Predictive Analytics-Driven Wearable System for Personalized Asthma Management in Disabled Patients

The inhaler is an important drug delivery system in the treatment of asthma, but inhaler technique is often inadequate. We assessed technique in children diagnosed with asthma, comparing the performance of three devices. In a cross-sectional survey, 523 children (271 boys, 252 girls, ages 5 to 12 years; mean+/-SD 7.53+/-1.79 years) demonstrated inhalation technique according to Netherlands Asthma Foundation criteria during a first visit to a primary care clinic in Abha, Saudi Arabia. Patients used the device with which they were most familiar (either pMDI, Turbuhaler or Diskus). Two hundred children (38% of total population) used a pMDI, while 323 (62% of total population) used one of the dry powder inhalers 173 (58%) the Turbuhaler and 150 (47%) the Diskus. Only 49 children (25% of the total population) completed the assessment without making a mistake. The remaining 474 (75% of the total population) performed one or more manuevers poorly. Only 80 children who used an MDI (40% of those using the device) completed 50% or more of the maneuvers correctly compared with 111 (69% of those using the device) and 100 (67% of those using the device) of those using the Turbuhaler and Diskus, respectively (P=0.001 for comparison of MDI with dry powder inhalers). Children whose mothers had intermediate school or higher education performed better than those whose mothers had less education (P=0.001). The father's education had no bearing on performance with the inhaler. The inhaler technique of most asthmatic children is poor, but technique is better in children who use a dry powder compared a metered-dose inhaler. The level of the mother's education is positively associated with better inhalation technique in the child.

To evaluate the impact of a booklet based training by a nurse on the development of skills regarding use of metered dose inhaler (MDI) among the teachers of the selected schools of Chandigarh, India. The present study was undertaken by randomly selecting government schools of Chandigarh from where 91 school teachers were enrolled. A booklet on asthma management containing information regarding asthma, its triggers, signs and symptoms, treatment, types of inhalers and steps of using MDI with spacer was used for training the subjects. Their knowledge and skills were evaluated through observation checklist. Three return demonstrations were taken from each teacher on three successive days. Main outcome measure was skill development of the teachers in the use of MDI with spacer. Pre and post tests scores were compared by repeated measures ANOVA. Most of the teachers didn't know theoretical or practical aspects of MDI. After training all the teachers performed correctly most of the steps of MDI use. Some teachers performed poorly in giving instruction to breathe in/out slowly and hand washing before/after MDI administration. There was a statistical significant improvement in the performance scores of the teachers after each return demonstration (p < 0.0005). Training strategy used in the study involving nursing personnel was successful in improving teachers' skills in MDI use for asthma management. More focus should be given on breathe in/out instructions and on hand washing before/after MDI use.

The Emerging Role of Leukotriene Antagonists in Asthma Therapy

Errors in the use of different inhalers were investigated in patients naive to the devices under investigation in a multicentre, single-visit, randomised, open-label, cross-over study. Patients with chronic obstructive pulmonary disease (COPD) or asthma were assigned to ELLIPTA vs DISKUS (Accuhaler), metered-dose inhaler (MDI) or Turbuhaler. Patients with COPD were also assigned to ELLIPTA vs Handihaler or Breezhaler. Patients demonstrated inhaler use after reading the patient information leaflet (PIL). A trained investigator assessed critical errors (i.e., those likely to result in the inhalation of significantly reduced, minimal or no medication). If the patient made errors, the investigator demonstrated the correct use of the inhaler, and the patient demonstrated inhaler use again. Fewer COPD patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS, 9/171 (5%) vs 75/171 (44%); MDI, 10/80 (13%) vs 48/80 (60%); Turbuhaler, 8/100 (8%) vs 44/100 (44%); Handihaler, 17/118 (14%) vs 57/118 (48%); Breezhaler, 13/98 (13%) vs 45/98 (46%; all P<0.001). Most patients (57–70%) made no errors using ELLIPTA and did not require investigator instruction. Instruction was required for DISKUS (65%), MDI (85%), Turbuhaler (71%), Handihaler (62%) and Breezhaler (56%). Fewer asthma patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS (3/70 (4%) vs 9/70 (13%), P=0.221); MDI (2/32 (6%) vs 8/32 (25%), P=0.074) and significantly fewer vs Turbuhaler (3/60 (5%) vs 20/60 (33%), P<0.001). More asthma and COPD patients preferred ELLIPTA over the other devices (all P⩽0.002). Significantly, fewer COPD patients using ELLIPTA made critical errors after reading the PIL vs other inhalers. More asthma and COPD patients preferred ELLIPTA over comparator inhalers.

IntroductionVerbal counselling (VC) is commonly used to train patients on correct inhaler technique. Patients forget the good inhaler use with time. Trainhaler (TH), Clement Clarke, UK, is a novel pressurised...

Background: Topical inhaled steroids, budesonide(Bu) and beclomethasone dipropionate (BOP), are now established as effective drugs in the management of chronic asthma. These drugs have high topical anti-inflammatory effect with low systemic activity. This study was performed to determine the effects of two inhaled corticosteroids, Bu and BOP, on the adrenocortical supression in 44 patients with bronchial asthma or chronic obstructive pulmonary disease. Methods: The adrenocortical function was assessed by measurement of serum cortisol concentration at 8 o'clock in morning and free cortisol in 24-hour urine collection at interval in 44 patients. No steroid was administered during the pretreatment period of 10 days and the final 6 days of the study. Each subject inhaled BOP or Bu, in daily doses of 800 or 1,600 micrograms for 12 days. The dose was delivered by metered dose inhaler (MDI) or diskhaler or large spacing device attached to MDI. Results: The levels of serum cortisol and 24-hour urinary free cortisol were decreased during the treatment period in patients inhaled Bu delivered by MDI in daily doses of 800 and 1,600 micrograms. In contrast, serum cortisol level was decreased on 6 and 12th day of treatment period in patients with BDP diskhaler in daily doses of 800 micrograms. In daily doses of 1,600 micrograms, the serum cortisol and 24hour urine free cortisol levels were decreased on 6, 9 and 12th day of treatment period in patients with BDP disk haler. The serum cortisol and 24-hour urinary free cortisol levels were not significantly decreased during the treatment period in patients inhaled Bu delivered by large spacing device attached to a MDI. Conclusion: These results showed that 1) the endogenous cortisol secretion was suppressed after inhalation of BDP and Bu in daily doses of 800 and 1,600micrograms, 2) Bu with MDI suppressed the adrenocortical function more than BDP with diskhaler, in daily doses of 1600 micrograms. and 3)large spacing device attached to a MDI might decrease the risk of suppression in the hypothalamic -pituitary- adrenal axis.

Although inhaled medications are effective therapies for COPD, many patients and providers use them incorrectly. We recruited providers who prescribe inhalers or teach inhaler technique and assessed their use of metered-dose inhalers (MDIs), various dry powder inhalers (DPIs), and Respimat using predefined checklists. Then they watched tablet-based multimedia educational videos that demonstrated correct inhaler technique by a clinical pharmacist with teach-back from a patient and were re-evaluated. We also recruited patients with COPD and assessed their use of their prescribed inhalers and then retested them after 3-6 months. Baseline and follow-up respiratory symptoms were measured by the COPD Assessment Test. Fifty-eight providers and 50 subjects participated. For all providers, correct inhaler technique (reported as percentage correct steps) increased after the videos: MDI without a spacer (72% vs 97%) MDI with a spacer (72% vs 96%), formoterol DPI (50% vs 94%), mometasone DPI (43% vs 95%), tiotropium DPI (73% vs 99%), and Respimat (32% vs 93%) (before vs after, P < .001 for all comparisons). Subjects also improved their inhaler use technique after viewing the educational videos: MDI without a spacer (69% vs 92%), MDI with a spacer (73% vs 95%), and tiotropium DPI (83% vs 96%) (before vs after, P < .001 for all comparisons). The beneficial effect of this educational intervention declined slightly for subjects but was durably improved after several months. COPD Assessment Test scores did not demonstrate any change in respiratory symptoms. A tablet-based inhaler education tool improved inhaler technique for both providers and subjects. Although this intervention did show durable efficacy for improving inhaler use by patients, it did not reduce their respiratory symptoms.

To determine whether cognitive status, hand strength, and demographic variables are predictive of correct use of metered-dose inhalers by older subjects. Clinic patients (n = 29) and healthy volunteers (n = 42) older than 50 years with no previous or limited metered-dose inhaler use were enrolled. After cognitive (Mini-Mental State Examination) and hand strength assessments, subjects received extensive instruction in proper metered-dose inhaler technique. Technique was independently assessed by two evaluators immediately after instruction and 1 week later. Correct technique was defined as (1) activating the canister in the first half of inhalation, (2) continuing to inhale slowly and deeply, and (3) holding breath at full inspiration (5 seconds). Data for the two subject groups were pooled for analyses. The mean age of the subjects was 69.7 years. Forty subjects (56%) demonstrated correct metered-dose inhaler technique at 1 week. Logistic regression showed that hand strength measurement (odds ratio, 0.68; 95% confidence interval, 0.55 to 0.84), Mini-Mental State Examination score less than 24 (odds ratio, 3.66; 95% confidence interval, 1.07 to 12.4), and male gender (odds ratio, 5.01; 95% confidence interval, 1.07 to 23.5) were significant predictors of incorrect inhaler use. Correct use of the metered-dose inhaler was unrelated to age, education, or subject status. Clinicians should consider cognitive status and hand strength when metered-dose inhaler therapy is initiated for an older adult. Patients with cognitive impairment and hand strength deficits may require more extensive training, frequent follow-up, or alternative dosage forms.

Delivery of a medicinal product directly to the target organ, for instance, the lung, offers many advantages to the patient but presents special difficulties in assessment of quality and bioequivalence, since conventional measurements are not always appropriate.This paper reviews, from a regulatory perspective, the standards set for determining the clinical equivalence of inhaled dosage forms, in particular, metered-dose inhalers (MDI), which are used in the management of asthma. This is particularly pertinent given the urgent need to reformulate products which contain chlorofluorocarbon (CFC) propellants.Generic MDI products have been approved and regulatory standards published in Canada, Australia, and New Zealand. Generic MDI products have been registered in Europe but there are no published standards. The United States Food and Drug Administration (FDA) has spent many years debating these issues and has released many draft and interim guidelines but as yet has not approved any generic MDIs. There is a...

Regardless of the device used, many patients have difficulty maintaining proper inhaler technique over time. Repeated education from caregivers is required to ensure persistence of correct inhaler technique, but no information is available to evaluate the time required to rectify inhaler errors in experienced users with a baseline faulty technique and whether this time of re-education to restore inhaler mastery can differ between devices. This was a multi-center, single-visit, open-label, cross-sectional study in a large group of 981 adult subjects (mean ± SD age 64 ± 15 y) experienced with inhaler use, mainly suffering from COPD and asthma, who showed faulty inhaler technique at a follow-up visit in chest clinics. These subjects received face-to-face practical education from trained caregivers until proper inhaler use could be demonstrated, and the time of instruction was recorded. The mean times (95% CIs) in minutes of instruction required for rectifying misuse and demonstrating inhaler mastery were 5.0 (3.6-6.4) min for the Diskus (n = 199), 5.3 (3.7-6.8) min for the HandiHaler (n = 219), 8.1 (5.6-10.5) min for the metered-dose inhaler (MDI) (n = 532), and 6.0 (5.0-7.0) min for the Turbuhaler (n = 169). The time to demonstrate good inhaler use for MDIs was higher (P < .05) than for all dry powder inhalers (DPIs). Between the DPIs, only the HandiHaler required more time for achieving mastery than the Diskus (P = .005). The variables associated with increasing time for correcting inhaler errors were an older age (0.05 min/y, 95% CI 0.03-0.07), a lower level of education (0.4 min/schooling level, 95% CI 0.7-0.1), and no reported previous instruction in inhaler use (1.96 min, 95% CI 1.35-2.58). In experienced subjects with baseline faulty inhaler use, the mean time of education required to achieve and demonstrate mastery with DPIs was lower than with MDIs.

This study aimed to analyze the quality, reliability, and content of YouTube videos related to the use technique of metered dose inhalers (MDIs). Considering the increasing use of digital platforms for health education, it is important to evaluate the accuracy and educational value of such online resources. This descriptive and cross-sectional study evaluated 377 YouTube videos retrieved through a systematic search. The video selection process was monitored using the PRISMA flow diagram according to predefined inclusion and exclusion criteria. The videos' content, quality, and reliability were assessed using the Modified DISCERN tool, Global Quality Scale, Patient Education Materials Assessment Tool, and a checklist containing MDI use steps. Statistical analyses were conducted to determine associations between evaluation scores and video characteristics. A total of 12 YouTube videos on MDI use were analyzed. Of these, 33.3% were uploaded in 2022, and 66.7% were produced by associations or unions in the health sector. The mean interaction index was 0.53 ± 0.32, and the Video Power Index was 0.08 ± 0.15. The mean reliability level of the videos was 2.91 ± 0.75, quality level 4.16 ± 0.76, understandability level 80.83 ± 18.75, actionability level 81.66 ± 18.16, information level 77.00 ± 15.06, and information accuracy level 76.25 ± 15.80. YouTube videos on MDI use were largely adequate in terms of content but demonstrated some deficiencies in reliability. It is recommended that digital health information be produced under professional supervision and in collaboration with health authorities to ensure accuracy and trustworthiness.

To examine the frequency of proper use of inhalation devices and influence of age and training on it. One hundred and five subjects of bronchial asthma and Chronic Obstructive Pulmonary Disease (COPD); aged between 18 to 75 y (mean ± SD; 46 ± 28.55) were studied. Subjects were enrolled over a period of three months. Data like weight, height and concomitant medications were recorded. It was an observational and questionnaire based study. Parameters were chosen to demonstrate the inhalational technique, errors committed in different steps of use & nature of medical, paramedical, nursing personals and others imparting training for use of inhaler device and time devoted for it. Of total 105 patients, 31 were using dry powdered inhalers (DPI), 50 on metered dose inhalers (MDI), and 24 on MDI with spacer devices. Among study population 83.81% were trained by healthcare professionals (doctors, nurse, pharmacists, paramedical or representatives of Pharmaceutical companies) and 16.19% are trained by general people. Among the MDI users (n=50) only 6%, 16.12% among the DPI users, 20.8%, among MDI with spacer users could use inhalers correctly. At 95% confidence limit there was significance of errors committed between DPI and MDI users (difference of SE is 2.56) and between spacer and MDI users (difference of SE 2.92). There was no difference found in regard of frequency of errors committed in taking different devices according to patient's socioeconomic, educational background and trainer. It was concluded that use of MDI with spacer most convenient method. Doctors often did not have sufficient time to train patients regarding proper technique of inhaler use. With ever increasing and widespread use of inhalers patients' education is becoming more important. Proper training will surely make these drugs more effective and cost benefit ratio more favourable.

Climate change is currently the greatest global health threat. As the planet experiences rising temperatures due to global warming, widespread health impacts are emerging, including extreme weather events, food insecurity due to droughts, and forced relocation of populations. From a respiratory health perspective, patients with lung disease experience negative health consequences due to high temperatures, risks from heat-related illnesses, exposure to wildfire smoke that causes poor air quality, and increased severity and duration of pollen seasons. The resulting health consequences contribute to increased use of healthcare services, which in turn generate their own contributions to healthcare pollution, thus further worsening the climate crisis. In fact, the health sector contributes more than 5.2% of net global greenhouse gas emissions. In Canada, healthcare activities are responsible for 4.6% of the country’s total greenhouse gas emissions, placing Canada’s healthcare system among the top four emitters per capita by country. In terms of the contributions of various healthcare sectors to greenhouse gas emissions, England’s National Health Service (NHS) demonstrated that anesthetic gases and metered dose inhalers (MDIs) play a significant role; MDIs alone contribute to 3.1% of the NHS’s total healthcare emissions. MDIs rely on hydrofluorocarbon (HFC) propellants to deliver medication, which act as potent greenhouse gases when released into the atmosphere. Depending on the formulation, one aerosol inhaler can have a carbon footprint equivalent to driving a gasoline-powered car up to 170 km. In Canada, short-acting beta-agonist (SABA) inhalers constitute 71% of total inhaler use, the majority of which are delivered via MDI devices. For these reasons, strategies that reduce the use of MDIs have the potential to reduce negative environmental consequences of respiratory care.

BackgroundCoronavirus is causing a shortage of critical inhalers needed by patients with Asthma and respiratory illness. Patients with Asthma are at higher risk if they tract the novel Coronavirus. As the coronavirus continues to spread, hospitals are turning to use more salbutamol MDI. Salbutamol MDI has become the line of defence for physicians in the emergency room who are treating patients with Corona Virus Disease 2019 (COVID-19) and have respiratory distress .[Hui et al 2020 ,and Center for Drug Evaluation and Research 2020]During the COVID pandemic, there has been a drastic increase in the use of MDI inhalers; therefore, it led to a decrease in availability and a break in the supply chain. Patients with Asthma are at higher risk if they tract the novel Coronavirus, and an inhaler could be a life or death for them. As the coronavirus continues to spread, hospitals are turning to use more salbutamol Metered Dose inhaler (MDI). Salbutamol MDI is now on short supply as the COVID-19 continues to spread. Salbutamol MDI has become the line of defence for physicians in the emergency room who are treating patients with COVID-19 and have respiratory distress. The current shortage of salbutamol MDI could be a result of stockpiling and hoarding of this life-saving inhaler. That had led to a critical shortage of Salbutamol MDI, and even the case shortage continues with some other alternatives such as Ipratropium MDI and even with long-acting B-agonists such as Salmeterol and Formoterol which also starting to have a limitation on ordering these agents.Coronavirus sparks fear of medication shortage. Coronavirus panic-buying also may have led to a shortage of critical inhalers. We have also got elderly patients with COPD who may need Ventolin MDI and also premature babies who may have caught Respiratory Syncytial Virus (RSV) and need salbutamol MDI to support their lungs have since been compromised, and they rely heavily on Asthma inhalers. Finding a safe and creative strategy is essential during the COVID-19 pandemic.

All included trials in this review are small and of a cross-over design. Most trials looked at very short-term effects of inhaled bronchodilators, and therefore did not measure longer-term outcomes. The certainty of evidence across all outcomes was very low, and therefore we have been unable to describe any effects with certainty.