Bao Le Khac, Khoa Nguyen Dang, Chi Le Thi Kim, Anh Nguyen Tuan
Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam.
Department of Respiratory, University Medical Center Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam.
J Clin Med. 2023 Jun 30;12(13):4420. doi: 10.3390/jcm12134420.
Chronic obstructive pulmonary disease (COPD) mainly affects individuals aged 60 and older. The proper use of inhalers is crucial for managing COPD. This study aimed to evaluate the prevalence and factors affecting the appropriate use of inhalers among elderly patients with COPD.
We enrolled 91 elderly patients with COPD admitted to the Department of Respiratory, University Medical Center HCMC between October 2020 and May 2021. Patients who were capable of using the inhaler would have their inhaler usage recorded through video footage. Two respiratory experts carefully analyzed 133 video-recorded demonstrations for evaluation purposes.
18.7% of the patients demonstrated the correct inhaler technique. Pressurized metered dose inhaler (pMDI) and Turbuhaler had the lowest documented correct usage rates (11.9% and 10.0%, respectively). Two critical steps, namely "holding breath for about five seconds or as long as comfortable" and "breathing out gently," were commonly performed incorrectly when using pMDI, Respimat, Breezhaler, or Turbuhaler. Multivariable logistic regression analysis showed that lower mMRC scores (AOR = 5.3, CI 1.1-25.5, = 0.037) and receiving inhaler instruction within the past three months (AOR = 5.2, CI 1.3-20.1, = 0.017) were associated with increased odds of using the inhaler correctly.
Our study found that less than 20% of elderly patients with COPD use inhalers correctly. Common errors include inadequate breath-holding and gentle exhalation. mMRC scores and recent inhaler instruction were predictors of proper use. These findings can aid clinicians in improving inhaler management for elderly patients with COPD.
慢性阻塞性肺疾病（COPD）主要影响60岁及以上的人群。正确使用吸入器对COPD的管理至关重要。本研究旨在评估老年COPD患者中吸入器正确使用的患病率及影响因素。
我们纳入了2020年10月至2021年5月期间在胡志明市大学医学中心呼吸科住院的91例老年COPD患者。能够使用吸入器的患者，其吸入器使用情况将通过视频记录。两名呼吸专家仔细分析了133次视频记录的演示以进行评估。
18.7%的患者展示了正确的吸入器使用技术。压力定量吸入器（pMDI）和都保的正确使用率最低（分别为11.9%和10.0%）。在使用pMDI、软雾吸入器、易纳器或都保时，两个关键步骤，即“屏住呼吸约5秒或尽可能长时间”和“轻轻呼气”，通常执行不正确。多变量逻辑回归分析显示，较低的mMRC评分（比值比[AOR]=5.3，置信区间[CI]1.1 - 25.5，P = 0.037）和在过去三个月内接受吸入器指导（AOR = 5.2，CI 1.3 - 20.1，P = 0.017）与正确使用吸入器的几率增加相关。
我们的研究发现，不到20%的老年COPD患者正确使用吸入器。常见错误包括屏气不足和呼气不当。mMRC评分和近期的吸入器指导是正确使用的预测因素。这些发现有助于临床医生改善老年COPD患者的吸入器管理。
