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
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
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
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
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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Journal Article•
TL;DR: The optimum inhalation technique for a beta-adrenergic aerosol indicated by these data (slow inhalation with 10 s breath holding) confirms the results of previous studies.
Abstract: The deposition of aerosol consisting of Teflon particles (mass median aerodynamic diameter 3.2 micrometers) labelled with 99Tcm has been measured in patients with obstructive airways disease. Aerosol was inhaled at 30 l min-1 with 4 s breath holding (patient group A) and at 30 l min-1 with 10 s breath holding (patient group B). A further group of patients (group C) inhaled at 90 l min-1 with 10 s breath holding. Each subject was given the aerosol during inhalation at three different lung volumes (20% VC, 50% VC and 80% VC) on three different days. The greatest whole lung, tracheobronchial and alveolar depositions occurred in group B patients, irrespective of the lung volume of aerosol actuation. By comparison, deposition was similar in groups A and C only when the aerosol was actuated at 20% VC. Whole lung deposition in groups A and B was significantly correlated both with the bronchodilator response to terbutaline sulphate aerosol administered under the same inhalation conditions and with the residence time of airborne particles in the respiratory tract. The optimum inhalation technique for a beta-adrenergic aerosol indicated by these data (slow inhalation with 10 s breath holding) confirms the results of previous studies.
175 citations
TL;DR: A simple feasible intervention in community pharmacies, incorporating daily reminders via Inhaler Technique Labels on inhalers, can lead to improvement in inhaler technique and asthma outcomes.
153 citations
Journal Article•
TL;DR: It is concluded that when a metered-dose aerosol is used in general clinical practice there is a considerable loss of potential efficacy.
Abstract: The FEV1-increase after inhalation of a beta 2-stimulant metered-dose aerosol was studied in 23 patients treated by specialists. The effect of their spontaneous inhalation technique was compared with that of controlled inhalation, which was optimised by means of a device controlling the breathing pattern and release of the metered-dose aerosol. This allowed quantitative assessment of the loss of bronchodilatation caused by the spontaneous inhalation technique. Thirteen patients who were observed to make inhalation errors showed a significant loss of bronchodilatation (30%), whereas ten patients who were observed to make no inhalation errors showed an insignificant loss of bronchodilatation (13%). It is concluded that when a metered-dose aerosol is used in general clinical practice there is a considerable loss of potential efficacy.
149 citations
TL;DR: The use of inhaled medications for the treatment of lung diseases has been part of the pharmaceutical armamentaria of health care providers for millennia as mentioned in this paper and has been widely used in medicine.
Abstract: The use of inhaled medications for the treatment of lung diseases has been part of the pharmaceutical armamentaria of health care providers for millennia. Two thousand years before the onset of the Christian Era, tribal Shaman of the Indus Valley used "smokes and fumes" from burning roots (datura, a congener of atropine) to treat cough and wheezing. 1,2 As contact between centers of civilization expanded, the use of inhaled vapors for medicinal and psychosocia! purposes became widespread in the ancient world, and the technology for aerosol delivery evolved from kettles and hot pots to the development of various types of pipes?, 3 However, with the rise of Christianity as the official religion of the Roman Empire, the ways of the past were suppressed. In their zeal to make a new beginning for mankind, the traditions and beliefs (both good and bad) of the "pagans" were repudiated by the early Christians, and the teachings and therapies of the ancients were held suspect. The Dark Ages sealed this position, and as intellectualism stagnate d in the West, former modes of therapy were lost. During this period the development of inhalational medicine continued mainly in the East. As the Renaissance brought current civilization into intellectual contact with the past, art, philosophy, and science flourished, and social and commercial pressures served as the impetus to repair the neglect of centuries. Progress, however, was slow and uneven, particularly in medicine. By the onset of the nineteenth century, Europeans ha d again recognized the value of inhalants and began to embrace their use enthusiastically,
144 citations
TL;DR: Among the inhalation modes tested, delivery to the lungs was optimised when powder was inhaled at 120 l min −1 , with the head in the normal position, and with 10 s breath-holding.
141 citations