Problems of elderly patients on inhalation therapy: Difference in problem recognition between patients and medical professionals

Background: There is no systematic analysis to identify problems involved with instruction on inhalation therapy for elderly patients. We conducted a nationwide questionnaire survey for patients and medical professionals. Methods: A questionnaire survey was conducted of adult patients on inhaled drugs (ages 18–92 years, 820 individuals) and medical professionals (pharmacists or nurses) who provided instruction on inhalation therapy to these patients in 23 institutions in Japan to investigate the technique and the level of understanding (knowledge) of the inhalation therapy. Changes in the recognition of performance of inhalation technique and inhalation knowledge with increasing age were analyzed. Results: According to patients' subjective assessment, there was no deterioration in the performance of the inhalation technique or loss of the knowledge with increasing age. On the other hand, medical professionals' objective assessment revealed a significant loss of both inhalation technique and knowledge with increasing age. Not many elderly patients noticed their own problems themselves, revealing a great perception gap between elderly patients and medical professionals. Thus, there was concern that patients would unconsciously practice the inhalation procedure improperly. On the other hand, in comparison with non-elderly patients, elderly patients were less resistant to continuation of therapy, suggesting that they would be more likely to accept instruction on inhalation therapy. Conclusions: Elderly patients are apt to assume that they “understand well”, therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent) instructions on inhalation therapy

Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices - Fig 1

<p>Schematic diagrams of inspiratory flow rate and the pressure drop monitoring system (a), typical inhalation flow pattern and parameters (b), and Schematic diagrams of attachment orifice (c).</p

Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices - Fig 5

<p><b>Participants’ peak inspiratory flow rate (a) and duration time (b) via soft mist inhaler, before/after inhalation instruction.</b> Black bars represent mean ± SD. Asterisk (*) indicates statistical significance (P < 0.05).</p

Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices - Fig 4

<p><b>Typical inspiratory flow profiles of a dry powder inhaler (Diskus</b>^<b>®</b><b>, a) and soft mist inhaler (b).</b> Dashed and solid lines represent before and after inhalation instruction, respectively.</p

Relationship between peak inspiratory flow rate and duration time.

<p>Data including both of before and after inhalation instruction. Filled and open circles represent dry powder inhaler and soft mist inhaler, respectively.</p

Assessment of inhalation flow patterns of soft mist inhaler co-prescribed with dry powder inhaler using inspiratory flow meter for multi inhalation devices - Fig 3

<p>Relationships between inspiratory flow rate and pressure drop of commercial inhalers (filled points) and simple attachment orifices (open points) (a). Relationships of pressure drops between commercial inhalers and orifices (b). Gray and red lines represent y = x and approximated line (y = 1.024 x + 0.003, R² = 0.9851), respectively. Bland-Altman plot for relationship of pressure drops between commercial inhalers and orifices (c). Gray solid and dotted lines represent bias and 95% limit of agreement interval of difference of pressure drop between commercial inhalers and orifices (-0.10, -1.38 to 1.18), respectively.</p

Lower limit of peak inhalation flow rates for commercial dry powder inhalers.

<p>Lower limit of peak inhalation flow rates for commercial dry powder inhalers.</p

Device-specific resistance and orifice diameters.

<p>Device-specific resistance and orifice diameters.</p

Participant characteristics.

<p>Participant characteristics.</p

Inhalation devices commercially available in Japan.

<p>a, Breezhaler^® (Novartis Pharma AG, Switzerland.); b, Clickhaler^® (Otsuka Pharmaceutical Co., Ltd., Japan); c, Diskhaler^® (GlaxoSmithKline, UK); d, Diskus^® (GlaxoSmithKline, UK); e, Ellipta^® (GlaxoSmithKline, UK); f, Handihaler^® (Boehringer Ingelheim GmbH, Germany); g, Jenuair^® (KYORIN Pharmaceutical Co., Ltd., Japan); h, pMDI (3M, USA); i, Respimat^® (Boehringer Ingelheim GmbH, Germany); j, Swinghaler^® (Otsuka Pharmaceutical Co., Ltd., Japan); k, Turbuhaler^® (AstraZeneca plc, UK); l, Twincaps^® (Daiichi Sankyo co., Ltd., Japan); and m, Twisthaler^® (Merck and Co., USA).</p