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吸入器的转换:一种值得关注的实用方法。

Switching Inhalers: A Practical Approach to Keep on UR RADAR.

作者信息

Kaplan Alan, van Boven Job F M

机构信息

Department of Family and Community Medicine, University of Toronto, Toronto, Canada.

Primary Care Respiratory Research, Observational and Pragmatic Research Institute, Singapore, Singapore.

出版信息

Pulm Ther. 2020 Dec;6(2):381-392. doi: 10.1007/s41030-020-00133-6. Epub 2020 Oct 13.

Abstract

The choice of an inhaler device is often as important as the medication put in it to achieve optimal outcomes for our patients with asthma and/or COPD. With a multitude of drug-device combinations available, optimization of respiratory treatment could well be established by switching devices rather than changing or even augmenting pharmacological or non-pharmacological therapies. Importantly, while notable between-device differences in release mechanism, particle size, drug deposition and required inspiratory flow exist, a patient uncomfortable with their device is unlikely to use it regularly and certainly will not use it properly. Switching requires a careful process and should not be done without patient consent. Switching devices entails several steps that need to be considered, which can be guided using the UR-RADAR mnemonic. It starts with (i) UncontRolled asthma/COPD (or UnaffoRdable device), followed by RADAR: (ii) review the patient's condition (e.g. diagnosis, phenotype, co-morbidities) and address reasons for suboptimal control (e.g. triggers, smoking, non-adherence, poor inhaler technique) to be ruled out before switching; (iii) assess patient's skills related to inhalation (e.g. inspiratory force); (iv) discuss inhaler switch options, patient preferences (e.g. size, daily regimen) and treatment goals; (v) allow patients input and use shared decision-making to decide final treatment choice, acknowledging individual patient skills, preferences and goals; and (vi) re-educate to the new device (at minimum, physical demonstration, verbal explanation and patient repetition, both verbally and physically) and prime the patient for the follow-up (i.e. explain the future patient journey, including multidisciplinary work flows with physicians, nurses and pharmacists).

摘要

对于哮喘和/或慢性阻塞性肺疾病(COPD)患者而言,吸入装置的选择往往与其中所使用的药物同等重要,这对于实现最佳治疗效果至关重要。鉴于有多种药物与装置的组合可供选择,优化呼吸治疗很可能通过更换装置来实现,而非改变甚至增加药物或非药物治疗方法。重要的是,虽然不同装置在释放机制、颗粒大小、药物沉积和所需吸气流量方面存在显著差异,但患者若对其使用的装置感到不适,就不太可能定期使用,而且肯定无法正确使用。更换装置需要一个谨慎的过程,未经患者同意不应进行。更换装置需要考虑几个步骤,可使用UR-RADAR助记法来指导。首先是(i)未得到控制的哮喘/COPD(或负担不起的装置),接着是RADAR:(ii)在更换装置之前,复查患者的病情(如诊断、表型、合并症),并排除控制不佳的原因(如触发因素、吸烟、不依从、吸入技术不佳);(iii)评估患者与吸入相关的技能(如吸气力量);(iv)讨论吸入器更换选项、患者偏好(如尺寸、每日用药方案)和治疗目标;(v)允许患者参与并采用共同决策来决定最终的治疗选择,同时考虑患者的个人技能、偏好和目标;以及(vi)对新装置进行再教育(至少进行实物演示、口头解释以及患者的口头和实际重复操作),并让患者为后续治疗做好准备(即解释未来的患者就医流程,包括与医生、护士和药剂师的多学科工作流程)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e045/7672131/ec6bcaacfd8c/41030_2020_133_Fig1_HTML.jpg

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