2002 OPEN FORUM Abstracts
INTRODUCTION OF THE DISKUS DELIVERY SYSTEM INTO THE PEDIATRIC ASTHMA COMPLIANCE AND TECHNIQUE (PACT) CLINIC. A PILOT STUDY
James E. Martin, RRT, Susan R. Ogrinc, RRT, Robert C. Cohn, MD, Departments of Pediatrics, and Pulmonary Services, MetroHealth Medical Center, Cleveland, OH
INTRODUCTION: Many forms of delivery devices are available for the inhalation route. Confusion on proper inhalation technique may affect medication delivery. Multiple inhalations from several devices have also been shown to reduce compliance. Our PACT Clinic addresses the issue of administration and adherence with therapy. For routine therapy, patients can be prescribed up to 8 puffs/day from multiple MDIs. To help with compliance our patients were giving the option of taking one inhalation BID with the Dry Powder Inhaler (DPI) Advair Diskus. An eight-step approach to Diskus administration similar to the MDI was developed to determine if the Diskus is a suitable alternative to MDI.
Methods: Data from twelve asthma patients average age 10.2 years (range 7-16), 9 male/3 female, 5 African American/4 Caucasian/3 Hispanic, seen in our PACT clinic were analyzed. All patients demonstrated their MDI technique a median of 5 times (3-12) before the introduction of the Diskus. There was an average of 2 (1-4) months between initial Diskus instruction and follow up evaluation. Administration technique was tested for both the MDI and Diskus using a placebo if necessary. After allowing the patient to demonstrate their technique, a thorough review and demonstration was performed.
Results: 9/12 (75%) patients performed all 8 steps of the Diskus correctly, where as 5/12 (42%) before and 4/12 (33%) after Diskus introduction performed all 8 MDI step successfully. Although not statistically significant (p>0.25) failure to perform a slow deep breath following the actuation of the MDI increased from 4/12 (33%) to 6/12 (50%) following the Diskus introduction.
CONCLUSION: The Diskus delivery system is easy to teach and easy to learn. Our patients performed the technique with far fewer reinforced steps than the MDI. A rapid inspiration required for DPI may have contributed to a more rapid inhalation seen in the MDI group following Diskus introduction. Continual evaluation and reinforcement maybe necessary to ensure proper inhalation for each delivery device.