Ibrahim Wanis H, Rasul Fatima, Ahmad Mushtaq, Bajwa Abeer S, Alamlih Laith I, El Arabi Anam M, Al-Mohannadi Dhabia, Siddiqui Mohammed Y, Al-Sheikh Israa S, Ibrahim Azdin A
Senior Consultant Pulmonologist and Professor of Clinical Medicine, Department of Medicine, Hamad General Hospital and Weill-Cornell Medical College, Doha, Qatar.
Consultant Physician, Department of Medicine, Hamad General Hospital, Doha, Qatar.
Can Respir J. 2018 Dec 18;2018:7649629. doi: 10.1155/2018/7649629. eCollection 2018.
Data on inhaler technique and its effects on maternal and fetal outcomes during pregnancy are seldom reported. The primary objective of this study was to evaluate inhaler technique and identify errors in inhaler use among pregnant women with asthma. Secondary objectives were to identify factors associated with poor inhaler technique and study the association between inhaler technique and maternal and fetal outcomes. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. Seventy-three and 41 asthmatic pregnant women reported using pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs), respectively. Overall, wrong inhaler technique was observed in 47 (64.4%) subjects. Among pMDI users, correct inhaler use was observed in only 26/73 (35.6%) of the patients, with lack of coordination between inhalation and generation of the aerosol and failure to breathe out gently before using the inhaler, being the most common errors. Among DPI users, 21 (51.2%) demonstrated correct inhaler use, with failure to perform a breath-hold for 10 seconds after inhaling the powder and to exhale gently before using the inhaler being the most common errors. Significant associations between inhaler technique and patient's understanding of asthma medications and the kind of follow-up clinic (respiratory versus nonrespiratory clinic) were found. No significant associations between inhaler technique and various maternal and fetal outcomes or asthma control were found. In conclusion, improper inhalation technique is significantly prevalent in pregnant asthmatic women, particularly among those being followed in nonspecialized respiratory clinics. The lack of significant association between the inhaler technique and asthma control (and hence maternal and fetal outcomes) may simply reflect the high prevalence of uncontrolled asthma and significant contribution of other barriers to poor asthma control in the current patient's cohort. Multidisciplinary management of asthma during pregnancy with particular emphasis on patient's education is imperative.
关于吸入器使用技术及其对孕期母婴结局影响的数据鲜有报道。本研究的主要目的是评估哮喘孕妇的吸入器使用技术并找出吸入器使用中的错误。次要目的是确定与吸入器使用技术不佳相关的因素，并研究吸入器使用技术与母婴结局之间的关联。这是一项针对80名经医生诊断为哮喘的孕妇的横断面、面对面、前瞻性研究。分别有73名和41名哮喘孕妇报告使用压力定量吸入器（pMDIs）和干粉吸入器（DPIs）。总体而言，47名（64.4%）受试者存在错误的吸入器使用技术。在使用pMDIs的患者中，只有26/73（35.6%）的患者正确使用了吸入器，吸入与气雾剂产生之间缺乏协调以及在使用吸入器前未轻轻呼气是最常见的错误。在使用DPIs的患者中，21名（51.2%）正确使用了吸入器，吸入粉末后未屏气10秒以及在使用吸入器前未轻轻呼气是最常见的错误。发现吸入器使用技术与患者对哮喘药物的理解以及随访诊所类型（呼吸科与非呼吸科诊所）之间存在显著关联。未发现吸入器使用技术与各种母婴结局或哮喘控制之间存在显著关联。总之，不正确的吸入技术在哮喘孕妇中显著普遍，尤其是在非专科呼吸科诊所就诊的患者中。吸入器使用技术与哮喘控制（以及母婴结局）之间缺乏显著关联可能仅仅反映了当前患者队列中未控制哮喘的高患病率以及其他因素对哮喘控制不佳的重大影响。孕期哮喘的多学科管理，尤其强调患者教育，势在必行。
