A comparison of the costs of bronchodilator delivery methods in children with asthma exacerbations treated in hospital. The first Polish study in children.

INTRODUCTION: Recommended methods of administering bronchodilator drugs in children with asthma exacerbations in a hospital include the pressurized metered-dose inhaler (pMDI) and nebulization (NEB). These methods differ in clinical effectiveness, safety and, as some studies indicate, the cost of their use in a child. AIM: To calculate the direct costs of hospital therapy conducted with the use of short-acting ß2-agonist (SABA) or its combination with short-acting muscarinic antagonist (SAMA) administered via pMDI with valved holding chamber (VHC) versus the same drugs in NEB in children with asthma exacerbation. MATERIAL AND METHODS: A retrospective analysis of the costs of SABA (salbutamol) and SABA + SAMA (fenoterol + ipratropium bromide) inhalation therapy was performed. Based on the data obtained from the financial department, the pharmacy, and the sterilization department of the university hospital, the direct unit cost of the inhalation therapy in the child was calculated. RESULTS: The results of the analysis indicate that in a hospital setting the cost of one-time SABA or SABA + SAMA administration via pMDI+VHC is 1.5-2.4 times lower compared to NEB. The payer incurred the lowest costs during anti-obstructive treatment using SABA with pMDI + VHC (PLN 9.39 for one inhalation procedure). The working time of medical staff during the inhalation treatment is the component generating the highest cost for the hospital (up to 40% of direct costs). CONCLUSIONS: In hospital conditions, the supply of SABA or SABA + SAMA with the use of pMDI + VHC in a child with asthma exacerbation is more beneficial financially than the supply of the same drugs in NEB.

[Cyclohaler's acceptance by asthma and COPD patients]. / Kryteria akceptacji cyclohalera przez chorych na astme i POChP.

INTRODUCTION: The patients' acceptance of the treatment scheme and their readiness to stick to the prescribed dosing is considered to be the most important condition on which successful treatment of asthma and COPD depends. With regard to this assumption, a study was designed whose aim was to find out how patients assess a particular powder inhaler, cyclohaler and to what degree they approve of its physical and technical features. MATERIAL AND METHODS: The study consisted in completing an anonymous questionnaire. The study group was recruited from asthmatic and COPD patients treated in outpatient units in Wroclaw and Lublin, Poland. 230 persons passed the recruitment stage, 220 completed the study. RESULTS: 96.4 and 94.5% of the patients ranked small size and low weight of the inhaler, respectively, as its most positive features, ranking the features higher than the device's colour (respectively p = 0.003 and p = 0.02). Other features, like dust protection and comfortable mouthpiece won almost equally high evaluation (respectively 97.3 and 98.2%). Most patients assessed these features as more important than discretion and easy handling and transportation (respectively p = 0.015 and p = 0.028). A high percentage of the study group praised the inhaler's technological efficacy. 94-96% at the least gave positive opinions about such features as: clear instruction, certainty of a dose's intake, the possibility of checking the amount of inhaled doses. CONCLUSION: The inhaler that was the object of the study enjoyed a high degree of acceptance mostly due to its features facilitating easy and efficient inhalation.