Inadequate inhaler technique, an everlasting problem, is associated with poor disease control – A cross sectional study

Introduction: Dry powder inhalers (DPI) have been in use in the treatment of chronic respiratory diseases for decades. DPIs require proper inhaler technique to ensure appropriate dose delivery to the lungs which in turn provides disease control and hence reduces the economic burden due to frequent acute attacks and hospital visits. Inadequate inhaler technique remains an everlasting problem among patients with chronic respiratory disease. Hence the aim is to assess the inhaler technique in patients using DPI and to determine the factors associated with inhaler technique.Material and methods: A cross-sectional study was conducted and 385 patients with asthma or chronic obstructive pulmonary disease (COPD) were recruited. Patient-related and disease-related factors were noted. Severity of the disease were assessed using asthma control test/COPD assessment test questionnaire and spirometer. The investigator assessed the inhaler technique of the patient against standard checklist.Results: Nearly 46.2% of the patients performed incorrect inhaler technique. Multivariate analysis showed factors like young age [Odd’s ratio (OR) 4.13, CI 1.31–17.8], well controlled disease (OR 2, CI 1.1–3.65), and the patients who learnt the technique from a medical personnel (OR 3.67, CI 1.46–9.24) had better inhaler technique.Conclusion: This study shows that the proper use of inhaler is still an unattained goal and significance of correct use has to bereiterated

Antibiotic Use in South East Asia and Policies to Promote Appropriate Use: Reports from Country Situational Analyses

Inappropriate use of antibiotics is rampant in South East Asia1-6 and is a major contributor to antimicrobial resistance.7-9 However, data on antibiotic use are scant, few effective interventions to improve appropriate antibiotic use have been implemented,10 11 and implementation of policies for appropriate use of antibiotics is also poor.12 13 An analysis of secondary data on antibiotic use from 56 low and middle income countries found that countries reporting implementation of more policies also had more appropriate antibiotic use.14 15 Effective policies included having a government health department to promote rational use of medicines, a national strategy to contain antimicrobial resistance, a national drug information centre, drug and therapeutic committees in more than half of all general hospitals and provinces, and undergraduate education on standard treatment guidelines.15 An updated essential medicines list and national formularies were also associated with lower antibiotic use

Promoting Quality Use of Medicines in South-East Asia: Reports from Country Situational Analyses

Irrational use of medicines is widespread in the South-East Asia Region (SEAR), where policy implementation to encourage quality use of medicines (QUM) is often low. The aim was to determine whether public-sector QUM is better in SEAR countries implementing essential medicines (EM) policies than in those not implementing them

Inadequate Inhaler Technique, an Everlasting Problem Associated with Poor Disease Control—A Cross-Sectional Study

Introduction: Dry powder inhalers (DPI) have been in use in the treatment of chronic respiratory diseases for decades. DPIs require proper inhaler technique to ensure appropriate dose delivery to the lungs which in turn provides disease control and hence reduces the economic burden due to frequent acute attacks and hospital visits. Inadequate inhaler technique remains an everlasting problem among patients with chronic respiratory disease. Hence the aim is to assess the inhaler technique in patients using DPI and to determine the factors associated with inhaler technique. Material and methods: A cross-sectional study was conducted and 385 patients with asthma or chronic obstructive pulmonary disease (COPD) were recruited. Patient-related and disease-related factors were noted. Severity of the disease were assessed using asthma control test/COPD assessment test questionnaire and spirometer. The investigator assessed the inhaler technique of the patient against standard checklist. Results: Nearly 46.2% of the patients performed incorrect inhaler technique. Multivariate analysis showed factors like young age [Odd’s ratio (OR) 4.13, CI 1.31–17.8], well controlled disease (OR 2, CI 1.1–3.65), and the patients who learnt the technique from a medical personnel (OR 3.67, CI 1.46–9.24) had better inhaler technique. Conclusion: This study shows that the proper use of inhaler is still an unattained goal and significance of correct use has to be reiterated

Authors′ reply

general view, grounds, 200

Using the Mercy Method for Weight Estimation in Indian Children

This study was designed to compare the performance of a new weight estimation strategy (Mercy Method) with 12 existing weight estimation methods (APLS, Best Guess, Broselow, Leffler, Luscombe-Owens, Nelson, Shann, Theron, Traub-Johnson, Traub-Kichen) in children from India. Otherwise healthy children, 2 months to 16 years, were enrolled and weight, height, humeral length (HL), and mid-upper arm circumference (MUAC) were obtained by trained raters. Weight estimation was performed as described for each method. Predicted weights were regressed against actual weights and the slope, intercept, and Pearson correlation coefficient estimated. Agreement between estimated weight and actual weight was determined using Bland–Altman plots with log-transformation. Predictive performance of each method was assessed using mean error (ME), mean percentage error (MPE), and root mean square error (RMSE). Three hundred seventy-five children (7.5 ± 4.3 years, 22.1 ± 12.3 kg, 116.2 ± 26.3 cm) participated in this study. The Mercy Method (MM) offered the best correlation between actual and estimated weight when compared with the other methods ( r 2 = .967 vs .517-.844). The MM also demonstrated the lowest ME, MPE, and RMSE. Finally, the MM estimated weight within 20% of actual for nearly all children (96%) as opposed to the other methods for which these values ranged from 14% to 63%. The MM performed extremely well in Indian children with performance characteristics comparable to those observed for US children in whom the method was developed. It appears that the MM can be used in Indian children without modification, extending the utility of this weight estimation strategy beyond Western populations

Additional file 1: of Promoting quality use of medicines in South-East Asia: reports from country situational analyses

Dataset created from extraction of data from country situational analysis reports, all available online at: http://www.searo.who.int/entity/medicines/country_situational_analysis/en/ and http://www.searo.who.int/entity/medicines/en/ . Excel file of the dataset created from data extracted from the country situational analysis reports and which was used in the analysis described in this manuscript. (XLSX 13 kb

Additional file 2: of Promoting quality use of medicines in South-East Asia: reports from country situational analyses

Medicines management in healthcare delivery: WHO/SEARO workbook tool and report template for undertaking a situational analysis of medicines management in health care delivery in low and middle-income countries, March 2016. Available online at: http://www.searo.who.int/entity/medicines/country_situational_analysis/en/ . PDF file of the data collection instrument used to collect data in the country situational analyses and that was analysed in this manuscript. (PDF 1236 kb

Effectiveness of COVID-19 vaccine (Covaxin) against breakthrough SARS-CoV-2 infection in India

India approved COVID-19 vaccine called Covaxin, developed by the Indian Council of Medical Research and Bharat Biotech Ltd. The primary objective of the study was to estimate the effectiveness of Covaxin in preventing breakthrough SARS-CoV-2 infection in healthcare workers (HCWs). A test-negative matched case-control study was conducted among HCWs of tertiary care hospital in Eastern India. Any HCW who tested positive for COVID-19 using RT-PCR during April and May 2021 was taken as the case. The HCWs who tested negative for COVID-19 by RT-PCR were considered as controls after matching with the date of testing and profession of the cases. Vaccination data were collected from the institution’s vaccine database and recall. In case of discrepancy, it was confirmed from the CoWIN portal (cowin.gov.in). The sample size was 670 participants (335 pairs). Conditional logistic regression models were used to calculate the adjusted odds ratio for breakthrough SARS-CoV-2 infection. Vaccine effectiveness was calculated using the following formula: VE = (1-aOR) × 100%. Sensitivity analysis was done for effectiveness of Covaxin, excluding Covishield vaccination. The mean age of participants was 29.1 years (SD = 7.1), and the majority were males (55.2%). Among the study participants, 60% were completely vaccinated, 18.51% were partially vaccinated, and 21.49% were unvaccinated. After adjusting for age, gender, type of household and past history of COVID-19 disease in conditional logistic models, the vaccine effectiveness was 22% (aOR 0.78, 95% CI: 0.52–1.17; p = .233). Sensitivity analysis with Covaxin showed an effectiveness of 29% (aOR 0.71, 95% CI: 0.47–1.08; p = .114) for preventing breakthrough SARS-CoV-2 infection