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spacers in 8 pediatric allergy clinic
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301
Abstracts
HOME BOUND ASTHMA EDUCATION FOR CHILDREN IN MEDIUM SIZED CITIES: EFFECTIVENESS
J ALLERGY CLIN IMMUNOL JANUARY 1996
303
Effects of an asthma educational videocassette for adults._G_..M_o_s_cut.o.Mt3,G BeLt_019.~.PS~C_'FDonner MD LM Fabbri _M._D__*~._M_N_._~.'..MD~._C~_E_ulJ_a_M__MD~D __P"~...gon MD**. "S. Manger" Foundation, Pavia; *Umversity of Fetrara;** Busto Arsizio General tlospital, ITALY. The effects on knowledge about asthma and on skill in using devices (i.e. metered inlmka's and peak flow touters) of a specially prepared videocassetictapewereobservedin a roulticonlre, conl~olleds~dy of 66 adultpatientswith mild to moderateasthma.At the end of the diagnostic procedure patients were randomly allocated to one of two study groups: Group A was given the tape, Group B only received verbal information. Questionnaires on patients' knowledge about asthma were adminis~,~red three times: immediately before the educational material was provided, immediately after, and 45 days later. At the same time-points ability in use of devices was assessed with a checldist. Scoring systems were devised for each measurement ANCOVA F test and Fisher exact test were used for statistical analysis In Group A know]egdeon asthinaand skill in using meteredinhalers significanlly increased i~rmaediately after the .'showing o f the tape and persisted ~ 45 days. No significara chmage was observed in Group B. We concludethat use of visualaidsimprovespatients' knowledge on asthma and may change ability in using some devices.
304
Compliance to peak expiratory flow (PEF) m e a s u r e m e n t s in l o n g - t e r m f o l l o w - u p o f a s t h m a . A..~ Cartier, J. COt~ P Robichaud, H Boutin, M Lavallee, A Flitch, M Rouleau, M Krausky, JL Malo, LP Boulet. Quebec and Montreal, Canada Objectives: To assess the compliance of asthma subjects to PEF measurements. Desifn: a descriptive and prospective single blind
ANALYSIS. HS P r a b h a k a r a MD, JW G e o r q i t i s M D and AJ A l t h a u s MD. W i n s t o n - S a l e m , NC. An A s t h m a E d u c a t i o n p r o g r a m (Ed) was e v a l u a t e d for e f f e c t i v e n e s s in a m e d i u m sized city (<1 m i l l i o n in 10 counties). ED was g r a d e d on the r e d u c t i o n of h o s p i t a l a d m i s s i o n s , ER visits, office v i s i t s and school absences. Trained nurses visited children with asthma and p a r e n t s in h o m e s e t t i n g who w e r e e d u c a t e d in p a t h o p h y s i o l o g y , triggers, a v o i d a n c e m e a s u r e s , asthma m e d i c a t i o n s , c o r r e c t use of n e b u l i z e r s and p e a k flow m e t e r s and m a n a g e m e n t . T h i r t y one p a t i e n t s w e r e e v a l u a t e d over 2 years (1 yr b e f o r e Ed and 1 yr p o s t Ed). H o s p i t a l i z a t i o n d r o p p e d from 2.0 (range 1.77-4.5) to 0.33 ( 0 . 2 9 - 2 . 2 5 ) / y r (p<0.02); o f f i c e / E R v i s i t s d r o p p e d from 13.4 (13.3-13.8) to 4.8 (4.6-9.2) (p<0.02); school a b s e n c e s c h a n g e d from 28.1 d a y s / y r (6-31) to 4.6 d a y s / y r (1.035.3) (p<0.05). Net s a v i n g s / p t was $1932. Home A s t h m a E d u c a t i o n p r o g r a m s are cost e f f e c t i v e for c h i l d r e n in c i t i e s w i t h m e d i u m s i z e d and rural p o p u l a t i o n s .
302
CORRECT USE OF METERED DOSE INHALERS/ SPACERS IN A PEDIATRIC ALLERGY CLINIC J Brauckmann, M D . . J P o n ~ a c i ¢ . M . D . Chicago, IL Many studies have shown that a large percentage of patients have difficulty using a metered dose inhaler (MDI) correctly and thus have advocated the addition of a spacer device, especially in the pediatric population. The purpose of this study is to determine the percentage of patients, referred to a pediatric allergy clinic for complaint of asthma or chronic cough, that use MDIs (with or without spacers), ff they do so correctly, and if not, how much education and followup is required before they demonstrate proper technique. 38 children were evaluated on their initial visit to our outpatient Allergy Clinic by a clinical nurse or physician for this study. Of the 38:27 used an inhaler, 23 also used a spacer device, and II were begun on an MDI/spacer at that visit. 15/27 demonstrated improper technique based on manufacturer recommendations. The most common mistakes made were failure to hold ones breath at the end of inspiration, inspiration too fast, failure to take a deep breath, and timing errors. One on one interventional teaching on correct technique was provided and adequate return demonstration by the patient observed at the end of each visit. For the majority, MDI teaching took less than 5 minutes. Thus far, 8 pat/eats have been assessed at their 4-6 week return visit: 3 failed to use thcir MDI with spacer correctly. In conclusion, many of the patients we see are not receiving their medications because of poor administration technique. A significant number will require repeated instruction to overcome this problem.
study of one year duration. Patients: 26 patients with moderate to severe asthma who took part to a study on asthma education (SAE) and were randomized in the group using a self-management plan based on PEF. Main outcome measures: patients were asked to measure PEF morning and evening, using an electronic peak flow meter (PFM) with a three-month memory. R~ultl: Compliance was good (> 60% of the measurements done) during the first month
in 75% of the subjects. However, at 3 months, it decreased to 50% and at one year it was down to 23"/.. Eight subjects out of 26 almost never measured PEF right from beginning. Twelve subjects out of 26 wrote PEF values in their diary card while in fact they were not measuring them. Eight of these 12 subjects measured PEF only a few times during the first week though they wrote PEF values in their diary card during the whole study period. Conclusions: After taking part to an (SAE), most subjects with moderate to severe asthma are not interested in measuring PEF regularly for long term period. Short term compliance is better. Consequently, when planning an educational intervention, PEF should be suggested to those asthmatics showing a strong interesl in using a PFM and for a few weeks. In the context of a study, the use of an electronic PFM with a memory would help ensured the veracity of these measures.
301
Abstracts
HOME BOUND ASTHMA EDUCATION FOR CHILDREN IN MEDIUM SIZED CITIES: EFFECTIVENESS
J ALLERGY CLIN IMMUNOL JANUARY 1996
303
Effects of an asthma educational videocassette for adults._G_..M_o_s_cut.o.Mt3,G BeLt_019.~.PS~C_'FDonner MD LM Fabbri _M._D__*~._M_N_._~.'..MD~._C~_E_ulJ_a_M__MD~D __P"~...gon MD**. "S. Manger" Foundation, Pavia; *Umversity of Fetrara;** Busto Arsizio General tlospital, ITALY. The effects on knowledge about asthma and on skill in using devices (i.e. metered inlmka's and peak flow touters) of a specially prepared videocassetictapewereobservedin a roulticonlre, conl~olleds~dy of 66 adultpatientswith mild to moderateasthma.At the end of the diagnostic procedure patients were randomly allocated to one of two study groups: Group A was given the tape, Group B only received verbal information. Questionnaires on patients' knowledge about asthma were adminis~,~red three times: immediately before the educational material was provided, immediately after, and 45 days later. At the same time-points ability in use of devices was assessed with a checldist. Scoring systems were devised for each measurement ANCOVA F test and Fisher exact test were used for statistical analysis In Group A know]egdeon asthinaand skill in using meteredinhalers significanlly increased i~rmaediately after the .'showing o f the tape and persisted ~ 45 days. No significara chmage was observed in Group B. We concludethat use of visualaidsimprovespatients' knowledge on asthma and may change ability in using some devices.
304
Compliance to peak expiratory flow (PEF) m e a s u r e m e n t s in l o n g - t e r m f o l l o w - u p o f a s t h m a . A..~ Cartier, J. COt~ P Robichaud, H Boutin, M Lavallee, A Flitch, M Rouleau, M Krausky, JL Malo, LP Boulet. Quebec and Montreal, Canada Objectives: To assess the compliance of asthma subjects to PEF measurements. Desifn: a descriptive and prospective single blind
ANALYSIS. HS P r a b h a k a r a MD, JW G e o r q i t i s M D and AJ A l t h a u s MD. W i n s t o n - S a l e m , NC. An A s t h m a E d u c a t i o n p r o g r a m (Ed) was e v a l u a t e d for e f f e c t i v e n e s s in a m e d i u m sized city (<1 m i l l i o n in 10 counties). ED was g r a d e d on the r e d u c t i o n of h o s p i t a l a d m i s s i o n s , ER visits, office v i s i t s and school absences. Trained nurses visited children with asthma and p a r e n t s in h o m e s e t t i n g who w e r e e d u c a t e d in p a t h o p h y s i o l o g y , triggers, a v o i d a n c e m e a s u r e s , asthma m e d i c a t i o n s , c o r r e c t use of n e b u l i z e r s and p e a k flow m e t e r s and m a n a g e m e n t . T h i r t y one p a t i e n t s w e r e e v a l u a t e d over 2 years (1 yr b e f o r e Ed and 1 yr p o s t Ed). H o s p i t a l i z a t i o n d r o p p e d from 2.0 (range 1.77-4.5) to 0.33 ( 0 . 2 9 - 2 . 2 5 ) / y r (p<0.02); o f f i c e / E R v i s i t s d r o p p e d from 13.4 (13.3-13.8) to 4.8 (4.6-9.2) (p<0.02); school a b s e n c e s c h a n g e d from 28.1 d a y s / y r (6-31) to 4.6 d a y s / y r (1.035.3) (p<0.05). Net s a v i n g s / p t was $1932. Home A s t h m a E d u c a t i o n p r o g r a m s are cost e f f e c t i v e for c h i l d r e n in c i t i e s w i t h m e d i u m s i z e d and rural p o p u l a t i o n s .
302
CORRECT USE OF METERED DOSE INHALERS/ SPACERS IN A PEDIATRIC ALLERGY CLINIC J Brauckmann, M D . . J P o n ~ a c i ¢ . M . D . Chicago, IL Many studies have shown that a large percentage of patients have difficulty using a metered dose inhaler (MDI) correctly and thus have advocated the addition of a spacer device, especially in the pediatric population. The purpose of this study is to determine the percentage of patients, referred to a pediatric allergy clinic for complaint of asthma or chronic cough, that use MDIs (with or without spacers), ff they do so correctly, and if not, how much education and followup is required before they demonstrate proper technique. 38 children were evaluated on their initial visit to our outpatient Allergy Clinic by a clinical nurse or physician for this study. Of the 38:27 used an inhaler, 23 also used a spacer device, and II were begun on an MDI/spacer at that visit. 15/27 demonstrated improper technique based on manufacturer recommendations. The most common mistakes made were failure to hold ones breath at the end of inspiration, inspiration too fast, failure to take a deep breath, and timing errors. One on one interventional teaching on correct technique was provided and adequate return demonstration by the patient observed at the end of each visit. For the majority, MDI teaching took less than 5 minutes. Thus far, 8 pat/eats have been assessed at their 4-6 week return visit: 3 failed to use thcir MDI with spacer correctly. In conclusion, many of the patients we see are not receiving their medications because of poor administration technique. A significant number will require repeated instruction to overcome this problem.
study of one year duration. Patients: 26 patients with moderate to severe asthma who took part to a study on asthma education (SAE) and were randomized in the group using a self-management plan based on PEF. Main outcome measures: patients were asked to measure PEF morning and evening, using an electronic peak flow meter (PFM) with a three-month memory. R~ultl: Compliance was good (> 60% of the measurements done) during the first month
in 75% of the subjects. However, at 3 months, it decreased to 50% and at one year it was down to 23"/.. Eight subjects out of 26 almost never measured PEF right from beginning. Twelve subjects out of 26 wrote PEF values in their diary card while in fact they were not measuring them. Eight of these 12 subjects measured PEF only a few times during the first week though they wrote PEF values in their diary card during the whole study period. Conclusions: After taking part to an (SAE), most subjects with moderate to severe asthma are not interested in measuring PEF regularly for long term period. Short term compliance is better. Consequently, when planning an educational intervention, PEF should be suggested to those asthmatics showing a strong interesl in using a PFM and for a few weeks. In the context of a study, the use of an electronic PFM with a memory would help ensured the veracity of these measures.