Browsing by Subject "asthma"

This study aims to address how easily an individual with no prior inhaler experience can learn to use a dry powder inhaler (DPI) through video education. This is a comparative study of four DPIs (Diskus, Easyhaler, Ellipta and Turbuhaler). Different properties affecting ease of use, patient preference as well as educational videos as a method of providing inhaler instructions were investigated. The study used a triangular methodology. The sample consisted of 31 individuals (24-35 years). All participants were considered inhaler naïve. After watching the video education material for a particular inhaler the participants' demonstrated the use of it. Educational videos for all four inhalers were watched and use of all placebo inhalers was demonstrated in a random order. These demonstrations were videotaped. The demonstrations were thereafter checked against a predefined checklist and all mistakes were recorded. Only 33 % of inhaler demonstrations were completed without the participants making any mistakes that could compromise the efficacy of the inhaled medication in a real-life situation. The frequency of error varied greatly between different types of inhalers. Ellipta proved to be most often used correctly with 55 % demonstrating use without making any mistakes. This was closely followed by Diskus for which 48 % demonstrated correct use. The difference between the average error frequency for Ellipta and Diskus was statistically insignificant. With Easyhaler 19 % percent of participants were able to demonstrate correct use, the corresponding percentage for Turbuhaler was 16 %. When comparing participants' demonstrations for Easyhaler and Turbuhaler, the difference in average error frequency between the devices were not statistically significant. The average frequency of error was lower when using Ellipta in comparison to Easyhaler and Turbuhaler (statistically significant). The same indications were found when comparing average frequency of error for Diskus, to those for Easyhaler and Turbuhaler. Comparing the participants self-reported correct use against the actual numbers it is clear that participants often thought they were using the inhaler correctly when they in fact were not. When asked to rank the inhalers from most preferred to least preferred, Ellipta emerged as a favorite. Turbuhaler received the second highest scores, Diskus the third and Easyhaler was least preferred. However, only the difference between preference scores for Ellipta and Easyhaler was deemed statistically significant. The high frequency of error suggests that even though participants generally considered the inhalers intuitive and easy to use, they would have required more comprehensive inhaler education in order to achieve correct inhaler technique. Further, the results indicate that video demonstrations are not ideal for providing inhaler education for first time inhalers users. The most prominent problem with video education is that it provides no feedback to the user regarding their inhaler technique. This may present real problems as the results of this study show that participants tended to overestimate their own inhaler technique. Patient education plays a central role in asthma care and needs to be given proper attention even though the inhalers might be considered intuitive and easy to operate. Interesting areas for future research include investigating interactive learning videos as a way of improving video education on inhaler technique.

PURPOSE: There is an increasing tendency to use oral appliance (OA) as an alternative treatment for sleep apnea. Here we report the long-term adherence and clinical effects of OA therapy. METHODS: All sleep apnea patients treated at the Department of Dentistry between the years 2006 and 2013 (n=1208) were reviewed. A questionnaire about OA adherence, asthma symptoms (Asthma Control Test™, ACT), and general health was sent to all patients who continued OA therapy after the 1-month follow-up visit (n=811). OA was adjusted to obtain at least 70 % of the maximal protrusion of the mandible. RESULTS: The response rate was 37.4 % (99 women, 204 men). The mean±SD age and BMI were 58.7±10.3 years and 27.3±4.0 kg/m(2), respectively. During the mean follow-up period of 3.3 years, there was no significant variation in BMI. Forty-one patients abandoned OA therapy yielding an adherence rate of 86 %. Ninety-seven percent of patients used OA ≥4 h/day, and the mean daily use was 7.2±1.1 h. The ACT score improved with OA use from 16.0±5.9 to 20.1±3.8 (p=0.004), indicating better asthma control. The apnea and hypopnea index decreased significantly from 27±19 at baseline to 10±10 with OA therapy (p=0.001). CONCLUSIONS: After a 1-month trial period, the long-term adherence to oral appliance was good. OA therapy decreased apneas and hypopneas significantly, and its long-term use was associated with an improvement in respiratory and asthma symptoms.

Tämän tutkimuksen tarkoitus oli arvioida painoindeksin yhteyttä fyysiseen suorituskykyyn, rasitusastmareaktioon ja rasituksen laukaisemiin hengitystieoireisiin (yskään, vinkunaan ja hengenahdistukseen) kouluikäisillä lapsilla. 1120 ulkojuoksukokeen tulokset käytiin retrospektiivisesti läpi. Nämä ulkojuoksukokeet oli suoritettu Iho- ja allergiasairaalassa osana kouluikäisten lasten tavanomaisia astmaselvittelyjä. Keuhkojen toimintaa arvioitiin spirometrialla. Astmalle diagnostisen rasituksen laukaiseman keuhkoputkien supistumisen eli rasitusastmareaktion rajana pidettiin vähintään 15 prosentin laskua uloshengityksen sekuntikapasiteetissa rasituksen jälkeen. Fyysinen suorituskyky arvioitiin laskemalla todellisesta juoksuajasta ja -matkasta 6 minuutissa juostu matka. Hengitystieoireet ja -löydökset kirjattiin kokeen aikana, ja lasten ikään ja sukupuoleen suhteutettu painoindeksi eli ISO-BMI laskettiin kansallisia kasvuviitearvoja käyttäen. Suurempi ISO-BMI ja ylipaino ennustivat heikompaa fyysistä suorituskykyä. Lisäksi suurempi ISO-BMI oli yhteydessä yskään ja hengenahdistukseen rasituskokeen aikana. Sen sijaan ISO-BMI ei liittynyt rasitusastmareaktioon eikä vinkunaan. Tämän tutkimuksen löydösten perusteella kouluikäisillä lapsilla ylipaino voi ennustaa heikompaa fyysistä suorituskykyä ja rasitusperäisten hengitystieoireiden ilmaantumista, mutta ei rasitusastmareaktiota. Mikäli asianmukaisia keuhkojen toimintatutkimuksia ei suoriteta, voidaan astmadiagnoosi asettaa väärin perustein. Tutkimus on toistaiseksi suurin kouluikäisten lasten ylipainon, rasitusastmareaktion ja fyysisen suorituskyvyn yhteyttä tarkasteleva tutkimus, mutta koska tutkimus oli luonteeltaan retrospektiivinen asiakirjatutkimus, tulokset tulisi jatkossa vahvistaa prospektiivisella seurantatutkimuksella.

PExA on uudenlainen ja kajoamaton pienten hengitysteiden tutkimusmenetelmä. Tutkimuk-semme tarkoituksena oli selvittää menetelmän soveltuvuutta astman diagnostiikassa lapsilla ja nuorilla. PExA-tutkimuksia ei ole aiemmin tehty lapsipotilailla. Satunnaisesti valitut tutkimushenkilöt olivat 4-18-vuotiaita, puolet tyttöjä ja puolet poikia. Ast-maatikkojen ryhmään kuului lapsia, joilla oli joko lääkärin diagnosoima astma tai oireita, joiden vuoksi he olivat astmaselvittelyissä. Kolmasosa tutkimushenkilöistä oli terveitä verrokkeja. Tutkimuksessamme arvioimme PExA-mittauksen kliinisen soveltuvuuden ja toistettavuuden lisäksi mittaustulosten eroja astmaatikoiden ja terveiden verrokkien välillä. Tarkasteltavia muuttujia olivat uloshengitysilman partikkeleiden massa, uloshengitetyn ilman kokonaistila-vuus ja ilmavirtauksen nopeus. PExA-mittaus tehtiin sekä ennen että jälkeen bronkodilaatio-testin. Suurin osa (88%) tutkimushenkilöistä suoritti PExA-mittauksen onnistuneesti. Nuorin tekni-sesti hyväksytyn mittauksen suorittanut oli neljävuotias, mutta vain harva alle kuusivuotias onnistui hengitystekniikan toteutuksessa. Havaitsimme, että uloshengitysilman partikkelien massa sekä massa uloshengitetyn ilman kokonaistilavuuden suhteen olivat terveillä verro-keilla suurempia kuin astmaatikoilla. PExA-menetelmä soveltui onnistuneesti terveiden lasten sekä astmaatikoiden kliiniseen tut-kimukseen 6-18-vuotialla. PExA 2.0 vaikuttaisi erottelevan terveet lapset astmaatikoista jo ensimmäisten puhallusten perusteella.

Background: Asthma with NSAID-exacerbated respiratory disease (NERD) is associated with uncontrolled or severe asthma. NERD patients are more prone to severe allergic reactions and their asthma exacerbations lead to hospitalisations twice as often compared to patients with non-NERD-asthma. NERD patients are prone to recurrent nasal polyposis requiring frequent endoscopic sinus surgeries. However, the early risk factors of NERD are not fully understood. The aim was to identify risk factors of NERD among patients with adult-onset asthma. Methods: We used data from 1350 population-based adult asthmatics with adult-onset asthma from Finnish national registers. NERD was defined as self-reported wheeze or other typical respiratory symptoms after ingestion of NSAIDs. Thirty-six covariates covering several domains (personal characteristics, life-style, early life factors, asthma characteristics and multimorbidities) were selected based on literature and were studied in association with NERD using logistic regressions. Results: The study population included 153 (11.3%) asthmatics with NERD. Thirty-six covariates were entered in univariate logistic regression analysis, in which 23 were associated with NERD (p < 0.05). These variables were entered in a multivariable logistic regression model in which allergic respiratory symptoms, female sex, osteoarthritis, difficult asthma, nasal polyps, second-hand smoke exposure at home, having 3 or more older siblings and being overweight were significantly associated with asthma with NERD (p < 0.05). Overweight decreased the risk of NERD, other factors increased it. Conclusion: According to our study, risk factors of NERD in part are associated with female sex, BMI, exposure to tobacco smoke, allergy, orthopaedic disorders and infection history, and their early recognition might thus be important to manage the burden of NERD.