The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

ASTHMAMANAGEMENT - WHERE TO START, HOW TO IMPROVE?

Sawsan Baddar, RN CRT1,Bazdawi Al-Riyami FRCP, PhD2, Omar Al-Rawas MBRCH, MRCP (UK), PhD2 Departments of Nursing1 andMedicine2, Sultan Qaboos University Hospital, Sultanate of Oman

Background: Asthmamanagement guidelines now recommend the use of inhaler devices for convenientand effective delivery of asthma medication. The availability of pharmaceuticalagents in different devices has made asthma more manageable, but has also becomea source of confusion to patients and healthcare providers. Simply applyingthe guidelines, however, does not result in patient compliance, good inhalertechnique or guarantee the success of asthma management.

Aim: To identify problemsrelated to the use of inhaler devices.

Method: A three months prospectivestudy from July to September 2000 was conducted in the asthma-counseling clinicof a tertiary care teaching hospital. Adult and pediatric patients and theircarers, who had used an asthma inhaler device for at least 2 months, were evaluatedfor appropriateness of asthma medication management. Appropriateness was assessedby a respiratory therapist through:

a. Inhaler demonstration by patient/carerpair and adherence to a structured checklist.

b. Verbal questionnaire utilizinga standardized format

c. Review of patient prescriptionand file

Result: Two hundred and elevenadults (13 years and above) and 55 children were evaluated, and five differenttype of devices and two types of spacers were used. Numerous and important patient-relatedand institution-related problems were identified in 99% of patients.

IdentifiedProblem No.Total No.%
1.Inhaler technique
Poor technique(all devices) 77 388 20
Moderate technique(all devices) 4538812

Ignorance about ?empty? device

1411312

2. Complianceof Patient

Omit morningpreventer

26226399

Reliever misuse

15621074

Long acting relievermisuse

3410233

Omit mouthwash after preventer

7913658

3. SpacerCondition

Damaged valve

64115

4. DeviceNot Available with Patient

Preventer 12026246

Reliever

11921056

Long acting Reliever

559459
Additional problemsincluded the prescribing, labeling and dispensing of devices.

Conclusion: Simple problemsthat can lead to failure in asthmatic management may lie undetected unless thereis consistent and regular counseling and follow up of all patients and theircarers.

Recommendation: A comprehensiveand integrated asthma management programme can be achieved through:

1. Inclusion of practical managementissues in asthma management guidelines

2. Management protocols which defineresponsibility for the ?who, what and how? of practical asthma management

3. Regular audit and research onpractical management issues.

4. Public awareness

OF-01-045

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