Abstract
Introduction: In Colombia, there is limited data on the use of inhalers in patients with COPD. Objective: The objective was to describe the technique of using metered-dose inhalers and dry powder in patients in a Colombian hospital. Methods: Observational, descriptive study of patients over 40 years of age with COPD, treated in a hospital in La Virginia, Risaralda, Colombia, between September 1st, 2019 and January 31st, 2020. The unit of analysis were patients in consultation. Sociodemographic and clinical variables, and a checklist for use of inhalers were included. Frequencies and proportions were applied for discrete variables, statistics of central tendency and dispersion for continuous variables. Results: A total of 104 patients with an average age of 73.6 ± 10.1 years were included; 57 were women (54.8%). In addition, 48 patients were classified as GOLD-D (46.2%). Similarly, 89 patients reported having received education on the use of bronchodilators (85.6%). The most common were metered-dose (MD) inhalers in 95 cases (91.3%), followed by single-dose dry powder inhalers in eight patients (7.7%). Likewise, 37 patients who used DM without inhalochamber (35.6%) did not comply with the steps of the checklist. In the multidose system, the most performed was to properly close the inhaler and the least performed was to expel the air slowly, avoiding doing so near the inhaler (n=6; 5.7%). Discussion: The characteristics of the technique of using inhalers in patients with COPD were described. Although no patient was able to use the inhaler “perfectly”, most have received education from health professionals. Conclusion: A high percentage of patients misuse the devices to deliver bronchodilators. This can negatively impact the control of the disease.
References
Ministerio de Salud y Protección Social de Colombia [Internet]. Bogotá: MSPS; 2013. Enfermedad pulmonar obstructiva crónica - EPOC, Dirección de Promoción y Prevención. Subdirección de enfermedades no transmisibles. Disponible en: https:// www.minsalud.gov.co/Paginas/La-importancia-de-prevenir-la-EPOC-en-pandemia.aspx
Organización Mundial de la Salud [Internet]. Ginebra: OMS; 2023. Enfermedad pulmonar obstructiva crónica (EPOC). Disponible en: https:// www.who.int/es/news-room/fact-sheets/detail/ chronic-obstructive-pulmonary-disease-(copd)
Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Eur Respir J [Internet]. 2023; 61(4): 2300239. doi: https://doi. org/10.1183/13993003.00239-2023
Velásquez-Morales A, Buitrago-Martín CL. Impacto en la educación del uso adecuado de inhaladores en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). [Tesis de especialización]. Bogotá: Universidad del Rosario; 2014. Disponible en: https://doi.org/10.48713/10336_9016
Abajo-Larriba AB, Díaz-Rodríguez Á, González- Gallego J, Méndez-Rodríguez E, Álvarez-Álvarez MJ, Capón-Álvarez J, et al. Diagnóstico y tratamiento del hábito tabáquico en pacientes con enfermedad pulmonar obstructiva crónica: estudio ADEPOCLE. Nutr Hosp [Internet]. 2016; 33(4): 954-961
Ministerio de Salud y Protección Social de Colombia. Anexo educativo de uso de inhaladores. 2016. Bogota: MSPS; 2016. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/ BibliotecaDigital/RIDE/VS/PP/ENT/anexo-educativo-uso-inhaladores.pdf
Ramadan WH, Sarkis AT. Patterns of use of dry powder inhalers versus pressurized metered-dose inhalers devices in adult patients with chronic obstructive pulmonary disease or asthma: An observational comparative study. Chron Respir Dis [Internet]. 2017; 14(3): 309-320. doi: https://doi. org/10.1177/1479972316687209
Padmanabhan M, Tamilarasu K, Rajaram M, Batmanabane G. Inadequate inhaler technique, an everlasting problem, is associated with poor disease control – A cross sectional study. Adv Respir Med [Internet]. 2019; 87(4): 217-225. doi: 10.5603/ ARM.a2019.0021
Palo J. Uso de inhaladores: detección de errores e intervención por el farmacéutico comunitario. Farm Comunitarios [Internet]. 2016; 8(4): 18-25. doi: 10.5672/FC.2173-9218.(2016/Vol8).004.03
Sánchez-García VL. Uso adecuado de la técnica inhalatoria en el manejo de pacientes con EPOC. [Tesis de pregrado]. Bogotá: Universidad Nacional de Colombia; 2012. doi: https://repositorio.unal. edu.co/handle/unal/10187
Khassawneh BY, Al-Ali MK, Alzoubi KH, Batarseh MZ, Al-Safi SA, Sharara AM, et al. Handling of inhaler devices in actual pulmonary practice: metered-dose inhaler versus dry powder inhalers. Respir Care. 2008; 53(3): 324-328.
De las Salas-Martínez RP, Mendoza-Ballesteros SP, Montenegro-Hernández N, Hernández-Cantillo MM, Saavedra-Jiménez AK, Díaz-Agudelo D. Uso de inhaladores de dosis medida en pacientes adultos: Necesidad de educación dirigida por enfermería. Salud Uninorte. 2014; 30(2): 158-169.
Vargas O, Martinez J, Ibanez M, Pena C, Santamaria M. The use of metered-dose inhalers in hospital environments. J Aerosol Med Pulm Drug Deliv [Internet]. 2013; 26(5): 287-296. doi: https://doi. org/10.1089/jamp.2011.0940
Duarte-de-Araújo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. COPD: Misuse of inhaler devices in clinical practice. Int J Chron Obstruct Pulmon Dis [Internet]. 2019; 14: 1209-1217. doi: https://doi.org/10.2147/copd.s178040
Ngo C, Phan D, Vu G, Dao P, Phan P, Chu H, et al. Inhaler technique and adherence to inhaled medications among patients with acute exacerbation of chronic obstructive pulmonary disease in Vietnam. Int J Environ Res Public Health [Internet]. 2019; 16(2): 185. doi: https://doi.org/10.3390/ ijerph16020185
Navaie M, Dembek C, Cho-Reyes S, Yeh K, Celli BR. Device use errors with soft mist inhalers: A global systematic literature review and meta-analysis. Chron Respir Dis [Internet]. 2020; 17. doi: https://doi.org/10.1177/1479973119901234
Feijoo D, Moreno L, Salar L. Cuidado que el medicamento no se te salga por la nariz. Farm Comunitarios. 2017; 9(4): 18-25.
Gregoriano C, Dieterle T, Breitenstein A, Dürr S, Baum A, Maier S, et al. Use and inhalation technique of inhaled medication in patients with asthma and COPD: data from a randomized controlled trial. Respir Res [Internet]. 2018; 19(1): 237. doi: https://doi.org/10.1186/s12931-018-0936-3
Larriba AB, Méndez E, González J, Capon J, Díaz A, Peleteoro B, et al. Estimación del porcentaje de pacientes con EPOC adiestrados en consulta para el manejo de inhaladores. Estudio ADEPOCLE. Nutr Hosp [Internet]. 2016; 33(6): 1405-1409. doi: 10.20960/nh.802
Forero JC. Terapia broncodilatadora: ¿Qué responsabilidad tenemos los médicos y los pacientes en su uso inadecuado? Acta Med Colomb [Internet]. 2015; 40(3): 191-193. doi: https://doi.org/10.36104/ amc.2015.716
Plaza V, Sanchis J, Roura P, Molina J, Calle M, Quirce S, et al. Physicians’ knowledge of inhaler devices and inhalation techniques remains poor in Spain. J Aerosol Med Pulm Drug Deliv [Internet]. 2012; 25(1): 16-22. doi: https://doi.org/10.1089/ jamp.2011.0895
Müller T, Müller A, Hübel C, Knipel V, Windisch W, Cornelissen CG, et al. Optimizing inhalation technique using web-based videos in obstructive lung diseases. Respir Med [Internet]. 2017; 129: 140-144. doi: https://doi.org/10.1016/j. rmed.2017.06.009
Maricoto T, Correia-de-Sousa J, Taborda-Barata L. Inhaler technique education in elderly patients with asthma or COPD: impact on disease exacerbations-a protocol for a single-blinded randomised controlled trial. BMJ Open [Internet]. 2019; 9(1). doi: https://doi.org/10.1136/bmjopen-2018-022685
Maldonado N. La educación sanitaria en los pacientes con EPOC aumenta la adherencia al tratamiento y disminuye los costes sanitarios. [Tesis de grado]. San Cugat del Vallés: Escuela Universitaria de Enfermería Gimbernat; 2016. Disponible en: https://eugdspace. eug.es/bitstream/handle/20.500.13002/386/ La%20ES%20a%20los%20pacientes%20 con%20EPOC%2C%20aumenta%20la%20 adherencia%20al%20tratamiento%20y%20 disminuye%20los%20costes%20sanitarios. pdf?sequence=1&isAllowed=y
López-Campos JL, Quintana Gallego E, Carrasco Hernández L. Status of and strategies for improving adherence to COPD treatment. Int J Chron Obstruct Pulmon Dis [Internet]. 2019; 14: 1503-1515. doi: https://doi.org/10.2147/copd.s170848
Molimard M, Raherison C, Lignot S, Balestra A, Lamarque S, Chartier A, et al. Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients. Eur Respir J [Internet]. 2017; 49(2). doi: https://doi.org/10.1183/13993003.01794-2016
Molimard M, Colthorpe P. Inhaler devices for chronic obstructive pulmonary disease: insights from patients and healthcare practitioners. J Aerosol Med Pulm Drug Deliv [Internet]. 2015; 28(3): 219- 228. doi: https://doi.org/10.1089/jamp.2014.1142
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Juan Daniel Castrillon-Spitia, Andrea Agudelo-Ramírez, Andrés Felipe Garzón-Rojas, Catherine Arias-Hernández, Claudia Marcela Trejos-Rojas, María Magdalena Restrepo-Gaviria, Mayra Alejandra Trejos-Ramírez, Manuel Pacheco Conrado-Gallego