Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma

© 2022. This document is made available under the CC-BY 4.0 license http://creativecommons.org/licenses/by /4.0/ This document is the published version of a published work that appeared in final form in npj primary care respiratory medicineTo analyze whether there is improvement in adherence to inhaled treatment in patients with COPD and asthma after an educational intervention based on the teach-to-goal method. This is a prospective, non-randomized, single-group study, with intervention and before-after evaluation. The study population included 120 patients (67 females and 53 males) diagnosed with asthma (70.8%) and COPD (29.1%). The level of adherence (low and optimal) and the noncompliance behavior pattern (erratic, deliberate and unwitting) were determined by the Test of the adherence to Inhalers (TAI). This questionnaire allows you to determine the level of adherence and the types of noncompliance. Low Adherence (LowAd) was defined as a score less than 49 points. All patients received individualized educational inhaler technique intervention (IEITI). Before the IEITI, 67.5% of the patients had LowAd. Following IEITI, on week 24, LowAd was 55% (p = 0.024). Each patient can present one or more types of noncompliance. The most frequent type was forgetting to use the inhaler (erratic), 65.8%. The other types were deliberate: 43.3%, and unwitting: 57.5%. All of them had decreased on the final visit: 51.7% (p = 0.009), 25.8% (p = 0.002), 39.2% (p = 0.002). There were no significant differences in adherence between asthma and COPD patients at the start of the study. The only predicting factor of LowAd was the female gender. An individualized educational intervention, in ambulatory patients with COPD and asthma, in real-world clinical practice conditions, improves adherence to the inhaled treatment

Metabolic responses to salinity changes in the subantarctic notothenioid teleost Eleginops maclovinus

Eleginops maclovinus is an endemic, subantarctic Notothenioidei species. This study examined the influence of different environmental salinities (5, 15, and 45 psu; and 32 psu as a control) on energy metabolism in E. maclovinus over a period of 14 days. Metabolite contents and enzymatic activities related to carbohydrate, amino acid, and lipid metabolisms were evaluated in metabolic (liver) and osmoregulatory (gill and kidney) tissues. At extreme salinities (5 and 45 psu), the liver showed a high consumption of energy reserves, mainly as amino acids and carbohydrates. Carbohydrate metabolism in the gills did not change under different salinities, but increased lactate levels were found, suggesting that this tissue may use lactate as an energy substrate. Amino acid metabolism in the gills decreased at 5 psu but increased at 45 psu, and lipid metabolism increased at 5 and 15 psu during the first days of the trial, indicating a possible use of lipids as energy. Kidney carbohydrate catabolism and amino acid metabolism increased after 14 days at 45 psu, while lipid metabolism did not vary in relation to salinity changes. Together, these results suggest that the liver is most affected by salinity changes, probably due to its role as a supplier of energetic substrates. The gills and kidney, osmoregulatory tissues, maintained their energy metabolism levels with minor modifications. In conclusion, E. maclovinus exhibits metabolic adjustments to adapt to different salinities, showing the best responses in isosmotic environmental salinities