1 Rosario University , Program of Physiotherapy, Bogotá, Colombia .
J Aerosol Med Pulm Drug Deliv. 2013 Oct;26(5):287-96. doi: 10.1089/jamp.2011.0940. Epub 2013 Mar 4.
Metered-dose inhalers (MDIs) have become a firsthand therapeutic strategy for the management of respiratory diseases, mainly for chronic obstructive pulmonary disease (COPD) and asthma. It has been determined, however, that patients do not always use these devices correctly. Our primary goal was to establish the level of technical knowledge of patients with COPD and/or asthma on the use of MDIs, as well as other associated factors related to the effective use of this delivery method.
This study was performed with 191 patients (49.2% male, 50.8% female) diagnosed with COPD and/or asthma at Hospital Universitario Mayor (Bogotá, Colombia). The agreement between different observers on nine aspects of the use of the inhaler was assessed by testing the unweighted kappa correlation coefficient and its significance. The correlations between demographic variables, risk factors, and proper knowledge of the adequate use of inhalers were established by means of the Pearson chi-square test (also called Fisher exact test) (expected values less than 5). Statistical tests were evaluated at a significance level equivalent to 5% (p<0.05).
The study detected deficiencies in educational factors, specifically regarding the initial contact with the patient and regular follow-up by the team of health professionals. It also showed insufficient strategies for the training of patients in the use of the inhalers. There were no significant differences by gender (p>0.05) in the implementation of the various aspects of the proper use sequence for MDIs. However, there were significant differences related to education levels, socioeconomic status, age, and current occupation. A worse inhaler technique was associated with lower education level (0.034), higher age (p=0.003), and absence of job (p=0.005). Changes in the education of patients on the issue, together with the use of the spacer/valved holding chamber proved to be valid strategies that, with the support of the patients' health-care team, were able to improve the MDI technique of the studied group.
定量吸入器（MDIs）已成为治疗呼吸系统疾病（主要是慢性阻塞性肺疾病（COPD）和哮喘）的首选治疗策略。然而，已经确定患者并不总是正确使用这些设备。我们的主要目标是确定 COPD 和/或哮喘患者对 MDI 使用的技术知识水平，以及与这种输送方法有效使用相关的其他相关因素。
这项研究是在哥伦比亚波哥大的 Hospital Universitario Mayor 对 191 名（49.2%为男性，50.8%为女性）确诊为 COPD 和/或哮喘的患者进行的。通过测试未加权 kappa 相关系数及其显著性来评估不同观察者对吸入器使用的九个方面的一致性。通过 Pearson 卡方检验（也称为 Fisher 确切检验）（预期值小于 5）确定人口统计学变量、危险因素与适当使用吸入器的知识之间的相关性。统计检验在等效于 5%的显著性水平下进行评估（p<0.05）。
该研究发现教育因素存在缺陷，特别是在与患者的初次接触和医疗保健团队的定期随访方面。它还表明，在培训患者使用吸入器方面，策略不足。在实施 MDI 正确使用顺序的各个方面，性别之间没有差异（p>0.05）。然而，在教育程度、社会经济地位、年龄和当前职业方面存在显著差异。较差的吸入器技术与较低的教育程度（0.034）、较高的年龄（p=0.003）和没有工作（p=0.005）相关。针对患者教育问题的变化，以及使用间隔器/阀控保持室被证明是有效的策略，在患者医疗保健团队的支持下，能够提高研究组的 MDI 技术。
