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.
|Poor technique(all devices)||77||388||20|
|Moderate technique(all devices)||45||388||12|
Ignorance about ?empty? device
2. Complianceof Patient
Long acting relievermisuse
Omit mouthwash after preventer
4. DeviceNot Available with Patient
Long acting Reliever
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