% of participants chosen correct answers about the ten questions about the use of inhaler. Question six (Which of the following is the wrong option when using Ellpta?) was the one with the highest percentage of correct answers (26.00%). The question with lowest rate of correct answers (9.50%) was question 3 (What are the main points that need to be followed when using DPI?). The most people of correct answers number is Ellpta(26.00%) and the least is Respimat(10.32%). Conclusion: The focus on community hospitals has some results in China. However, knowledge on inhaler devices should be continued to strengthen among nurses in hospital. It is necessary to create training opportunities for nurses to increase their awareness and knowledge of chronic respiratory diseases management.

Clinical Impact of Pharmaceutical Consultations in Patients Treated for Chronic Obstructive Pulmonary Disease: Study Protocol for a Randomized Controlled Trial (BPCObs study).

BackgroundChronic obstructive pulmonary disease (COPD) is an irreversible chronic respiratory disease whose evolution depends on the patient’s adherence to inhaler devices. Pharmacists may play a role in adherence to medication therapy in hospital and in primary care interacting with patients to provide advice on proper use. This paper presents the protocol for a randomized controlled trial conducted at a university hospital to assess the clinical impact of pharmaceutical consultations on COPD exacerbations, medical care, adherence to inhaler devices and quality of life. MethodsThis trial will include 226 COPD patients treated with inhaler devices: 94 in a control group with the usual hospital care, 66 receiving a pharmaceutical consultation at the hospital and 66 receiving several pharmaceutical consultations at their community pharmacy. The aim of these interventions is to inform patients about COPD and medication therapy, train them in the proper use of inhaler devices and make them aware of good therapeutic adherence. Patients will be randomized to either the control group or the experimental hospital group by the clinical pharmacist at the hospital. Community pharmacists will include patients in the experimental community group. All patients will be monitored for 12 months by their community pharmacists (CPs). The primary outcome is the mean number of COPD exacerbations. Secondary outcomes include the number of medical consultations, emergency visits and hospitalizations; patients’ adherence to inhaler devices and ability to use them and quality of life. DiscussionOur study is the first randomized controlled trial in France to assess the effect of pharmaceutical interventions on COPD exacerbations. Study limitations include patient recruitment and the CPs’ adherence to follow-up. Indeed, the success of this trial depends on the willingness of CPs to collect the data. However, we envisage this work as the first step towards building a network of CPs trained for clinical research. Trial registrationClinicaltrials.gov, NCT03704545. Registered on October 12th, 2018. https://clinicaltrials.gov/ct2/show/NCT03704545?cond=COPD&cntry=FR&city=nimes&draw=2&rank=1

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

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.

Critical inhaler technique errors in Swedish patients with COPD: a cross-sectional study analysing video-recorded demonstrations

A correct use of inhaler devices is essential in chronic obstructive pulmonary disease (COPD) treatment. Critical errors were studied by analysing 659 video-recorded demonstrations of inhaler technique from 364 COPD patients using six different inhaler device models. The majority of the included patients used two (55%) or more (20%) device models. Overall, 66% of the patients made ≥1 critical error with at least one device model. The corresponding numbers for patients using 1, 2 and ≥3 device models were 43%, 70% and 86%, respectively. The only factor associated with making ≥1 critical error was simultaneous use of two (adjusted odds ratios (aOR) 3.17, 95% confidence interval (95% CI) 1.81, 5.64) or three or more (aOR 8.97, 95% CI 3.93, 22.1) device models. In conclusion, the proportion of patients making critical errors in inhaler technique was substantial, particularly in those using several different device models. To obtain optimal COPD treatment, it is important to assess a patient’s inhaler technique and to minimise the number of inhaler device models.

Pharmacology

Pharmacology is the study of the actions, mechanisms, uses, and adverse effects of a drug. A drug is any natural or synthetic substance that changes the physiological state of a living organism. In respiratory medicine drugs are used for the prevention, diagnosis, and treatment of a disease. This chapter begins by outlining basic pharmacology and pharmacokinetics, absorption, distribution, metabolism, and excretion. It then covers pharmacodynamics and adverse drug reactions (ADRs). It then begins to look at β‎2 agonists for asthma and COPD, oral bronchodilators, anticholinergic bronchodilators, theophyllines, and corticosteroids. Combinations of different drug therapies for respiratory conditions are described. Monoclonal antibody therapies are described, including dosing regimens, administration, side effects, and interactions. Different inhaler devices are covered. Patient engagement and placebo devices are included.