Understanding and use of inhaler medication by asthmatics in specialty care in Trinidad: a study following development of Caribbean guidelines for asthma management and prevention

STUDY OBJECTIVES: Following the development of the Caribbean Guidelines for Asthma Care, we examined the utilization of inhaled medications in asthmatic patients in Trinidad, West Indies. SETTING: Chest Clinic, Ministry of Health, Trinidad. PARTICIPANTS: Physician-diagnosed asthmatic patients who attended the Chest Clinic between July 1998 and August 2000. MEASUREMENTS AND RESULTS: A consecutive sample of patients who were > 7 years of age (n = 402) was interviewed about compliance with, understanding of, and use of inhaler medication. The inhaler technique of these patients was directly observed. Inhaled steroid therapy was prescribed in 83% of patients but were prescribed the least in elderly patients (63%) and children (62%). Salbutamol was prescribed in 98% of patients, and ipratropium and sodium cromoglycate were selectively prescribed in elderly men and children, respectively. Only 33% of patients used the inhaler correctly, and children and the elderly were the least efficient in its use. The use of a spacer device was advised in 19% of patients, including only 6% of the elderly patients. Explanations for different inhaler therapies were given to 62% of patients, and 53% of patients could describe these reasons. The reported 40% noncompliance rate among patients in the sample was primarily a result of long waiting periods at the pharmacy (58%) and the personal cost incurred on purchasing the medication (52%). CONCLUSIONS: Educating patients, with a focus on children and the elderly, in inhaler techniques and reinforcing understanding of asthma medications can improve asthma management in Trinidad. Asthma caregivers in the Caribbean should ensure the appropriate dissemination of the guidelines and should outline strategies for their implementation.

Demonstration of bioequivalence between ventasol syrup and ventolin syrup in humans and in dogs

Ventasol syrup, a new locally produced salbutamol formulation, was compared with the standard salbutamol formulation, ventolin syrup, for determination of oral bioequivalence in stable asthmatic human subjects and in dogs. On separate occasions, each subject received a single 10 ml oral dose of each formulation containing 4 mg salbutamol. In the human subjects, statistically similar peak plasma concentrations of salbutamol were obtained (196ñ7ng/ml for ventasol syrup and 185ñ6ng/ml for ventolin syrup) 3 hours after oral administration of the formulations. From the ratio of the AUC 0-y for the formulations (1.04), a relative oral bioavailability of 104 percent, indicating equivalent total salbutamol output, was also obtained in the human subjects. Similarly, in the dogs, the formulations produced statistically equivalent peak plasma concentrations of salbutamol (259ñ24ng/ml for ventasol syrup and 285ñ29ng/ml for ventolin syrup) 3 hours after oral administration. Also, from the ratio of AUC 0-y for the formulation (1.02), a relative oral bioavailability of 102 percent, indicating similar total salbutamol output, was obtained in the dogs. From these results, it is concluded that oral bioequivolence between ventasol syrup and ventolin syrup was demonstrated in human subjects and in dogs. (AU)

100 cases of acute asthma

The clinical notes of 100 patients (mean age 6.5 years) consecutively diagnosed and treated as acute asthma are reviewed. The vast majority of the patient (82 percent) were from the 1-10 age group. 99 patients received nebulised salbutamol as first line treatment. This way significantly different from 1982 when 100 percent of the acute asthmatics received adrenaline s.c. (p<0.001). Of the 100 patients 40 received antibiotics, mainly amoxicillin and 63 were admitted to the hospital for post-primary treatment. The number of chest radiographs that were requested was significantly smaller (p<0.01) than the number in 1882. Attention needs to be directed towards improving the recording of clinical notes and to avoiding unnecessary and often harmful medications (AU)