Li Huaidong, Chen Yuanyuan, Zhang Zhaorui, Dong Xiaoxuan, Zhang Guogang, Zhang Hui
1 Department of Respiratory Disease, the 88th Hospital of the Chinese People's Liberation Army , Tai'an 271000, China .
J Aerosol Med Pulm Drug Deliv. 2014 Jun;27(3):219-27. doi: 10.1089/jamp.2012.1033. Epub 2013 Aug 1.
The incorrect handling of Diskus inhalers in Chinese patients with chronic obstructive pulmonary disease (COPD) is not well documented.
The present study was conducted to evaluate in detail the handling errors related to the Diskus device, and to elucidate the importance of educating COPD patients on the proper use of the device.
A total of 384 COPD patients from a pulmonary clinic in China over a period of 5 years were included in the study. The compliance of COPD patients to the 13 discrete steps of Diskus usage were scored and analyzed by three measures: (1) On day 0, patients were given only a package insert on Diskus, and the handling error rate was assessed. Then the patients were given instruction on the 13-step Diskus procedure until they could demonstrate the proper technique. (2) On days 1, 2, and 3, the observation group was continuously educated on a 13-step procedure, and the percentage of patients who scored 100% for each step was recorded. The control group had no such training. (3) On days 10, 20, and 30, the percentage of all subjects correctly performing the Diskus 13-step inhalation procedure was assessed.
Incorrect handling techniques on Diskus usage were widely distributed among Chinese COPD patients. Step 8 ("Inhale forcefully from the beginning, slowly, deeply, and uniformly during the inspiratory phase until the lungs are full") was the most commonly mishandled step (93.8%). The total score and individual step scores of the patients from the observation group were significantly improved during 3-day continuous education. There was also a significantly higher percentage of correctly performed steps in the observation group than in the control group upon assessment on day 10 (96.24% vs. 85.63%, respectively; p<0.01), day 20 (97.31% vs. 86.09%, respectively; p<0.01), and day 30 (98.19% vs. 87.39%, respectively; p<0.01).
Handling errors of the Diskus 13-step inhalation procedure were commonly observed in Chinese COPD patients. Continuous educational interventions and regular supervision by health-care providers are therefore crucial for the optimum use of the Diskus inhaler.
中国慢性阻塞性肺疾病（COPD）患者对都保吸入器的错误使用情况尚无充分记录。
本研究旨在详细评估与都保装置相关的使用错误，并阐明对COPD患者进行该装置正确使用教育的重要性。
本研究纳入了中国一家肺科诊所5年间的384例COPD患者。通过三种方式对COPD患者都保使用的13个独立步骤的依从性进行评分和分析：（1）在第0天，仅给患者提供都保的包装说明书，并评估使用错误率。然后向患者讲解都保的13步操作步骤，直至他们能够演示正确的技术。（2）在第1、2和3天，对观察组患者持续进行13步操作步骤的教育，并记录每一步得100分的患者百分比。对照组未接受此类培训。（3）在第10、20和30天，评估所有受试者正确执行都保13步吸入操作步骤的百分比。
都保使用的错误操作技术在中国COPD患者中广泛存在。步骤8（“从一开始就用力吸气，在吸气阶段缓慢、深入且均匀地吸气，直到肺部充满”）是最常出现操作错误的步骤（93.8%）。在3天的持续教育期间，观察组患者的总分和各步骤得分均有显著提高。在第10天（分别为96.24%对85.63%；p<0.01）、第20天（分别为97.31%对86.09%；p<0.01）和第30天（分别为98.19%对87.39%；p<0.01）评估时，观察组正确执行步骤的百分比也显著高于对照组。
在中国COPD患者中，常见都保13步吸入操作的使用错误。因此，医护人员持续的教育干预和定期监督对于都保吸入器的最佳使用至关重要。
