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慢性阻塞性肺疾病或哮喘患者经培训与咨询后吸入技术的改善

Improvement in Inhaler Techniques After Training and Counseling in Patients With Chronic Obstructive Pulmonary Disease or Asthma.

作者信息

Abbas Muhammad Asad, Tariq Owais, Bin Zafar Saad, Jamil Muhammad Irfan, Hamid Khizra, Iqbal Aqsa, Ahmed Adeel, Naeem Iqra

机构信息

General Medicine, Pak Emirates Military Hospital, Rawalpindi, PAK.

Gastroenterology, Lahore General Hospital, Lahore, PAK.

出版信息

Cureus. 2024 Jun 12;16(6):e62255. doi: 10.7759/cureus.62255. eCollection 2024 Jun.

Abstract

Background Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma significantly impair quality of life and impose a substantial burden on healthcare systems. Proper inhalation technique is important for effective management of these diseases, yet remains poorly performed by many patients. This study evaluated the impact of structured counseling and training sessions on inhaler use among patients with COPD and asthma, aiming to enhance technique correctness and disease control. Methodology This cross-sectional study analyzed 150 patients with asthma and COPD who fulfilled the inclusion criteria for inhalation techniques. Patients were counseled regarding the proper seven-step inhalation technique for each inhaler type [metered-dose inhaler (MDI), MDI with spacer, and dry powder inhaler (DPI)] through practical demonstration at baseline visits. Correct use of inhalers was assessed by a predefined checklist for each inhaler device at the baseline visit and after three months. The correctness of the inhalation technique was evaluated by scoring each of the seven steps. The disease control assessment was done using the COPD assessment test (CAT) and asthma control test (ACT) at the baseline visit and after three months. Results In this study of 150 patients, there were 97 (64.7%) males and 53 (35.3%) females. In total, 67 (44.7%) were diagnosed with asthma and 83 (55.3%) with COPD. The mean age was 45.33 ± 12.62 years. Post-counseling improvements in inhaler technique were marked, with MDI users enhancing their technique score from an average of 4.4 to 6.1, MDI with spacer from 4.56 to 6.26, and DPI from 4.92 to 6.24 (p < 0.001 for all). Disease control also showed significant gains; CAT scores decreased for MDI users from 23.4 to 20.5, MDI with spacer from 23.92 to 20.96, and DPI from 24.89 to 21.96. Concurrently, ACT scores increased for MDI users from 16.4 to 18.0 (p = 0.002), MDI with spacer from 17.29 to 19.04, and DPI from 16.42 to 18.37 (p < 0.001 for both), reflecting substantive advances in managing COPD and asthma symptoms. Furthermore, patients with primary education exhibited a significant boost in technique mastery post-counseling (p < 0.001), underscoring the potential of well-crafted counseling to transcend educational barriers in promoting effective inhaler use. Conclusions Post-counseling, inhaler technique improved significantly across all types, with MDI with spacer users demonstrating the most progress. Technique scores increased notably (p < 0.001), and disease control scores for COPD and asthma, measured by CAT and ACT, also showed significant improvements (p < 0.001). Remarkably, primary education level participants exhibited substantial technique gains post-intervention, emphasizing the effectiveness of counseling irrespective of initial educational status in enhancing inhaler use and disease management.

摘要

背景 慢性阻塞性肺疾病(COPD)和哮喘等慢性呼吸道疾病严重损害生活质量,并给医疗系统带来沉重负担。正确的吸入技术对于有效管理这些疾病很重要,但许多患者的执行情况仍然很差。本研究评估了结构化咨询和培训课程对COPD和哮喘患者吸入器使用的影响,旨在提高技术正确性和疾病控制水平。

方法 这项横断面研究分析了150名符合吸入技术纳入标准的哮喘和COPD患者。在基线访视时,通过实际演示向患者讲解了每种吸入器类型(定量吸入器(MDI)、带储雾罐的MDI和干粉吸入器(DPI))正确的七步吸入技术。在基线访视时和三个月后,通过针对每种吸入器设备的预定义检查表评估吸入器的正确使用情况。通过对七个步骤中的每一步进行评分来评估吸入技术的正确性。在基线访视时和三个月后,使用COPD评估测试(CAT)和哮喘控制测试(ACT)进行疾病控制评估。

结果 在这项对150名患者的研究中,男性97名(64.7%),女性53名(35.3%)。总共67名(44.7%)被诊断为哮喘,83名(55.3%)被诊断为COPD。平均年龄为45.33±12.62岁。咨询后吸入器技术有显著改善,MDI使用者的技术得分从平均4.4提高到6.1,带储雾罐的MDI从4.56提高到6.26,DPI从4.92提高到6.24(所有p<0.001)。疾病控制也有显著改善;MDI使用者的CAT评分从23.4降至20.5,带储雾罐的MDI从23.92降至20.96,DPI从24.89降至21.96。同时,MDI使用者的ACT评分从16.4提高到18.0(p=0.002),带储雾罐的MDI从17.29提高到19.04,DPI从16.42提高到18.37(两者p<0.001), 这反映了在管理COPD和哮喘症状方面的实质性进展。此外,接受小学教育的患者在咨询后技术掌握程度有显著提高(p<0.001),强调了精心设计的咨询在促进有效使用吸入器方面克服教育障碍的潜力。

结论 咨询后,所有类型的吸入器技术都有显著改善,带储雾罐的MDI使用者进步最大。技术得分显著提高(p<0.001),通过CAT和ACT测量的COPD和哮喘疾病控制评分也有显著改善(p<0.001)。值得注意的是,小学教育水平的参与者在干预后技术有显著提高,强调了咨询在提高吸入器使用和疾病管理方面的有效性,无论初始教育状况如何。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9166/11245178/86c94776c84d/cureus-0016-00000062255-i01.jpg

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