[Evaluation of the management of inhalers by the nursing personnel in a reference hospital]. / Valoración del manejo de los inhaladores por el personal de enfermería en un hospital de referencia.

OBJECTIVES: To evaluate the knowledge and skills of nurses on the management of inhaled therapy in different hospitalization wards. MATERIAL AND METHODS: We carried out a cross-sectional study, in which nurses were asked to perform a practical demonstration of the management of a pressurized canister with an inhalation chamber, without previous theoretical instruction about the technique. The inhalation technique was evaluated step by step following the recommendations of the Spanish Society of Pneumologists and Chest Surgeons (SEPAR). RESULTS: We could obtain the participation of 144 of the 177 nurses working in different wards (29 males, 115 females, mean age 42.5 + 7 years). Previous knowledge of the management of inhalers was declared by 85.4%. We found that 70.8% of the nurses did not correctly perform all the steps: 24.5% made only one mistake, while the rest had mistakes in two or more steps. The most common mistakes were: not to perform a slow and deep exhalation before using the inhaler (27.3%), not to hold the breath after the inhalation (24.4%), and not to wait 30 seconds between inhalation manoeuvres (21.5%). When evaluating different wards, we found that 44.4% of the nurses in the Short Stay Unit performed the technique correctly in contrast to 31.3% of the nurses in the Pneumology Ward. CONCLUSIONS: The percentage of mistakes in the inhalation technique by the nursing personnel was high. The health personnel must have an adequate level of training in order to correctly instruct the patient, because the efficacy of inhaled treatment greatly depends on the adequacy of the technique.

Valoración del manejo de los inhaladores por el personal de enfermería en un hospital de referencia / Evaluation of the managemente of inhalers by the nursing personner in a reference hospital

Objetivo: valorar los conocimientos y adiestramiento del personal de enfermería con el paciente respiratorio en el manejo de la terapia inhalada en distintas salas de hospitalización.Material y métodos: se diseñó un estudio prospectivo con 144 enfermos/as mediante una encuesta individual en la que se solicitó a cada unode ellos una demostración práctica del manejo del cartucho presurizado con cámara inhalatoria, sin realizar una instrucción teórica previa sobrela técnica. Se revisó la técnica inhalatoria siguiendo los pasos establecidos en la normativa SEPAR.Resultados: participaron 144 de los 177 enfermeros/as (81,4%) que trabajan en las diferentes salas de hospitalización (29 varones, 115 mujeres,edad media 42,5 + 7 años). El 85,4% (123/144) reconocía tener conocimientos previos del manejo de los inhaladores. Tras la demostración práctica se comprobó que el 70,8% de los enfermeros realizaban incorrectamente algún paso de la maniobra inhalatoria; de ellos el 24,5% cometió un sólo error y el resto dos o más. Los errores más frecuentes fueron: no efectuar una espiración lenta y profunda antes de iniciar la inhalación (27,3%), no aguantar la respiración durante 10 segundos (24,4%), y no esperar 30 segundos antes de iniciar la siguiente inhalación (21,5%). Analizando estos resultados por salas de hospitalización, el 44,4% de la Unidad de Corta Estancia efectuaba correctamente la técnica frente al 31,3% en Neumología. Conclusiones: el porcentaje de errores en la técnica de inhalación es elevado por parte del personal de enfermería. Es importante que el personal sanitario posea un grado de conocimientos adecuado para poder instruir adecuadamente al paciente, ya que de ello depende en gran medida la eficacia del tratamiento

Objectives: To evaluate the knowledge and skills of nurses on the management of inhaled therapy in different hospitalization wards. Material and methods: We carried out a cross-sectional study, in which nurses were asked to perform a practical demonstration of the management of a pressurized canister with an inhalation chamber, without previous theoretical instruction about the technique. The inhalation technique was evaluated step by step following the recommendations of the Spanish Society of Pneumologists and Chest Surgeons (SEPAR). Results: We could obtain the participation of 144 of the 177 nurses working in different wards (29 males, 115 females, mean age 42.5 + 7 years). Previous knowledge of the management of inhalers was declared by 85.4%. We found that 70.8% of the nurses did not correctly perform all the steps: 24.5% made only one mistake, while the rest had mistakes in two or more steps. The most common mistakes were: not to perform a slow and deep exhalation before using the inhaler (27.3%), not to hold the breath after the inhalation (24.4%), and not to wait 30 seconds between inhalation manoeuvres (21.5%). When evaluating different wards, we found that 44.4% of the nurses in the Short Stay Unit performed the technique correctly in contrast to 31.3% of the nurses in the Pneumology Ward. Conclusions: The percentage of mistakes in the inhalation technique by the nursing personnel was high. The health personnel must have an adequate level of training in order to correctly instruct the patient, because the efficacy of inhaled treatment greatly depends on the adequacy of the technique

Exposición al humo ambiental de tabaco en el medio laboral / No disponible

No disponible

[Body mass, dyspnea, and quality of life as success predictors in emphysema surgery for reduction of pulmonary volume]. / Masa corporal, disnea y calidad de vida como predictores de éxito en la cirugía de reducción de volumen en el enfisema.

OBJECTIVES: Lung volume reduction surgery has recently been proposed as a palliative treatment for advanced emphysema. Some patients improve and others remains the same, being debated at this time the factors that predict improvement. The purpose of this work is to find predictive factors for positive response in patients operated with this surgery. MATERIAL AND METHODS: Patients with positive response (7 patients) and patients without positive response (5 patients) have been compared in our series of lung volume reduction surgery (12 patients). Positive response to surgery was defined as Delta FEV1 > or = 15%, dyspnea transitional index (Mahler scale) > or = 3, and improvement in the scoring surgery of quality of life for chronic respiratory disease questionnaire (Guyatt and Güell) > or = 1.5 3 months after the surgery. Basal values of FEV1, FEF50/FIF50%, hyperinsufflation degree, heterogeneity, PaO2, PaCO2, type of surgery, body mass index (BMI), dyspnea basal index (DBI) and quality of life questionnaire score (QLQS). RESULTS: Patients without and with positive response were different only because their baseline BMI, DBI and QLQS were lower. Other parameters studied (although the population was rather homogeneous) did not show significant differences between the two groups. CONCLUSIONS: Patients with higher subjective problems (dyspnea and quality of life) and more malnourished are those with less benefit from surgery for pulmonary volume reduction.

[Inhalation technique in patients with chronic respiratory diseases]. / Técnica de inhalación en los pacientes con enfermedades respiratorias crónicas.

OBJECTIVE: To determine how inhalers are used by patients with chronic respiratory diseases in the Community of Valencia (Spain) and to identify the factors associated with correct use. MATERIAL AND METHODS: We carried out a prospective study of 554 patients (331 men, 223 women, mean age 50.5 +/- 21.5 years) who underwent spirometric testing (292 with bronchial asthma, 192 with COPD, 15 with bronchiectasis and 55 with other diagnoses). The patients were asked what type of inhaler they used. Pressurised canisters (PC) were used by 39.9%, inhalation chambers (IC) by 37.9% and dry powder inhalers (Turbuhalers) (DP) by 22.2%. They were also asked what instructions they had received; the inhalation techniques recommended by the Spanish Society of Pneumologists and Chest Surgeons (SEPAR) was reviewed step by step. RESULTS: a) Four hundred thirty-two patients (78%) reported having received instruction in how to use the inhaler; b) One hundred seventy-five (31.6%) used the correct technique: 25.3% using PC, 32.4% using IC and 41.5% using DP (p = 0.008); c) The most common errors were not holding the breath after inhaling in the case of PC users, not waiting 30 seconds between inhalation maneuvers and the lack of synchrony with inspiration among PC users; d) Use of correct inhalation technique was associated with prior instruction (rs = 0.249; p < 0.001) and younger age (rs = 0.92; p = 0.03). CONCLUSIONS: A high percentage of patients, particularly those using PC and those who received no instruction, use inhalers incorrectly in the Community of Valencia. We therefore recommend health education programs that target the main errors identified.

Técnica de inhalación en los pacientes con enfermedades respiratorias crónicas / Inhalation technique of patients with chronic respiratory diseases

Objetivo: Conocer cómo utilizan los inhaladores los pacientes con enfermedades respiratorias crónicas de la Comunidad Valenciana y las características asociadas a la utilización correcta de los mismos. Material y métodos: Realizamos un estudio prospectivo a 554 pacientes (334 varones, 223 mujeres, edad media 50 ñ 21,5 años), que acudieron al laboratorio de exploración funcional respiratoria para la realización de una espirometría (asma bronquial, 292; EPOC, 192; bronquiectasias, 15; otros diagnósticos, 55). Se les preguntaba sobre el tipo de inhalador empleado (cartucho presurizado [CP], 39,9 por ciento; cámara de inhalación [CI] 37,9 por ciento, y polvo seco [turbuhaler] [PS], 22,2 por ciento) e instrucciones recibidas, y se revisaba, paso a paso, la técnica de inhalación (TI) según la normativa SEPAR. Resultados: a) 432 pacientes (78 por ciento) reconocían la instrucción previa en el manejo del inhalador; b) realizan correctamente TI 175 pacientes (31,6 por ciento): CP 25,3 por ciento, CI 32,4 por ciento y PS 41,5 por ciento (p = 0,008); c) los errores más frecuentes fueron no aguantar la respiración tras la inhalación, no esperar 30 s entre las tomas y la falta de sincronía con la inspiración en el caso de CP, y d) la TI correcta presentó una asociación con instrucción previa (rs = 0,249; p < 0,001) y menor edad (rs = 0,92; p = 0,03). Conclusiones: En la Comunidad Valenciana existe una elevada proporción de pacientes que utilizan mal los inhaladores, especialmente entre los que utilizan CP y los que no recibieron instrucción. Por ello, abogamos por desarrollar programas de educación sanitaria, insistiendo en los principales fallos encontrados. (AU)