[en] OBJECTIVES: The study aimed to assess usage of inhalation devices in asthma and chronic obstructive pulmonary disease (COPD). METHODS: In this two-round Delphi survey, 50 experts in asthma and COPD completed a 13-item, Internet-based, self-administered questionnaire about choice of inhalation device, training and monitoring of inhalation techniques, the interchangeability and the role of costs in the selection of inhalation devices. For each item, the median (central tendency) and interquartile ranges (degree of consensus) were calculated. RESULTS: Experts considered that the choice of inhalation device was as important as that of active substance (very good consensus) and should be driven by ease of use (good to very good consensus) and teaching (very good consensus). Experts recommended giving oral and visual instructions (good consensus) and systematic monitoring inhalation techniques. Pulmonologists and paramedics have predominantly educational roles (very good consensus). Experts discouraged inhalation device interchangeability (good consensus) and switching for cost reasons (good to very good consensus) without medical consultation (good consensus). CONCLUSIONS: The results of this survey thus suggested that inhalation devices are as important as active substances and training and monitoring are essential in ensuring effective treatment of asthma and COPD. Inhalation device switching without medical consultation should be avoided.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Ninane, Vincent
Brusselle, Guy G.
Louis, Renaud ; Université de Liège - ULiège > Département des sciences cliniques > Pneumologie - Allergologie
Dupont, Lieven
Liistro, Giuseppe
De Backer, Wilfried
Schlesser, Marc
Vincken, Walter
Language :
English
Title :
Usage of inhalation devices in asthma and chronic obstructive pulmonary disease: a Delphi consensus statement.
Global Initiative for Asthma. Global strategy for asthma management and prevention (updated 2012). 2012. Available from: Http://www. ginasthma.org
Broeders ME, Vincken W, Corbetta L. The ADMIT series-issues in inhalation therapy. 7. Ways to improve pharmacological management of COPD: The importance of inhaler choice and inhalation technique. Prim Care Respir J 2011;20:338-43
Cochrane MG, Bala MV, Downs KE, et al. Inhaled corticosteroids for asthma therapy: Patient compliance, devices, and inhalation technique. Chest 2000;117:542-50
Laube BL, Janssens HM, de Jongh FH, et al. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J 2011;37:1308-31
Michele TM, Pinheiro S, Iyasu S. The safety of tiotropium-The FDA's conclusions. N Engl J Med 2010;363:1097-9
Accordini S, Corsico AG, Braggion M, et al. The cost of persistent asthma in Europe: An international populationbased study in adults. Int Arch Allergy Immunol 2013;160: 93-101
Nowak D, Berger K, Lippert B, et al. Epidemiology and health economics of COPD across Europe: A critical analysis. Treat Respir Med 2005;4:381-95
Agence Federale des Medicaments et des Produits de Sante. Regles operationnelles pour la prescription en DCI dans la pratique medicale et pharmaceutique et dans le dossier medical electronique. 2011. Available from: http://www.faggafmpsbe
Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008;31: 143-78
Dekhuijzen P, Picado C, Lavorini F, et al. Inhaler choice in asthma and COPD: A poorly addressed issue in guidelines. 6th IPCRG World Conference; Edinburgh; 2012. Available from: Https://www. theipcrg.org/display/ EVENTSEdinburgh
Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176:532-55
Hsu CC, Sandford B. The Delphi technique: Making sense of consensus. PARE 2007;12:1-8
Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: An American College of Chest Physicians Delphi consensus statement. Chest 2001;119:590-602
Delbecq AL, Van de Ven AH, Gustafson DH. Group techniques for program planning: A guide to nominal group and Delphi processes. Scott Foresman Co; Glenview, IL: 1975
Sinha IP, Smyth RL, Williamson PR. Using the Delphi technique to determine which outcomes to measure in clinical trials: Recommendations for the future based on a systematic review of existing studies. PLoS Med 2011;8:e1000393
Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (Updated 2013). 2013. Available from: Http://www. Goldcopdorg
Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest 2005;127:335-71
Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000;32(4):1008-15
Plaza V, Calle M, Molina J, et al. External validation of the recommendations of the multidisciplinary consensus about inhaled therapies. Arch Bronconeumol 2012;48: 189-96
Song WS, Mullon J, Regan NA, Roth BJ. Instruction of hospitalized patients by respiratory therapists on metered-dose inhaler use leads to decrease in patient errors. Respir Care 2005;50:1040-5
Vincken W, Dekhuijzen PR, Barnes P. The ADMIT series - issues in inhalation therapy. 4) how to choose inhaler devices for the treatment of COPD. Prim Care Respir J 2010;19:10-20
Mehuys E, Van BL, De BL, et al. Effectiveness of pharmacist intervention for asthma control improvement. Eur Respir J 2008;31:790-9
Kucukarslan S, Lai S, Dong Y, et al. Physician beliefs and attitudes toward collaboration with community pharmacists. Res Social Adm Pharm 2011;7:224-32
Williams AE, Chrystyn H. Survey of pharmacists' attitudes towards interchangeable use of dry powder inhalers. Pharm World Sci 2007;29:221-7
Takemura M, Mitsui K, Ido M, et al. Effect of a network system for providing proper inhalation technique by community pharmacists on clinical outcomes in COPD patients. Int J Chron Obstruct Pulmon Dis 2013;8:239-44
Thomas M, Price D, Chrystyn H, et al. Inhaled corticosteroids for asthma: Impact of practice level device switching on asthma control. BMC Pulm Med 2009;9:1
Price D. Do healthcare professionals think that dry powder inhalers can be used interchangeably?. Int J Clin Pract Suppl 2005;149:26-9
Price D, Summers M, Zanen P. Could interchangeable use of dry powder inhalers affect patients?. Int J Clin Pract Suppl 2005;149:3-6
Vinchurkar S, De Backer L, Vos W, et al. A case series on lung deposition analysis of inhaled medication using functional imaging based computational fluid dynamics in asthmatic patients: Effect of upper airway morphology and comparison with in vivo data. Inhal Toxicol 2012;24:81-8