ABSTRACT
Many chronic obstructive pulmonary disease (COPD) patients use their inhaler ineffectively and there is a trend towards increased inhaler resistance. We wanted to answer two questions: Is there a difference in preference and ease of use between Diskus (DK) and Handihaler (HH)? How acceptable are inhalation resistances? Sixty COPD patients, naive to DK and HH, but experienced in the use of other inhalers, had to read the instruction leaflet and demonstrate their inhalation technique. If errors were made, instruction was given and inhalation technique was checked again. Patients had to state a preference for DK or HH. Subsequently they inhaled through a range of resistances and scored the acceptability. There was no difference in the number of instructions needed for both inhalers. One third inhaled perfectly after reading the instruction leaflet, which increased to 85% after one instruction. More patients preferred the DK (43) than the HH (16). With decreasing resistance acceptability increases, but it reaches a plateau. Patients have a clear preference for the DK. There is no difference in the number of instructions needed to obtain a perfect inhalation technique, but for some patients one instruction is not enough. The trend to increase the resistance of inhalers has reached a critical point with regard to acceptability.
Subject(s)
Nebulizers and Vaporizers , Patient Satisfaction , Administration, Inhalation , Adult , Aged , Bronchodilator Agents/administration & dosage , Comprehension , Drug Labeling , Equipment Design , Forced Expiratory Volume/drug effects , Humans , Metered Dose Inhalers , Patient Education as Topic , Pulmonary Disease, Chronic Obstructive/drug therapy , RheologyABSTRACT
D-dimer test combined with clinical probability assessment has been proposed as the first step in the diagnostic work-up of patients with suspected pulmonary embolism (PE). In a prospective management study we investigated the safety and efficiency of excluding PE by a normal D-dimer combined with a low or moderate clinical probability. Of the 202 study patients this combination ruled out PE in 64 (32%) patients. The 3-month thromboembolic risk in these patients was 0% (95% CI, 0.0-5.6%). The prevalence of PE in the entire cohort was 29% (59 patients), whereas in the low, moderate and high clinical probability groups this was 25%, 26% and 50%, respectively. We conclude that ruling out suspected PE by a normal D-dimer combined with a low or moderate clinical probability appears to be a safe and efficient strategy. The accuracy of the clinical probability assessment is modest.