Gracia-Antequera M, Morales Suárez-Varela M
Department of Pediatrics, Hospital Universitario Doctor Peset, Valencia, 46017, España.
Allergol Immunopathol (Madr). 1999 Sep-Oct;27(5):255-60.
most patients use their inhalers incorrectly and recent asthma management clinical guidelines recommend demonstrating skills and correcting performance at each asthma follow-up visit. However, this statement is poorly evidence-based and few intervention studies have assessed quantitatively the effectiveness of this recommendation.
from a total of 3,076 children and adolescents with asthma attending an outpatient clinic, a random, representative sample of 255 was obtained and assessed at baseline with a standardised questionnaire regarding their skills when using one of three inhaler devices: pressurised direct aerosol (PDA), dry powder (DP) and aerosol pressurised in expanded camera (APEC). Structured sessions of correct use and handling of inhalers were offered and a new assessment was undertaken after an average of 10.5 months (SD 4.5).
only 142 asthmatics maintained the same inhaler device during the study period. An increase of correct manoeuvres was observed for all three devices, and the relative risk and 95% confidence interval (RR and 95% CI) of incorrect post-intervention use was 0.23 (95% CI 0.10-0.56) for PDA, 0.59 (95% CI 0.38-0.92) for DP, and 0.54 (95% CI 0.32-0.90) for APEC. A multivariate analysis indicates that this improvement was observed irrespective of gender and age interval, and that it was even better when parents cooperated with medical and nursing staff.
a dramatic improvement in correct manoeuvres with any of three inhaler devices after active performance training was observed. This easy, highly effective, low cost (in terms of time and personnel) intervention should be routinely implemented in any control visit of asthmatics, leading to a better management of asthma.
大多数患者吸入器使用方法不正确，近期哮喘管理临床指南建议在每次哮喘随访时展示使用技巧并纠正操作。然而，这一说法缺乏充分证据，很少有干预研究定量评估该建议的有效性。
从3076名到门诊就诊的儿童和青少年哮喘患者中，随机抽取255名具有代表性的样本，并在基线时用标准化问卷评估他们使用三种吸入装置之一的技巧，这三种装置分别是：压力定量气雾剂（PDA）、干粉吸入器（DP）和储雾罐压力定量气雾剂（APEC）。提供了关于正确使用和操作吸入器的结构化培训课程，并在平均10.5个月（标准差4.5）后进行了新的评估。
在研究期间，只有142名哮喘患者一直使用同一种吸入装置。观察到所有三种装置的正确操作都有所增加，干预后使用错误的相对风险和95%置信区间（RR和95%CI），PDA为0.23（95%CI 0.10 - 0.56），DP为0.59（95%CI 0.38 - 0.92），APEC为0.54（95%CI 0.32 - 0.90）。多变量分析表明，无论性别和年龄区间如何，都观察到了这种改善，而且当父母与医护人员合作时改善更明显。
在进行积极的操作培训后，观察到使用三种吸入装置中任何一种的正确操作都有显著改善。这种简单、高效、低成本（在时间和人力方面）的干预措施应在哮喘患者的任何一次控制访视中常规实施，从而实现更好的哮喘管理。
