Association between health literacy, inhaler technique and disease control in obstructive airway disease

OBJECTIVE: The association of health literacy with compliance, inhaler technique and disease control with respect to both asthma and chronic obstructive pulmonary disease (COPD) patients is poorly addressed. We examined the association between health literacy, inhaler technique and disease control in patients suffering from obstructive lung disease in Trinidad. DESIGN AND METHODS: The method was a cross-sectional study which employed 781 patients from Chest Clinics in Trinidad (Arima Health Facility, Eric Williams Medical Sciences Complex, Port of Spain and San Fernando General Hospitals). Out-patients were interviewed on a pilot tested questionnaire for information on compliance and disease control. Morisky 8- item Medication Adherence Questionnaire, Asthma Control Test (ACT), and COPD Assessment Test (CAT) were used to assess compliance, asthma and COPD control respectively. Health literacy was assessed using Rapid Estimate of Adult Literacy in Medicine – short form (REALM- SF), and inhaler technique was observed on dummies.

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.

Plastic bottles as spacers for a pressurized metered-dose inhaler: In vitro characteristics

Homemade spacer devices are commonly used by children with asthma to improve aerosol deposition from pressurized metered dose inhalers (pMDI); however, the efficacy and efficiency of these devices are not fully characterized. We determined the quality of fine particle fraction (<4.7 um) and ultrafine particle fraction (<3.3 um) of three bottles (from 280 ml to 500 ml) commonly used as spacers in Trinidad and Tobago and compared their performance to the commercially available valved holding chamber (OpT) and pMDI. These data were obtained in vitro using a cascade impactor. All 3 bottles and OpT were similar (p>0.05) in reducing the amount of albuterol emitted as large particles (>4.7 um) to less than 10 ug. The diffreent sized bottles (from 280 ml to 500 ml) produced identical quantities of albuterol in the fine particle and ultrafine particle ranges (p>0.05). All of the sample bottle spacers emitted a higher amount (p<0.002) of fine and ultrafine particles than the OpT and pMDI alone. The OpT resulted in a significantly higher fraction of fine particles (p<0.05) and greater quantity of drug (<0.05) in the ultrafine range as compared to MDI only. The sizes of particles obtained from the bottle spacers are those that have a high probability of reaching the lower airway; however, the clinical relevance of these findings remains to be determined. (AU)