Department of Medicine, University of Chicago, Instructor, Section of Hospital Medicine, Chicago, IL 60637, USA.
J Gen Intern Med. 2011 Jun;26(6):635-42. doi: 10.1007/s11606-010-1624-2. Epub 2011 Jan 20.
Patients are asked to assume greater responsibility for care, including use of medications, during transitions from hospital to home. Unfortunately, medications dispensed via respiratory inhalers to patients with asthma or chronic obstructive pulmonary disease (COPD) can be difficult to use.
To examine rates of inhaler misuse and to determine if patients with asthma or COPD differed in their ability to learn how to use inhalers correctly.
A cross-sectional and pre/post intervention study at two urban academic hospitals.
Hospitalized patients with asthma or COPD.
A subset of participants received instruction about the correct use of respiratory inhalers.
Use of metered dose inhaler (MDI) and Diskus devices was assessed using checklists. Misuse and mastery of each device were defined as <75% and 100% of steps correct, respectively. Insufficient vision was defined as worse than 20/50 in both eyes. Less-than adequate health literacy was defined as a score of <23/36 on The Short Test of Functional Health Literacy in Adults (S-TOFHLA).
One-hundred participants were enrolled (COPD n = 40; asthma n = 60). Overall, misuse was common (86% MDI, 71% Diskus), and rates of inhaler misuse for participants with COPD versus asthma were similar. Participants with COPD versus asthma were twice as likely to have insufficient vision (43% vs. 20%, p = 0.02) and three-times as likely to have less-than- adequate health literacy (61% vs. 19%, p = 0.001). Participants with insufficient vision were more likely to misuse Diskus devices (95% vs. 61%, p = 0.004). All participants (100%) were able to achieve mastery for both MDI and Diskus devices.
Inhaler misuse is common, but correctable in hospitalized patients with COPD or asthma. Hospitals should implement a program to assess and teach appropriate inhaler technique that can overcome barriers to patient self-management, including insufficient vision, during transitions from hospital to home.
患者被要求在从医院到家庭的过渡期间承担更多的护理责任，包括使用药物。然而，向哮喘或慢性阻塞性肺疾病（COPD）患者分发的呼吸吸入器药物可能难以使用。
检查吸入器误用的发生率，并确定哮喘或 COPD 患者在正确使用吸入器方面的能力是否存在差异。
在两家城市学术医院进行的横断面和前后干预研究。
患有哮喘或 COPD 的住院患者。
一部分参与者接受了关于正确使用呼吸吸入器的指导。
使用计量吸入器（MDI）和 Diskus 设备的情况通过检查表进行评估。将每种设备的误用和掌握程度定义为<75%和 100%的步骤正确。视力不足定义为双眼视力均差于 20/50。健康素养不足定义为成人简易健康素养测试（S-TOFHLA）得分<23/36。
共纳入 100 名参与者（COPD 组 40 名；哮喘组 60 名）。总体而言，误用情况很常见（MDI 为 86%，Diskus 为 71%），且 COPD 患者与哮喘患者的吸入器误用率相似。与哮喘患者相比，COPD 患者视力不足的可能性是其两倍（43%对 20%，p=0.02），健康素养不足的可能性是其三倍（61%对 19%，p=0.001）。视力不足的患者更有可能误用 Diskus 设备（95%对 61%，p=0.004）。所有参与者（100%）都能够熟练掌握 MDI 和 Diskus 设备的使用。
吸入器误用很常见，但在 COPD 或哮喘住院患者中是可以纠正的。医院应实施一项评估和教授适当吸入器技术的计划，该计划可以克服从医院到家庭过渡期间患者自我管理的障碍，包括视力不足和健康素养不足等问题。
