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Vol. 7. Issue 1.
Pages 9-24 (January - February 2001)
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Vol. 7. Issue 1.
Pages 9-24 (January - February 2001)
ARTIGO ORIGINAL/ORIGINAL ARTICLE
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Estudo comparativo do manuseamento dos vários dispositivos de inalação utilizados em Portugal*
Comparative study of the management of the different inhalation devices used in Portugal
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António Morais, Luís Rocha, Venceslau Hespanhol
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RESUMO

A terapêutica inalatória tern urn papel fundamental no tratamento das doençs respiratórias. Esta importância deve-se à administração directa do fármaco na area em tratamento, o que leva à necessidade de menores doses de farmaco, com menores efeitos secundários, um mais rápido início de acção e uma maior eficácia terapêutica do mesmo. Quando prescrevemos urn inalador, temos que ter em conta as varias caracteristicas quer do farmaco, quer do inalador, nomeadamente a facilidade com que este ultimo pode ser manuseado.

O objectivo deste estudo foi o de pesquisar o grau de dificuldade exigido na realização da manobra inalat6ria dos vários inaladores existentes em Portugal, alem das preferencias em relação aos mesmos por parte da população estudada. Uma população de 80 individuos, com media de idades de 45 anos (24-78), sendo 49 (61,2%) homens e 31 (38,8%) mulhercs, sem anterior contacto com inaladores, apos a aprcsentação de 6 inaladores frequentementc utilizados em Portugal (MDI e os DPI's Rotahaler, Turbohaler, Diskus, Diskhaler e Aerolizer), escolhiam qual delcs eque achavam ser esteticamentc o mais c o menos atractivo. Seguidamente cram instruldos sobre a maneira correcta de inalar com os aparelhos de inalação incluidos no estudo. Apos a instrução de cada inalador, tinham 3 tentativas para inalar de forma correcta com o mcsmo. Após as manobras inalat6rias com os 6 inaladorcs, os individuos CSCOlhiam qual deles e que tinha sido o mais fáicil co mais difícil de manusear, e em caso de terem de efectuar terapêutica inalatória qual deles é que escolheriam é qual deles é que rejeitariam.

O Disk us - 22 (27,5 %) e o Aerolizer - 21 (26,2 %) foram considerados os mais atractivos enquanto o Turbuhaler foi considcrado o menos atraente-18 (22,5 %). 0 Turbuhaler- 25 (31,2%), foi considerado como o mais facil de ser manuseado versus o MDI - 36 (45%) considerado o mais diflcil. O Turbuhaler seguido pelo Diskus foram aqueles que se revelaram de mais facil manuseamento, enquanto o MDI foi o que provocou mais dificuldades, com 38 (47,5%) dos individuos a serem capazes de o manusear de forma correcta nas 3 tentativas dadas. 0 Turbuhaler - 25 (31,2%) foi o inalador mais escolhido, seguido pelo Disk us - 23 (28,7%), sendo o MDI- 38 (47,5 %) o inalador mais rejeitado. Em relação a algumas características da população, verificou-se que o Turbulzaler foi mais escolhido pelo sexo feminino e pelo grupo com estudos universitarios, enquanto que o Diskus foi o mais preferido pelos homens e pelos individuos com menores habilitações litenirias.

Os autores concluem que o Turbuhaler se apresenta como o inalador de mais facil manuseamento, ao contn1rio do MDI que foi o que se associou a maiores dificuldades na realização da sua manobra inalat6ria. A escolha do inalador foi determinada especialmente pelo grau de facilidade na realização·da manobra inalat6ria. Existcm diferen.;as na prefcrencia dos inaladores por parte dos indivlduos que participaram nestc estudo tendo em conta algumas das suas caracteristicas, nomeadamente o scxo e as habilitações literarias.

REV PORT PNEU 2001; VII (NōESPECIAT/BRASlL): 9-24

Palavras-chave:
inaladorcs
manuscamento
manobra inalatória
prefcrências
ABSTRACT

The inhalation therapy has a fundamental role in the treatment of respiratory diseases. This importance is related to several facts: through this therapy, the drug has a direct action in the area under treatment, smaller amounts of the drug are needed, there are less side effects and there is a faster efficient result at beginning of the drug's action. When prescribing an inhaler, the physician has to consider several variables, namely their ability to be easily handled.

The aim of this work is the study of the individual adjustment to each of the inhalation devices available in Portugal, the difficulty degree detected in the individual use of devices and their preferences about them.

The population was constituted by eighty individuals, 49 (61,2%) males and 31 (38,8%) females, with ages ranging from 24 to 78 (mean 45 years), who never had contact with an inhaler before. After the presentation of the studied inhalers (MDI and the DPI's Rotahaler, Turbulzaler, Diskus, Diskhaler e Aerolizer), each of the individuals chooses the most and the least attractive. Then they were instructed how to handle each of the inhalers properly. They had three chances to handle each inhaler successfully after instruction. After the inhaling act, each individual had to select which inhaler were the easiest and the most difficult to handle and which one he/she would choose and would reject.

The Diskus - 22 (27,5 %) and Aerolizer - 21 (26,2 %) were considered the most attractive; the Turbuhaler - 18 (22,5%) was considered the least attractive. The Turbuhaler followed by Diskus were the easiest to handle; on the contrary the MDI was the most difficult to handle. The Turbuhaler - 25 (31,2%) was elected as the easiest to handle; the MDI- 36 (45%) was selected as the most difficult to use. The Turbuhaler -25 (31,2%) followed by Diskus - 23 (28,7%) was the inhaler most chosen and the MDI - 38 (47,5%) was the most rejected. The study of the inhalers preferences according to some population characteristics showed us that the Turbuhaler is chosen preferentially by females and individuals with university grade while Diskus is chosen predominantly by males and individuals with less academic qualifications.

The authors conclude that the Turbuhaler was the easiest to usc and the MDI was the most difficult. The choice of the inhaler was determined mainly by the easiness of the inhalation. There are some differences related to the inhalers preferences according to some population characteristics, namely sex and academic qualilications.

REV PORT PNEU 2001; VII (:Nō ESPECIAI/BRASIL): 9-24

Key-words:
inhalers
handling
inhaling
preferences
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BIBLIOGRAFIA
[1.]
O. Selroos, A. Pietinalho, H. Riska.
Delevery Devices for Inhaled Asthma Medication - Clinical Implications of Differences in Effectiveness.
Clin Immunother, 6 (1996), pp. 273-299
[2.]
P.M. O’ Byrne.
Clinical comparisons of inhaler systems: What are the important aspects?.
J Aerosol Med, 8 (1995), pp. S39-S46
[3.]
S.W. Clarke.
Therapeutic aerossols I - Physical and practical considerations.
Thorax, 38 (1983), pp. 881-886
[4.]
C.J. Thomson, M.T. Irvine, C.K. Grathwohl, M.B. Roth.
Misuse of Metered Dose Inhalers in Hospitalized Patients.
Chest, I05 (1994), pp. 715-717
[5.]
D. King, S.M. Earnshaw, J.C. Delaney.
Pressurized aerossol inhalers: the cost of misuse.
Br J Clin Pharmacol, 45 (1991), pp. 48-49
[6.]
P. De Blaquiere, D.B. Christensen, W.B. Carter, T.R. Martin.
Use and Misuse of Metered Dose Inhalers by Patients with Chronic Lung Disease.
Am Rev Resp Diseases, 140 (1989), pp. 910-916
[7.]
B.A. Manzella, C.M. Brooks, J.M. Richards, R.A. Windsor, S. Soong, W.C. Bailey.
Assessing the use of metered dose inhalers by adults with asthma.
J Asthma, 26 (1989), pp. 223-230
[8.]
S.W. Epstein, C.P.R. Manning, M.J. Ashley, P.N. Corey.
Survey of the clinical use of pressurized aerosol inhalers.
Can Med Assoc J, 120 (1979), pp. 813-816
[9.]
S. Hiltons.
An audit of inhaler technique among asthma patients of 34 general practioners.
Br J Gen Prac, 40 (1990), pp. 505-506
[10.]
D.E. Goodman, E. Israel, M. Rosemberg, K. John-Ston, S.T. Weiss, J.M. Drazen.
The influence of age, diagnosis and gender on proper use of metered dose inhalers.
Am J Respir Crit Care Med, 150 (1994), pp. 1256-1261
[11.]
S. Pederson, L. Frost, T. Arnfred.
Errors in inhalation technique and efficiency in inhaler use in asthmatic children.
Allergy, 41 (1986), pp. 118-124
[12.]
J. Van Der Palen, J.J. Klein, A.H.M. Kerkhoff, C.L.A. Van Herwaarden.
Evaluation of the effectiveness of four different inhalers in patients with chronic obstrutive pulmonary disease.
Thorax, 50 (1995), pp. 1183-1187
[13.]
J. Boe, G. Stiksa, K. Svensso, E. Asbrink.
New method of evaluating pati ent preference for different inhalati on delivery systems.
Annals of Allergy, 68 (1992), pp. 255-260
[14.]
J. Van Der Palen, J.J. Klein, A.M. Schildkamp.
Comparison of a cw Multidose Powder Inhaler (Dis kus/Accuhaler) and Turbuhaler, regarding Preference and ease of use.
J Asthma, 35 (1998), pp. 147-152
[15.]
M. Schilaeppi, K. Edwards, R.W. Fuller, R.K. Sharma.
Patient perception of the Diskus inhaler. A comparison with the turbuhaler inhaler.
Br J Clin Prac, 50 (1996), pp. 14-19
[16.]
L.M. Campbell, T.J. Anderson, M.R. Parashchak, C.M. Burke, S.A. Watson, M.L. Turbitt.
A comparison of the efficacy of long acting beta 2- agonists: cformoterol via Turbuhaler and salhutamol via pressurized metered dose inhaler or Accuhaler in mild to moderate asthmatics. Force Research Group.
Respir Mcd, 93 (1999), pp. 236-244
[17.]
R.K. Sharma, K. Edwards, C. Hallet, R.W. Fuller.
Perception among pacdriatic patients of the Diskus inhaler, a novel multidose powder inhaler for use in the treatment of asthma. Comparison with Turbuhaler inhaler.
Clin Drug Invest, II (1996), pp. 145-153
[18.]
E. Van Dompling, P.M. Grunsven, C.P. Van Schayck, et al.
Treatment with inhaled steroids in asthma and chronic bronchitis: long term compliance and inhaler technique.
Fam Pract, 9 (1992), pp. 161-166
[19.]
A. Anani, A.J. Higgi Ns, G.K. Crompton.
Breathactuated inhaJcrs: comparison of tcrbutalinc with salbutamol rotahaler.
Eur Resp J, 2 (1989), pp. 640-642
[20.]
P.H. Brown, J. Lenney, S. Armstrong, A.C.W.S. Wing, G.K. Crompton.
Breath-actuated inhalers in chronic asthma: comparison of Diskhaler and Turbohaler for delivery of beta agonists.
Eur Resp J, 5 (1992), pp. 1143-1145
[21.]
G.R. Petrie, Y.F.J. Choo-Kang, R.A. Clarck.
An assessment of the acceptability of two breath-actu ated corticosteroid inhalers - Comparison of Turbuhalcr and Diskhaler.
Drug Invest, 2 (1990), pp. 129-131
[22.]
C.J. Nimmo, O.N. Chen, S.M. Martinusen, T.L. Ustad, O.N. Ostrow.
Assessment of patient acceptance and inhalation technique of a pressurized aerossol inhaler and two breath-actuated devices.
Ann Pharmacother, 27 (1993), pp. 922-927
[23.]
S. Oliver, P.J. Rees.
Inhaler usc in chronic obstructive pulmonary disease.
Int J Clin Pract, 51 (1997), pp. 443-445
[24.]
A.M. Clauzel, M. Molimard, V. Legros, E. Lepere, N. Febvre, F.B. Michel.
Use of fonnoterol dry powder administered for three months via a single dose inhaler in 1380 asthmatic patients.
J lnvestig Allergol Clin lmmunol, 8 (1998), pp. 265-270
[25.]
K.G. Nielsen, M. Skov, M. Klug, M. Ifversen, H. Bisgaard.
Flow dependent effect of formoterol dry powder inhaled from the Aerolizcr.
Eur Resp J, 10 (1997), pp. 2105-2109
[26.]
J.B. Leicallon, G. Kaiser, M. Palmisano, J. Morgan, G. Della Cioppa.
Pharmacokinetics and tolerability of formoterol in healthy volunteers after a single high dose of Foradil dry powder inhalation via Acrolizcr.
Eur J Cl in Pharmacol, 55 (1999), pp. 131-138
[27.]
J. Lotvall, A. Mellen, P. Arvidsson, M. Palmqvist, P. Radielovic, J. Kottakis, P. Pfister.
Similar bronchodilatation with formotcrol delivered by Acrolizcr or Turbuhaler.
Can Resp J, 6 (1999), pp. 412-416
[28.]
M.G. Horsley, G.R. Baile.
Risk factors for inadequate use of pressurized acrossol inhalers.
J Clin Pharm Ther, 13 (1988), pp. 139-143
[29.]
P. Gayard, J. Orehek.
Maivaisc utilization des aerosoldoseurs par les asthmatiques.
Respiration, 40 (1980), pp. 47-52
[30.]
J. Vander Palen, J. Klein, M. Rovers.
Compliance wi th inhaled medication and self treatment guideli nes following a self management programme in adult asthmatics.
Eur Resp J, 10 (1997), pp. 652-657
[31.]
O.K. Ng, V. Lee, J.C. Ho.
Comparison of prefcrance and ease of usc of breath-actuated inhalation devices in children.
Respirology, 4 (1999), pp. 255-257
[32.]
R. Wettengel, K. Laurikainen, M. Silvasti, P. Toivanen, K. Sauter.
Therapeutic Equi valence and Acceptabi lity of Two Multidose Powder Inhalers in the Treatment of Asthma.
Respiration, 67 (2000), pp. 77-82
[33.]
K.M. Buston, S.F. Wood.
Non-compliance amongst adolescents with asthma: listening to what they tdl us about self management.
Fam Pract, 17 (2000), pp. 134-138
[34.]
S.M. Van Es, E.M. Le Coq, A.I. Brouwer, I. Mesters, A.F. Nagelkerke, V.T. Colland.
Adherence related behavior in adolescents with asth ma: results focus group interviews.
J Asthma, 35 (1998), pp. 637-646
[35.]
M. Rich, L. Schneider.
Eflicacy and tolerability of formotcrol in cldery patients with reversible obstructi ve airways diseases.
Rcspir Mcd, 92 (1998), pp. 562-567
[36.]
N.C. Thomson, R. Augus, E. Quebe-Fehling, R. Bram Billa.
Efficacy and tolerability of formoterol in eldery patients with reversible obstructive airways diseases.
Rcspir Mcd, 92 (1998), pp. 562-567
[37.]
M.A. Todd, J.J. Baskett, D.E. Richmond.
Inhaler devices and cldery.
N Z Med J, 103 (1990), pp. 43-46
[38.]
R. Laird, K. Chamberlain, J. Spicer.
Self management practices in adult asthmatics.
N Z Mcd J, 107 (1994), pp. 73-75

Trabalho concotTente ao Premia Thome Villar/Boehringer Ingelhcim, 1999 (Secção A)

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Pulmonology
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