Inhaler mishandling remains common in real life and is associated with reduced disease control
TL;DR: In this paper, the authors investigated the prevalence of inhaler mishandling in a large population of experienced patients referring to chest clinics; to analyze the variables associated with misuse and the relationship between inhaler handling and health-care resources use and disease control.
About: This article is published in Respiratory Medicine.The article was published on 2011-06-01 and is currently open access. It has received 681 citations till now. The article focuses on the topics: Dry-powder inhaler & Inhaler.
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University of Marburg1, Temple University2, NewYork–Presbyterian Hospital3, University of Texas Health Science Center at San Antonio4, National Institutes of Health5, McGill University Health Centre6, Brigham and Women's Hospital7, Guangzhou Medical University8, Katholieke Universiteit Leuven9, University of Modena and Reggio Emilia10, Flinders University11, Royal Devon and Exeter Hospital12, University of the Republic13, Hokkaido University14, University of Paris15, University of Barcelona16, University of British Columbia17, University of Manchester18
TL;DR: The assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation, and the concept of deescalation of therapy is introduced in the treatment assessment scheme.
Abstract: This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.
2,547 citations
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University of Marburg1, Temple University2, NewYork–Presbyterian Hospital3, University of Texas Health Science Center at San Antonio4, National Institutes of Health5, McGill University Health Centre6, Brigham and Women's Hospital7, Guangzhou Medical University8, Katholieke Universiteit Leuven9, University of Modena and Reggio Emilia10, Flinders University11, Royal Devon and Exeter Hospital12, University of the Republic13, Hokkaido University14, Paris Descartes University15, University of Barcelona16, University of British Columbia17, University of Manchester18, United Nations Industrial Development Organization19, Imperial College London20
TL;DR: The assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation, and the concept of de-escalation of therapy is introduced in the treatment assessment scheme.
Abstract: This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
818 citations
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University of Marburg1, Temple University2, NewYork–Presbyterian Hospital3, University of Texas Health Science Center at San Antonio4, National Institutes of Health5, McGill University Health Centre6, Brigham and Women's Hospital7, Guangzhou Medical University8, Katholieke Universiteit Leuven9, University of Modena and Reggio Emilia10, Flinders University11, Royal Devon and Exeter Hospital12, University of the Republic13, Hokkaido University14, University of Paris15, University of Barcelona16, University of British Columbia17, University of Manchester18
TL;DR: The assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation, and the concept of de‐escalation of therapy is introduced in the treatment assessment scheme.
Abstract: This Executive Summary of the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: (i) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; (iv)non-pharmacological therapies are comprehensively presented and (v) the importance of co-morbid conditions in managing COPD is reviewed.
683 citations
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Woolcock Institute of Medical Research1, University of Cape Town2, University of Manitoba3, Laval University4, Federal University of Bahia5, Harvard University6, Helsinki University Central Hospital7, Kagoshima University8, Erasmus University Rotterdam9, University of Wisconsin-Madison10, McMaster University11, University of Pisa12, University of Southern Denmark13, Universidade Federal de Santa Catarina14, University of Costa Rica15, Boston Children's Hospital16, The Chinese University of Hong Kong17, University of British Columbia18
TL;DR: The changes include a revised asthma definition, tools for assessing symptom control and risk factors for adverse outcomes, and updated strategies for adaptation and implementation of GINA recommendations.
Abstract: Over the past 20 years, the Global Initiative for Asthma (GINA) has regularly published and annually updated a global strategy for asthma management and prevention that has formed the basis for many national guidelines. However, uptake of existing guidelines is poor. A major revision of the GINA report was published in 2014, and updated in 2015, reflecting an evolving understanding of heterogeneous airways disease, a broader evidence base, increasing interest in targeted treatment, and evidence about effective implementation approaches. During development of the report, the clinical utility of recommendations and strategies for their practical implementation were considered in parallel with the scientific evidence.This article provides a summary of key changes in the GINA report, and their rationale. The changes include a revised asthma definition; tools for assessing symptom control and risk factors for adverse outcomes; expanded indications for inhaled corticosteroid therapy; a framework for targeted treatment based on phenotype, modifiable risk factors, patient preference, and practical issues; optimisation of medication effectiveness by addressing inhaler technique and adherence; revised recommendations about written asthma action plans; diagnosis and initial treatment of the asthma-chronic obstructive pulmonary disease overlap syndrome; diagnosis in wheezing pre-school children; and updated strategies for adaptation and implementation of GINA recommendations.
657 citations
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University of Marburg1, Temple University2, NewYork–Presbyterian Hospital3, University of Texas Health Science Center at San Antonio4, National Institutes of Health5, McGill University Health Centre6, Brigham and Women's Hospital7, Guangzhou Medical University8, Katholieke Universiteit Leuven9, University of Modena and Reggio Emilia10, Flinders University11, Royal Devon and Exeter Hospital12, University of the Republic13, Hokkaido University14, Paris Descartes University15, University of Barcelona16, University of British Columbia17, University of Manchester18, University of Birmingham19
TL;DR: The assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation, and the importance of comorbid conditions in managing COPD is reviewed.
Abstract: This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
444 citations
References
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TL;DR: Assessing the total lung capacity is indispensable in establishing a restrictive ventilatory defect or in diagnosing abnormal lung distensibility, as may occur in patients …
Abstract: Lung volumes are subdivided into static and dynamic lung volumes. Static lung volumes are measured by methods which are based on the completeness of respiratory manoeuvres, so that the velocity of the manoeuvres should be adjusted accordingly. The measurements taken during fast breathing movements are described as dynamic lung volumes and as forced inspiratory and expiratory flows.
### 1.1 Static lung volumes and capacities
The volume of gas in the lung and intrathoracic airways is determined by the properties of lung parenchyma and surrounding organs and tissues, surface tension, the force exerted by respiratory muscles, by lung reflexes and by the properties of airways. The gas volumes of thorax and lung are the same except in the case of a pneumothorax. If two or more subdivisions of the total lung capacity are taken together, the sum of the constituent volumes is described as a lung capacity. Lung volumes and capacities are described in more detail in § 2.
#### 1.1.1 Determinants
Factors which determine the size of the normal lung include stature, age, sex, body mass, posture, habitus, ethnic group, reflex factors and daily activity pattern. The level of maximal inspiration (total lung capacity, TLC) is influenced by the force developed by the inspiratory muscles (disorders include e.g. muscular dystrophy), the elastic recoil of the lung (disorders include e.g. pulmonary fibrosis and emphysema) and the elastic properties of the thorax and adjacent structures (disorders include e.g. ankylosis of joints). The level of maximal expiration (residual volume, RV) is determined by the force exerted by respiratory muscles (disorders include e.g. muscle paralysis), obstruction, occlusion and compression of small airways (disorders include e.g. emphysema) and by the mechanical properties of lung and thorax (disorders include diffuse fibrosis, kyphoscoliosis).
Assessing the total lung capacity is indispensable in establishing a restrictive ventilatory defect or in diagnosing abnormal lung distensibility, as may occur in patients …
5,052 citations
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TL;DR: Results reinforce the usefulness of a brief, easy to administer, patient-based index of asthma control.
Abstract: Background Asthma guidelines indicate that the goal of treatment should be optimum asthma control In a busy clinic practice with limited time and resources, there is need for a simple method for assessing asthma control with or without lung function testing Objectives The objective of this article was to describe the development of the Asthma Control Test (ACT), a patient-based tool for identifying patients with poorly controlled asthma Methods A 22-item survey was administered to 471 patients with asthma in the offices of asthma specialists The specialist's rating of asthma control after spirometry was also collected Stepwise regression methods were used to select a subset of items that showed the greatest discriminant validity in relation to the specialist's rating of asthma control Internal consistency reliability was computed, and discriminant validity tests were conducted for ACT scale scores The performance of ACT was investigated by using logistic regression methods and receiver operating characteristic analyses Results Five items were selected from regression analyses The internal consistency reliability of the 5-item ACT scale was 084 ACT scale scores discriminated between groups of patients differing in the specialist's rating of asthma control (F = 345, P P 1 (F = 43, P = 0052) As a screening tool, the overall agreement between ACT and the specialist's rating ranged from 71% to 78% depending on the cut points used, and the area under the receiver operating characteristic curve was 077 Conclusion Results reinforce the usefulness of a brief, easy to administer, patient-based index of asthma control
2,400 citations
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TL;DR: The results show that the BDI, MRC scale, and OCD provide significantly related measures of Dyspnea, and the clinical ratings of dyspnea correlate significantly with physiologic parameters of lung function; and breathlessness may be related to the pathophysiology of the specific respiratory disease.
1,374 citations
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TL;DR: It is demonstrated that incorrect DPI technique with established DPIs is common among patients with asthma and COPD, and suggests that poor inhalation technique has detrimental consequences for clinical efficacy.
542 citations
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TL;DR: Misuse of pressurized metered-dose inhalers, which is mainly due to poor coordination, is frequent and associated with poorer asthma control in inhaled corticosteroid-treated asthmatics, highlighting the importance of evaluating inhalation technique and providing appropriate education in all patients.
Abstract: This study assessed whether the improper use of pressurized metered-dose inhalers (pMDIs) is associated with decreased asthma control in asthmatics treated by inhaled corticosteroids (ICS). General practitioners (GPs) included consecutive asthmatic outpatients treated by pMDI-administered ICS and on-demand, short-acting beta2-agonists. They measured an asthma instability score (AIS) based on daytime and nocturnal symptoms, exercise-induced dyspnoea, beta2-agonist usage, emergency-care visits and global perception of asthma control within the preceding month; the inhalation technique of the patient also was assessed. GPs (n=915) included 4,078 adult asthmatics; 3,955 questionnaires were evaluable. pMDI was misused by 71% of patients, of which 47% was due to poor coordination. Asthma was less stable in pMDI misusers than in good users (AIS: 3.93 versus 2.86, p<0.001). Among misusers, asthma was less stable in poor coordinators (AIS: 4.38 versus 3.56 in good coordinators, p<0.001). To conclude, misuse of pressurized metered-dose inhalers, which is mainly due to poor coordination, is frequent and associated with poorer asthma control in inhaled corticosteroid-treated asthmatics. This study highlights the importance of evaluating inhalation technique and providing appropriate education in all patients, especially before increasing inhaled corticosteroid dosage or adding other agents. The use of devices which alleviate coordination problems should be reinforced in pressurized metered-dose inhaler misusers.
513 citations