• Korean Journal of Adult Nursing
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• v.27 no.6
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• pp.665-672
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• 2015

Purpose: The aims of current study were to assess the inhaler competency and medication adherence, and to identify association of inhaler competency with medication adherence in patients with obstructive lung disease. Methods: We did a secondary analysis of the Hanyang Obstructive Pulmonary Evaluation data in a single institution from June 2014 to April 2015 after an approval of Institutional Review Board. A total of 150 patients with asthma or chronic obstructive lung disease participated in the study. Inhaler competency was evaluated accuracy in each step for using metered dose inhaler. Medication adherence was calculated using actually dispensed doses based on the prescribed inhaler doses. Results: Older adults (${\geq}65$) had lower competency in using inhaler (66.7 vs 83.3, z=-4.52, p<.001) and poorer medication adherence (67.7 vs 91.8, $x^2=14.06$, p<.001) than adults (<65). Inhaler competency was associated with medication adherence (p=.26, p=.001). Surprisingly, more than 50% of patients were current smokers. Conclusion: Inhaler competency and medication adherence were lower in older adults with obstructive lung disease than those in adult-age patients. Therefore, an individual education program for older patients should be developed to improve the rates of proper use of inhalers. Nursing management for obstructive lung disease should focus on developing behavioral intervention strategies for smoking cessation.

• Korean Journal of Adult Nursing
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• v.24 no.2
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• pp.160-170
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• 2012

Purpose: The aim of this study was to assess knowledge, attitude, correct metered dose inhaler (MDI) use and compliance with self management among patients with chronic obstructive pulmonary disease (COPD). Methods: The participants of this study consisted of 109 COPD patients who were outpatients in C and K hospital located in G city from March 1 to September 30th, 2010. Data were measured using self-administered questionnaires and observational checklist. The data were analyzed using SPSS/WIN 18.0 program that included mean, standard deviation, ANOVA, Sheffe test, and Pearson's correlation. Results: There were significant relationships between knowledge and attitude (r=.33, $p$ <.001), between knowledge and correct MDI use (r=.37, $p$ <.001), and between knowledge and self-management compliance (r=.28, $p$=.003). There was significant relationship between attitude and self-management compliance (r=.33. $p$ <.001). In contrast, attitude was not significantly related to correct MDI use. Conclusion: The study showed that COPD knowledge and attitude of patients were related compliance in managing their disease. Therefore, strategies need to be utilized in education programs which would improve knowledge and subsequently improve attitude and compliance.

• The Journal of Korean Academic Society of Nursing Education
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• v.16 no.1
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• pp.111-120
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• 2010

Purpose: The purpose of this study was to evaluate the correct use of inhalers and to examine the patients characteristics affecting correct use of inhalers in patients with obstructive pulmonary disease. Method: Subjects were 280 patients with obstructive pulmonary disease who visited the internal pulmonary outpatient departments in 2 university hospitals in Korea. Inhaler use of each patient was assessed using a checklist recommended by the National Asthma Education and Prevention Program Expert Panel. Result: Most subjects used a DPI or MDI. The overall mean score of correct use was 72.09. Most subjects responded they knew well how to use their inhalers. Most frequent error was 'not fully exhaling before inhalation'. A younger age, higher educational level, living with family, and awareness of inhaler use were significantly associated with correct use of inhalers. Conclusion: The findings of this study showed that most of patients were unable to use inhalers correctly even though they had prior educational experiences. Regular assessing of inhaler use and adequate inhaler education considering patients characteristics by nurses are needed.

• Tuberculosis and Respiratory Diseases
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• v.85 no.1
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• pp.25-36
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• 2022

Background: Only a few studies directly compared the therapeutic efficacy and safety of two pressurized metered-dose inhalers (pMDIs) in asthma. We analyzed the asthma treatment outcomes, safety, and patient preferences using formoterol/beclomethasone (FORM/BDP), a pMDI with extra-fine particles, compared with formoterol/budesonide (FORM/BUD), another pMDI with non-extra-fine particles. Methods: In this randomized, double-blind, double-dummy parallel group study, 40 adult asthmatics were randomized to FORM/BDP group (n=18; active FORM/BDP and placebo FORM/BUD) or FORM/BUD group (n=22; active FORM/BUD and placebo FORM/BDP). During the two visits (baseline and end of 8-week treatment), subjects were asked to answer questionnaires including asthma control test (ACT), asthma control questionnaires (ACQ), and Quality of Life Questionnaire for Adult Korean Asthmatics (QLQAKA). Lung function, compliance with inhaler, and inhaler-handling skills were also assessed. Results: Ten subjects in the FORM/BDP group and 14 in the FORM/BUD group completed follow-up visits. ACT, ACQ, QLQAKA (a primary outcome), and adverse events did not differ between two groups. We found that the increase in forced expiratory volume in 1 second/forced vital capacity and forced expiratory flow at 25% to 75% of the pulmonary volume in the FORM/BDP group was higher than in the FORM/BUD group. Regarding preference, subjects responded that the flume velocity of FORM/BDP was higher, but more adequate than that of FORM/BUD. They also answered that FORM/BDP reached the trachea and bronchus and irritated them significantly more than FORM/BUD. Conclusion: The use of pMDI with extra-fine particles may relieve small airway obstruction more than the one with non-extra-fine particles despite no significant differences in overall treatment outcomes. Some asthmatics have a misconception about the adequacy of high flume velocity of pMDIs.

• Tuberculosis and Respiratory Diseases
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• v.84 no.1
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• pp.46-54
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• 2021

Background: The aim of this study was to investigate inhaler device handling in elderly patients. Inhaler devices with respect to misuse and error correction were also compared. Methods: Inhaler use technique was assessed using standardized checklists at the first visit and 3-month follow-up visit after retraining. The primary outcome was difference in the acceptable use ratio among inhaler devices. Secondary outcomes included differences in error correction, the most common step of misuse, and factors affecting the accuracy of inhaler use. Results: A total of 251 patients (mean age, 76.4 years) were included. The handling of 320 devices was assessed in the study. All patients had been trained before. However, only 24.7% of them used inhalers correctly. Proportions of acceptable use for Evohaler, Respimat, Turbuhaler, Ellipta, and Breezhaler/Handihaler were 38.7%, 50.0%, 61.4%, 60.8%, and 43.2%, respectively (p=0.026). At the second visit, the acceptable use ratio had increased. There were no significant differences among inhaler types (Evohaler, 63.9%; Respimat, 86.1%; Turbuhaler, 74.3%; Ellipta, 64.6%; and Breezhaler/Handihaler, 65.3% [p=0.129]). In multivariate analysis, body mass index, Turbuhaler, and Ellipta showed positive correlations with acceptable use of inhalers, whereas Chronic Obstructive Pulmonary Disease Assessment Test score showed a negative correlation. Conclusion: Although new inhalers have been developed, the accuracy of inhaler use remains low. Elderly patients showed more errors when using pressurized metered-dose inhalers than using dry powder inhalers and soft-mist inhalers. However, there were no significant differences in misuse among inhaler devices after individual training. Results of this study suggests that repeat training is more important than inhaler type.

• Tuberculosis and Respiratory Diseases
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• v.80 no.4
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• pp.377-384
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• 2017

Background: Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management. Methods: We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit. Results: The outcomes of 127 COPD patients were analyzed. CAT scores ($19.6{\pm}12.5$ vs. $15.1{\pm}12.3$) improved significantly after this program (p<0.05). Patients with improved CAT scores of 4 points or more had a better understanding of COPD management and the correct technique for using inhalers than those who did not have improved CAT scores (p<0.05). Conclusion: A comprehensive education program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management.

• Journal of Korean Academy of Nursing
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• v.40 no.2
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• pp.202-212
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• 2010

Purpose: This study was done to evaluate the effectiveness of an education program for patients with asthma who use inhalers. Methods: The research design for this study was a non-equivalent control group quasi-experimental study. Participants in this study were 36 patients for the control group, and 43 patients for the experimental group. The experimental group participated in the education program. The control group received the usual care. Data were collected before and 1 month and 2 months after the program finished and were analyzed using the SPSS 12.0 program. Results: The experimental group had significantly higher scores of knowledge of inhalers, and inhalation technique compared to the control group. However, no significant differences were found between two groups for PEFR, asthma instability, and satisfaction with inhalers. Conclusion: According to the results, the education program was effective in improving knowledge of inhalers, and inhalation technique. Therefore, it is recommended that this education program be used in clinical practice as an effective nursing intervention for patients with asthma on inhalers.

• Korean Journal of Clinical Pharmacy
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• v.9 no.2
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• pp.97-102
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• 1999

The effects of pharmacist's intervention for asthma patients using self-monitoring of peak expiratory flow rate in medication teaching model was evaluated for 3 months in improving clinical outcomes including emergency visits, hospitalizations, antibiotics use, symptoms and sleep disturbance. Twenty seven patients were enrolled in study and twenty three patients completed the follow-up schedules. The selected patients were given the pre-designed instruction for medication including appropriate use of medication, metered-dose inhaler(MDI) technique, identifying and controling asthma triggers and recognizing early signs of deterioration. There were significant improvements in clinical outcomes, in terms of emergency visits, hopitalizations, antibiotics use, symptoms and sleep disturbance. There were also significant improvements in the MDI use, environmental control, and medication knowledges. There was a progressive increase in peak expiratory flow rate during the three-month intervention. In conclusion, pharmacist's intervention using self-monitoring of peak expiratory flow rate has a significant impact on improving clinical outcomes in asthma patients.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.888-899
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• 1995

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.

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1063-1071
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• 1997

Backgroung : The efficacy of oral corticosteroids in the treatment of chronic asthma is undisputed, but their long-term use is associated with adverse side-effects, including supression of the hypothalamic-pituitary adrenal axis function, osteoporosis, weight gain, hypertension and impaired glucose tolerance. The introduction of inhaled corticosteroids in the early 1970's represented a significant therapeutic advance in the management of asthma, since these compounds combined high topical potency with low systemic activity. Fluticasone propionate is a new topically active synthetic glucocorticosteroid that combinds a high degree of efficacy with negligible systemic bioavailability. This study was perfomed to determine the effect of inhaled fluticasone propionate on the adreocortical supression in patients with bronchial asthma or chronic obstructive pulmonary disease. Method : The adrenocortical function was assessed by measurement of plasma cortisol concentration at 8 o'clock in morning and free cortisol in 24 hour urine collection at interval. Absolutely, no steroid was taken during pretreatment period of 10days. There after each subject inhaled fluticasone aerosol, in daily doses of 500 or 1000micrograms for 12days. The dose was delivered by metered dose inhaler(MDI). Results : The serum cortisol and 24hour urinary free cortisol were not decreased during the treatment period in patients with inhaled fluticasone propionate in daily doses of 500 micrograms. In contrast, serum cortisol was significantly decreased on 9th and 12th day(p less than 0.05). And, 24hour urinary free cortisol was also significantly decreased on 3rd and 12th day of treatement period(p less than 0.05) in patients with inhaled fluticasone in daily doses of 1000 micrograms. Conclusion : These results suggested that endogenous cortisol secretion was not supressed after short-term inhalation of fluticasone in daily dose of 500 micrograms, but in daily dose of 1000 micrograms, the endogenous cortisol secretion was supressed.