Takaku Yotaro, Kurashima Kazuyoshi, Ohta Chie, Ishiguro Takashi, Kagiyama Naho, Yanagisawa Tsutomu, Takayanagi Noboru
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Itai, 1696, Kumagaya city, Saitama, Japan.
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Itai, 1696, Kumagaya city, Saitama, Japan.
Respir Med. 2017 Feb;123:110-115. doi: 10.1016/j.rmed.2016.12.012. Epub 2016 Dec 21.
In the treatment of asthma and chronic obstructive pulmonary disease (COPD), errors in handling and wrong techniques in using inhalation devices are associated with poor disease control. The aim of this study was to evaluate the number of instructions that are necessary to minimize errors in using pressurized metered-dose inhaler (pMDI), soft mist inhaler (SMI), and dry powder inhaler (DPI). Among 216 patients with asthma (n = 135) and COPD (n = 81), we studied 245 cases that used different types of inhalation devices. After initial guidance, 145 of 245 cases (59%) made at least one error that could affect efficacy. For every device, at least three instructions were required to achieve entirely no errors or less than 10% errors in total. The most common error on the use of pMDI was device handling, whereas that of DPI was inhalation manner. Both errors were associated with low peak flow rate. In both patients with asthma and in patients with COPD, the most common error was inhalation manner. We concluded that it is necessary to repeat at least three times of instructions to achieve effective inhalation skills in both asthma and COPD patients.
在哮喘和慢性阻塞性肺疾病（COPD）的治疗中，吸入装置的操作失误和使用技术错误与疾病控制不佳有关。本研究的目的是评估为尽量减少使用压力定量吸入器（pMDI）、软雾吸入器（SMI）和干粉吸入器（DPI）时的错误所需的指导次数。在216例哮喘患者（n = 135）和COPD患者（n = 81）中，我们研究了245例使用不同类型吸入装置的病例。初始指导后，245例病例中有145例（59%）至少出现了一个可能影响疗效的错误。对于每种装置，至少需要三条指导才能完全不出现错误或使总错误率低于10%。使用pMDI最常见的错误是装置操作，而使用DPI最常见的错误是吸入方式。这两种错误都与低峰流速有关。在哮喘患者和COPD患者中，最常见的错误都是吸入方式。我们得出结论，有必要至少重复三次指导，以使哮喘和COPD患者掌握有效的吸入技巧。
