Acute exacerbations of asthma occurring frequently time to check your techniques
DOI:
https://doi.org/10.18203/2349-3933.ijam20195167Keywords:
Asthma, Cough severity index, Inhaler scoring system, Inhalational therapy, Metered-dose inhaler techniquesAbstract
Background: Asthmatics form a predominant section of patients in OPD. If poorly controlled the frequency of attacks requiring an emergency department visit adds to the burden. It was noticed that the patients who were on inhalational therapy had poor control despite the absence of other factors which could lead to exacerbations. Hence author evaluated the inhalational techniques.
Methods: A prospective study undertaken in the department of medicine in tertiary care hospital in Dakshina Kannada District, Karnataka enlisting 25 patients admitted with acute exacerbation of bronchial asthma. The patients were assessed for their symptoms, signs and recurrent attacks along with their cough severity index and inhaler scores and the observations were tabulated.
Results: Of the twenty-five, 15 were on inhalation therapy with various modes of deliveries. There were 15 males and 10 females from ages 20 to 50years. The number of attacks of asthma was higher in those not on inhalation therapies than those using inhalation therapies. Also, the level/severity of cough, measured as Cough Severity Index, was assessed among the two groups. Those on inhalation therapy had a lower grade of cough than those not on therapy . Mean AEC was 94 among those on inhalation therapy and 209 among those not on therapy. Inhalational score was calculated for each patient. There is a strong negative correlation of -0.709 between inhalation score and recurrent attacks, which is statistically significant (p=0.003). Lower inhalation scores were associated with recurrent attacks.
Conclusions: Recurrent exacerbations in an asthmatic patient on inhalation therapy are due to improper inhalational technique. It was suggested that it is wise to spend time with the patients in authors OPD set up and teach them the correct techniques of using inhalational therapy hence reducing frequency of attacks and cost of health care in such patients.
Metrics
References
Papadopoulos NG, Agache I, Bavbek S, Bilo BM, Braido F, Cardona V, et al. Research needs in allergy: an EAACI position paper, in collaboration with EFA. Clini Translational Allergy. 2012 Dec;2(1):21.
Roorda RJ. Prognostic factors for the outcome of childhood asthma in adolescence. Thorax. 1996 Jan 1;51(Suppl 1):S7-12.
Longobardi L, Di Giorgio A, Perrotta F, Costigliola A, Cerqua F.et al. Bronchial asthma in the elderly patient. J Gerontol Geriatr. 2016;64:55-65.
Bateman ED, Reddel HK, van Zyl-Smit RN, Agusti A. The asthma-COPD overlap syndrome: towards a revised taxonomy of chronic airways diseases? Lancet Respirat Med. 2015 Sep 1;3(9):719-28.
Bousquet J, Mantzouranis E, Cruz AA, Aït-Khaled N, Baena-Cagnani CE, Bleecker ER, et al. Uniform definition of asthma severity, control, and exacerbations: document presented for the World Health Organization Consultation on Severe Asthma. J Allergy Clini Immunol. 2010 Nov 1;126(5):926-38.
Manali ED, Stathopoulos GT, Kollintza A, Kalomenidis I, Emili JM, Sotiropoulou C, et al. The Medical Research Council chronic dyspnea score predicts the survival of patients with idiopathic pulmonary fibrosis. Respiratory Med. 2008 Apr 1;102(4):586-92.
Shembel AC, Rosen CA, Zullo TG, Gartner‐Schmidt JL. Development and validation of the cough severity index: a severity index for chronic cough related to the upper airway. Laryngoscope. 2013 Aug;123(8):1931-6.
Allen SC, Ragab S. Ability to learn inhaler technique in relation to cognitive scores and tests of praxis in old age. Postgrad Medica J. 2002 Jan 1;78(915):37-9.
Ayele AA, Tegegn HG. Nonadherence to inhalational medications and associated factors among patients with asthma in a referral hospital in Ethiopia, using validated tool TAI. Asthma Res Prac. 2017 Dec;3(1):7.
Lurslurchachai L, Krauskopf K, Roy A, Halm EA, Leventhal H, Wisnivesky JP. Metered dose inhaler technique among inner‐city asthmatics and its association with asthma medication adherence. Clini Respira J. 2014 Oct;8(4):397-403.
Almomani BA, Mokhemer E, Al-Sawalha NA, Momany SM. A novel approach of using educational pharmaceutical pictogram for improving inhaler techniques in patients with asthma. Respira Med. 2018 Oct 1;143:103-8.