Short-term effects of air pollutant exposure on small airway dysfunction, spirometry, health-related quality of life, and inflammatory biomarkers in wildland firefighters: a pilot study.

Clinical Trials Registry: Study ID: TCTR20200828005.

The effectiveness of large group demonstration training method on the use of pressurized metered-dose inhaler in elderly with chronic obstructive pulmonary disease.

Background: Pressurized metered-dose inhaler (pMDI) is the most commonly used inhaler devices in community hospitals in Thailand. However, the research work on large group demonstration training method in the use of pMDI and pMDI with spacer in cases of chronic obstructive pulmonary disease (COPD) is very limited. Therefore, this study aimed to evaluate the effectiveness of this training method in elderly with COPD patients. Methods: This prospective cross-sectional study was conducted at COPD clinic, Chiang Dao Hospital, Chiang Mai, Thailand between June 2019 and July 2019. All patients being treated in the clinic were assessed for their inhalation technique and inspiratory flow. After the initial assessment, patients were given instructions regarding the correct inhalation technique of pMDI and pMDI with spacer devices through large group demonstration. One month later, inhalation techniques and inspiratory flow were re-assessed. Results: A total of 104 COPD patients were included, mean age 70.9±8.3 years, 51 (49.0%) male. At their first visit, 75.0% of pMDI and 81.7% of pMDI with spacer users performed at least one essential step incorrectly. After receiving large group demonstration training, there was a statistically significant increase in all devices; 26.7% vs. 56.7%, P=0.001 for correct technique, 41.7% vs. 62.7%, P=0.026 for appropriate flow, and 11.7% vs. 36.7%, P=0.001 for correct technique and flow. Conclusions: The provision of large group training significantly increases the correct use of inhalation techniques and inspiratory flow for pMDI and pMDI with spacer in elderly with COPD.

Reliability of the Thai version of the International Physical Activity Questionnaire Short Form in chronic obstructive pulmonary disease.

OBJECTIVE: To determine the reliability of the Thai version of International Physical Activity Questionnaire Short Form (IPAQ-SF) in Chronic Obstructive Pulmonary Disease (COPD) patients. METHODS: A cross sectional study was carried out in COPD subjects at Chiang Dao hospital, Chiang Mai, Thailand in June and July 2019. COPD subjects were asked to complete the Thai version of the IPAQ-SF. Calculations for each level of activity were carried out separately (vigorous activity, moderate activity, walking, and sitting). This was carried out twice with an interval of four weeks between visits. The test-retest reliability of the IPAQ was assessed using the intraclass correlation (ICC) with a 95% confidence interval (CI). Cohen's kappa coefficient and percentage agreement were used to test the repeatability of the physical activity classification between the two visits. RESULTS: Sixty COPD subjects (50% male), with a mean age of 71.2 ± 7.7 years were included. The least reliability was established for sitting time (ICC = 0.439; 95%CI; 0.212, 0.621, p-value < 0.001) and the greatest for the total physical activity (ICC = 0.837; 95%CI; 0.741, 0.899, p-value < 0.001). The Kappa statistic was 0.433 with a 95%CI; 0.237, 0.639, p-value < 0.001 and the percentage agreement of the physical activity classification between the two visits was 66.7%. CONCLUSION: The test-retest reliability was adequate for vigorous activity and total physical activity. Although there are concerns about the agreement for classification of physical activity, the IPAQ-SF may be a useful if not definitive tool for assessing physical activity in COPD.

Real-world observational study of the evaluation of inhaler techniques in asthma patients.

BACKGROUND: Inhaler devices are a keystone in the management of asthma during the maintenance phase of treatment. OBJECTIVE: To evaluate techniques for using inhaler devices in asthma patients. METHODS: A prospective cross-sectional study was conducted to assess patient compliance with correct techniques for using inhaler devices across three regimens: pressurized metered-dose inhaler (pMDI), Accuhaler®, and Turbuhaler®. The compliance of patients with essential steps for correct device usage in the case of each regimen was recorded. These were recorded when patients presented for a routine visit and one month after receiving face-to-face training. The percentage of compliance between the use of the devices and the risk factors related to incorrect techniques were analyzed by logistic regression analysis. The percentages of incorrect techniques were compared between the two visits using a Chi-squared test. RESULTS: A total of 108 asthma patients (35.2% male), with a mean age of 57.5 ± 12.3 years were evaluated. Percentages of incorrect use of Accuhaler®, pMDI, and Turbuhaler® were 50%, 48%, and 55.6%, respectively. The most common incorrectness's is breath out gently to residual volume (approximately one-third). Previous treatment by a pulmonologist for less than 2 years was the single factor related to incorrect technique [Adjusted OR = 2.8 (95%CI, 1.2-6.3), p = 0.02]. Formal training resulted in a statistically significant decrease in percentage of incorrect techniques (52.8% vs. 32.1%, p = 0.02). CONCLUSIONS: Inhalation technique in asthma patients was mostly unsatisfactory, especially in patients who had been treated by a pulmonologist for less than 2 years. Face-to-face training significantly improved good technique in all devices.

Evaluating inhaler use technique in COPD patients.

BACKGROUND: Poor inhalation techniques are associated with decreased medication delivery and poor disease control in chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate techniques for using inhaler devices in COPD patients. METHODS: A prospective cross-sectional study was conducted to assess patient compliance with correct techniques for using inhaler devices across four regimens, ie, the pressurized metered-dose inhaler (pMDI), the pMDI with a spacer, the Accuhaler, and the Handihaler. The percentage of compliance with essential steps of correct device usage for each regimen was recorded without prior notification when COPD patients presented for a routine visit, and 1 month after receiving face-to-face training. We compared the percentage of compliance between the devices and risk factors related to incorrect techniques using logistic regression analysis. Percentage of patient compliance with correct techniques was compared between the two visits using the chi-square test. Statistical significance was set at P<0.05. RESULTS: A total of 103 COPD patients (mean age 71.2±9.2 years, males 64.1%, low education level 82.5%, and percent predicted forced expiratory volume in 1 second 51.9±22.5) were evaluated. Seventy-seven patients (74.8%) performed at least one step incorrectly. Patients using the Handihaler had the lowest compliance failure (42.5%), and the odds ratio for failure with the other devices compared with the Handihaler were 4.6 (95% confidence interval [CI] 1.8-11.8) for the pMDI, 3.1 (95% CI 1.2-8.2) for the pMDI with a spacer, and 2.4 (95% CI 1.1-5.2) for the Accuhaler. Low education level was the single most important factor related to incorrect technique (adjusted odds ratio 4.1, 95% CI 1.2-13.4, P=0.022). Formal training resulted in a statistically significant decrease in percentage of incorrect techniques for all devices and for the pMDI (59.4% vs 48.6%, P<0.001; 72.4% vs 48.3%, P=0.039, respectively). CONCLUSION: Inhalation technique in COPD patients without face-to-face training was mostly unsatisfactory, especially in patients with low education levels. The Handihaler was the inhaler device associated with the lowest technique failure. Face-to-face inhalation technique training significantly increased technique compliance for the pMDI.