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Prescription of inhalers among pulmonologists and nonpulmonologists: is there a difference

Abstract

Objective

The objectives of this study were to evaluate prescription of inhalers and to assess knowledge and practice of doctors who can deal with asthma and chronic obstructive pulmonary disease patients, regarding inhalation therapies and inhalation techniques.

Patients and methods

A prospective, cross-sectional survey was carried out on physicians from different specialties who can deal with asthma and chronic obstructive pulmonary disease patients.

Results

The questionnaire was completed by 443 respondents. Ninety percent of nonpulmonologists mentioned that they frequently see and manage patients with chronic pulmonary diseases. Totally, 25 physicians reported that they never prescribe inhaler medications. The most common cause for no or little prescription was that ‘patients refused to use inhalers’ (42.0%). The respondents were pediatricians (37.3%), internists (33.7%), primary-care physicians (16.0%), and pulmonologists (12.9%). About 52% stated that they themselves provided device training for their patients. Pressurized metered dose inhalers were preferred by 64.8% of physicians. Only 21.3% had good general inhaler therapy knowledge (score >2). Pulmonologists scored higher than other specialty groups regarding good knowledge of inhalation therapy (66.7%), whereas pediatricians scored the lowest (8.3%).

Conclusion

Prescription of inhalers, knowledge among physicians regarding inhalation therapy, and correct use of inhalers varied between pulmonologists and nonpulmonologists, and was generally inadequate. More effort is needed to change the attitude of physicians toward the concept of inhalation therapy.

References

  1. Gibbs KP, Small M. Asthma. In: Walker R, Edwards C, editors. Clinical pharmacy and therapeutics. 3rd ed. Philadelphia: Churchill Livingstone; 2003. pp. 375–395.

    Google Scholar 

  2. Gibbs KP, Small M. Chronic obstructive pulmonary disease. In: Walker R, Edwards C, editors. Clinical pharmacy and therapeutics. 3rd ed. Philadelphia: Churchill Livingstone; 2003. pp. 397–411.

  3. Global initiative for asthma 2015, guidelines. Available at: http://www.ginasthma.com/.

  4. Chronic obstructive pulmonary disease, guidelines 2015. Available at: http://www.goldcopd.com/ Guidelineitem.asp

  5. Campos HS, Lemos ACM. Asthma and COPD according to the pulmonologist. J Bras Pneumol 2009; 35:301–309.

    Article  Google Scholar 

  6. 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 2011; 25:16–22.

    Article  Google Scholar 

  7. Hanania NA, Wittman R, Kesten S, Chapman KR. Medical personnel’s knowledge of and ability to use inhaling devices. Metered-dose inhalers, spacing chambers, and breath-actuated dry powder inhalers. Chest 1994; 105:111–116.

    Article  CAS  Google Scholar 

  8. Molimard M, Raherison C, Lignot S, Depont F, Abouelfath A, Moore N. Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care. J Aerosol Med 2003; 16:249–254.

    Article  CAS  Google Scholar 

  9. Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur Respir J 2002; 19:246–265.

    Article  CAS  Google Scholar 

  10. Barnes PJ. Achieving asthma control. Curr Med Res Opin 2005; 21(Suppl 4):S5–S9.

  11. Plaza Moral V. GEMA: Spanish guideline on the management of asthma. Arch Bronconeumol 2009; 45(Suppl. 7):2–35.

  12. Laube BL, Janssens HM, de Jongh FH, Devadason SG, Dhand R, Diot P, et al., ERS/ISAM task force report: what the pulmonary specialist should know about the new inhalation therapies. Eur Respir J 2011; 37: 1308–1331.

  13. De Blaquiere P, Christensen DB, Carter WB, Martin TR. Use and misuse of metered-dose inhalers by patients with chronic lung disease. Am Rev Respir Dis 1989; 140:910–916.

    Article  Google Scholar 

  14. Thompson J, Irvine T, Grathwohl K, Roth B. Misuse of metered-dose inhalers in hospitalized patients. Chest 1994; 105:715–717.

    Article  CAS  Google Scholar 

  15. Goodman DE, Israel E, Rosenberg M, Johnson R, Weiss ST, Drazen JM. The influence of age, diagnosis, and gender on proper use of metered-dose inhalers. Am J Respir Crit Care Med 1994; 150:1256–1261.

    Article  CAS  Google Scholar 

  16. Van der Palen J, Klein JJ, Kerkhoff AHM, van der Herwaarden CLA. Evaluation of the effectiveness of four different inhalers in patients with chronic obstructive pulmonary disease. Thorax 1995; 50:1183–1187.

    Article  Google Scholar 

  17. Unlu M, Şahin U, Akkaya A. KOAH: lı hastalarda inhalasyon aletlerinin yanlış kullanılmasına eğitimin katkısı. Selcuk Universitesi Tıp Fakultesi Dergisi 2001; 17:33–36.

    Google Scholar 

  18. Kelling JS, Strhol KP, Smith RL, Altose MD. Physician knowledge in the use of canister nebulizers. Chest 1983; 83:612–614.

    Article  CAS  Google Scholar 

  19. Kim SH, Kwak HJ, Kim TB, Chang YS, Jeong JW, Kim CW, et al. Inappropriate techniques used by internal medicine residents with three kinds of inhalers (a metered dose inhaler, Diskus, and Turbuhaler): changes after a single teaching session. J Asthma 2009; 46:944–950.

    Article  Google Scholar 

  20. British Thoracic Society Scottish Intercollegiate Guidelines Network: British guideline on the management of asthma. Thorax 2008; 63(Suppl 4): iv1–iv121.

  21. Chrystyn H, Price D. Not all asthma inhalers are the same: factors to consider when prescribing an inhaler. Prim Care Respir J 2009; 18: 243–249.

    Article  Google Scholar 

  22. Doyle S, Lloyd A, Williams A, Chrystyn H, Moffat M, Thomas M, Price D. What happens to patients who have their asthma device switched without their consent? Prim Care Respir J 2010; 19:131–139.

    Article  Google Scholar 

  23. Self TH, Arnold LB, Czosnowski LM, Swanson JM, Swanson H. Inadequate skill of healthcare professionals in using asthma inhalation devices. J Asthma 2007; 44:593–598.

    Article  Google Scholar 

  24. Dolovich MB, Ahrens RC, Hess DR, Anderson P, Dhand R, Rau JL, et al. American College of Chest Physicians; American College of Asthma, Allergy, and Immunology. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest 2005; 127:335–371.

    Article  Google Scholar 

  25. Sestini P, Cappiello V, Aliani M, Martucci P, Sena A, Vaghi A, et al. Prescription bias and factors associated with improper use of inhalers. J Aerosol Med 2006; 19:127–136.

    Article  Google Scholar 

  26. Plaza V, Giner J, Gómez J, Casan P, Sanchis J. Health workers’ knowledge and skills regarding the use of the Turbuhaler inhaler. Arch Bronconeumol 1997; 33:113–117.

    Article  CAS  Google Scholar 

  27. Plaza V, Sanchis J. Medical personnel and patient skill in the use of MDI. A multicentric study. CESEA group. Respiration 1998; 65: 195–198.

    Article  CAS  Google Scholar 

  28. Pharm D, Jessica LW, Pharm D, Christa MG, Pharm D, Amanda HT, et al. Inhalation therapy: help patients avoid these mistakes. J Fam Pract 2011; 60:714–721.

    Google Scholar 

  29. Barthwal MS, Deoskar RB, Rajan KE. Status of inhalation therapy in bronchial asthma in adults above twelve years of age in Armed Forces. J Assoc Physicians India 2005; 53:681–683

  30. Bedi RS. Asthma management by private general practitioners of Punjab. Indian J Chest Dis Allied Sci 1994; 36:9–13.

    CAS  PubMed  Google Scholar 

  31. Çalışkaner AZ, Özturk C, Ceylan E, Pekan S, Yilamaz Ö, Özturk S, et al. The knowledge and considerations of the physicians regarding the inhaler devices in asthma and COPD: the INTEDA-1 study. Tuberk Toraks 2013; 61:183–192.

    Article  Google Scholar 

  32. Lee-Wong M, Mayo PH. Results of a programme to improve house staff use of metered dose inhalers and spacers. Postgrad Med J 2003; 79: 221–225.

    Article  CAS  Google Scholar 

  33. Press VG, Pincayage AT, Pappalardo AA, Baker DC, Conwell WD, Cohen JC, et al. The Chicago Breathe Project: a regional approach to improving education on asthma inhalers for resident physicians and minority patients. J Natl Med Assoc 2010; 102:548–555.

    Article  Google Scholar 

  34. Lenney J, Innes JA, Cromptom GK. Inappropriate inhaler use: assessment of use and patient preference of seven inhalation devices. EDICI. Respir Med 2000; 94:496–500.

    Article  CAS  Google Scholar 

  35. Crompton GK, Dewar MH, Allbut HM, Innes JA. Inhaler preference and technique in inhaler native subjects: a comparison of HFA and conventional devices. Thorax 2000; 55(Suppl 3):A61.

  36. Lavorini F, Corrigan CJ, Barnes PJ, Dekhuijzen PR, Levy ML, Pedersen S, et al. Retail sales of inhalation devices in European countries: so much for a global policy. Respir Med 2011; 105:1099–1113.

    Article  CAS  Google Scholar 

  37. Ashraf M, Iman G. Do Egyptian patients use their inhalers correctly? A checklist auditing for inhalation devices usage techniques. Egypt J Chest Dis Tuberc 2015; 64:497–504.

    Article  Google Scholar 

  38. Loh LC, Wong PS. Asthma prescribing practices of government and private doctors in Malaysia −- a nationwide questionnaire survey. Asian Pac J Allergy Immunol 2005; 23:7–17.

    PubMed  Google Scholar 

  39. Kishore PV, Palaian S, Alam K, Shankar PR, Bajaracharya B, Den Ende JV. A correct use of a metered dose inhaler: a prospective interventional study among healthcare professionals in a Nepalese Teaching Hospital. J Clin Diagn Res 2008; 2:720–725.

    Google Scholar 

  40. Nadi E, Zeraati F. Evaluation of the metered-dose inhaler technique among healthcare providers. Acta Med Iran 2005; 43:268–272.

    Google Scholar 

  41. Baddar SA, Al-Rawas OA, Al-Riyami KA, Worthing EA, Hanssens Y, Taqi AM, Al Riyami BM. Metered-dose inhaler technique among healthcare providers practicing in Oman. J Sci Res Med Sci 2001; 1:39–43.

    Google Scholar 

  42. Mirici A, Meral M, Akgun M, Sağlam L, İnandı T. İnhalasyon tekniklerine hasta uyumunu etkileyen faktorler. Solunum Hastalıkları 2001; 12: 13–21.

  43. Ceylan E, Akkoçlu A, Ergör G, Yıldız F, İtil O. Inhaler use and device preferences of asthmatic patients: role of education on appropriate device use. Turk Respir J 2008; 10:40–47.

    Google Scholar 

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Correspondence to Ali Omar Abdel Aziz.

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Abdel Fattah, M.T., Abdel Aziz, A.O., Abdel Aziz, M.O. et al. Prescription of inhalers among pulmonologists and nonpulmonologists: is there a difference. Egypt J Bronchol 11, 301–310 (2017). https://doi.org/10.4103/ejb.ejb_26_16

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