Koh Hock Peng, Teoh Paula Suen Suen, Roslan Nurul Liana
Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia.
Emergency and Trauma Department, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia.
Intern Emerg Med. 2024 Nov 5. doi: 10.1007/s11739-024-03810-5.
Understanding the patients' clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients (n = 85, 70.8%). Most were on regular follow-up (n = 72, 60.0%) and adhered to their inhaler(s) (n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly (n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers' mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.
了解患者的临床特征、最佳吸入器使用的障碍以及依从性对于实现哮喘和慢性阻塞性肺疾病（COPD）的治疗目标至关重要。本研究旨在评估哮喘和COPD患者的吸入器技术，并确定到急诊科（ED）就诊的患者中吸入器依从性的预测因素。这项前瞻性横断面研究招募了2022年3月至2023年2月因轻至中度加重到一家三级医院门诊急诊科就诊的患者。本研究采用便利抽样。对所有受试者的吸入器技术和依从性进行了评估。采用回归分析来确定吸入器依从性的预测因素。我们招募了120名受试者，平均年龄为47.8±16.0岁，主要是哮喘患者（n = 85，70.8%）。大多数患者接受定期随访（n = 72，60.0%）并坚持使用吸入器（n = 86，71.7%）。不到一半的受试者正确使用吸入器（n = 45，37.5%）。确定了吸入器依从性的三个预测因素：定期随访（校正比值比[aOR]2.072，p = 0.041）、正确的吸入器技术（aOR 3.071，p = 0.039）以及解释吸入器作用方式的能力（aOR 10.906，p = 0.031）。哮喘和COPD患者中吸入器技术错误率较高，令人担忧。在管理这组患者时，应针对已确定的吸入器依从性预测因素采取措施。除了在急诊科进行加重期治疗外，转诊至公共基层医疗诊所进行定期随访、评估吸入器技术以及提供咨询以增强患者知识也至关重要。
