Prevalência e preditores do uso incorreto dos dispositivos inalatórios em pacientes portadores de Doença Pulmonar Obstrutiva Crônica Prevalence and predictors of incorrect use of inhaler devices in patients with COPD
Resumo
Objetivo: Inferir a prevalência e preditores do uso incorreto dos dispositivos inalatórios em pacientes ambulatoriais portadores de doença pulmonar obstrutiva crônica (DPOC). Métodos: Foi realizado um estudo de corte transversal em pacientes portadores de DPOC atendidos no Ambulatório Central em Anápolis - Goiás. Resultados: A prevalência de indivíduos com uso incorreto do dispositivo de inalação foi de 96% (24 indivíduos). Observou-se que a média de erro entre o grupo que usava um dispositivo era significativamente menor que a do grupo que usava três dispositivos (p=0,04). Foi encontrada correlação negativa entre o número de erros e o VEF1 pós BD em litros (r=0,55; p=0,004), e uma regressão linear mostrou que o número de erros pode ser previsto pelo VEF1 pós BD em litros (p=0,004), que está inversamente relacionado ao número de erros ao usar o dispositivo. Conclusão: Conclui-se que o número de dispositivos inalatórios e a gravidade da doença respiratória são preditores do uso incorreto de dispositivos inalatórios em pacientes com DPOC.
Referências
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11- Maciel PP. Efeito Da Intervenção Educativa Sobre A Técnica De Administração De Medicamentos Inalatórios Por Profissionais De Enfermagem. [trabalho de conclusão de curso]. Porto Alegre: Universidade Federal do Rio Grande do Sul Escola de Enfermagem; 2009.
12- Goris S, Tasci T, Elmali F. The effects of training on inhaler technique and quality of life in patients with COPD. J Aerosol Med Pulm Drug Deliv. 2013 Dec; 26(6): 336-44. http://dx.doi.org/10.1089/jamp.2012.1017
13- Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999; 54(7): 581-6. http://dx.doi.org/10.1136/thx.54.7.581
14- Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N: Development and first validation of the COPD Assessment Test. Eur Respir J 2009; 34(3): 648-4. http://dx.doi.org/10.1183/09031936.00102509
15- Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults: United States, 1992, and changes in the definition of current cigarette smoking. MMWR Morb Mortal Wkly Rep. 1994 May; 43(19): 342-6.
16- Dalcin PTR, Grutcki DM, Laporte PP, Lima PBL, Menegotto SM, Pereira RP. Fatores relacionados ao uso incorreto dos dispositivos inalatórios em pacientes asmáticos. J Bras Pneumol. 2014; 40(1): 13-20. http://dx.doi.org/10.1590/S1806-37132014000100003
17- Burge S, Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J Suppl. Jun 2003; 41: 46s-53s. http://dx.doi.org/10.1183/09031936.03.00078002
18- Lwanga SK, Lemeshow S. Sample size determination in health studies: a pratical manual. World Health Organization, Geneva. 1991.
19- Molimard M, Raherison C, Lignot S, Depont F, Abouelfath A, Moore N. Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care. J Aerosol Med. 2003; 16(3): 249-54. http://dx.doi.org/10.1089/089426803769017613
20- Rootmensen, GN, Van Keimpema AR, Jansen HM, Haan RJ. Predictors of incorrect inhalation technique in patients with asthma or COPD: a study using a validated videotaped scoring method. J Aerosol Med Pulm Drug Deliv. 2010 Oct; 23(5): 323-8. http://dx.doi.org/10.1089/jamp.2009.0785
21- Espanhol, RLP. DPOC - Doença Pulmonar Obstrutiva Crónica [tese de mestrado em ciências farmacêuticas]. Porto: Universidade Fernando Pessoa Departamento de Ciências Farmacêuticas; 2011.
22- Petro W, Schuppenies A. Inhalation therapy by dose-inhalers: analysis of patients performance and possibilities for improvement. Pneumologie. 2005 May; 59(5): 316-20. http://dx.doi.org/10.1055/s-2004-830213
23- Stelmach R, Robles-Ribeiro PG, Ribeiro M, Oliveira JC, Scalabrini A, Cukier A. Incorrect application technique of metered dose inhalers by internal medicine residents: impact of exposure to a practical situation. J Asthma. 2007 Nov; 44(9): 765-8. http://dx.doi.org/10.1080/02770900701645694
24- Muchão FP, Perín SL, Rodrigues JC, Leone C, Silva Filho LV. Evaluation of the knowledge of health professionals at a pediatric hospital regarding the use of metered-dose inhalers. J Bras Pneumol. 2008 Jan; 34(1): 4-12. http://dx.doi.org/10.1590/S1806-37132008000100003
25- Plaza V, Sanchis J. Medical personnel and patient skill in the use of metered dose inhalers: a multicentric study. CESEA Group. Respiration. 1998; 65(3): 195-8. http://dx.doi.org/10.1159/000029259
26- Lavorini F, Magnan A, Dubus JC, Voshaar T, Corbetta L, Broeders M, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008 Apr; 102(4): 593-604. http://dx.doi.org/10.1016/j.rmed.2007.11.003
27- Van Der Palen J, Klein JJ, Van Herwaarden CL, Zielhuis GA, Seydel ER. Multiple inhalers confuse asthma patients. Eur Respir J. 1999 Nov; 14(5): 1034-7. http://dx.doi.org/10.1183/09031936.99.14510349
28- Leiva-Fernández J, Leiva-Fernández F, García-Ruiz A, Prados-Torres D, Barnestein-Fonseca P. Efficacy of a multifactorial intervention on therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled trial. BMC Pulm Med. 2014 Apr; 14(70): 1-12. http://dx.doi.org/10.1186/1471-2466-14-70
29- Takemura M, Mitsui K, Itotani R, Ishitoko M, Suzuki S, Matsumoto M, et al. Relationships between repeated instruction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2011; 6: 97-104. http://dx.doi.org/10.2147/COPD.S1617.
2- Sullivan SD, Ramsey SD, Lee TA. The Economic Burden of COPD. Chest. 2000 Feb; 117(2): 5S-9S. http://dx.doi.org/10.1378/chest.117.2_suppl.5S
3- Miravitlles, M. Avaliação econômica da doença pulmonar obstrutiva crônica e de suas agudizações: aplicação na América Latina. J Bras Pneumol. 2004 Jun; 30(3): 274-85. http://dx.doi.org/10.1590/S1806-37132004000300015
4- Bourbeau J, Sebaldt RJ, Day A, Bouchard J, Kaplan A, Hernandez P, et al. Practice patterns in the management of chronic obstructive pulmonary disease in primary practice: The CAGE study. Can Respir J. 2008; 15(1): 13-9.
5- Broeders ME, Sanchis J, Levy ML, Crompton GK, Dekhuijzen PN, ADMIT Working Group. The ADMIT Series – Issues in Inhalation Therapy. 2. Improving technique and clinical effectiveness. Prim Care Respir J. 2009; 18(2): 76-82. http://dx.doi.org/10.4104/pcrj.2009.00025
6- Souza MLM, Meneghini AC, Ferraz E, Vianna EO, Borges MC. Técnica e compreensão do uso dos dispositivos inalatórios em pacientes com asma ou DPOC. J Bras Pneumol. 2009 Sep; 35(9): 824-31. http://dx.doi.org/10.1590/S1806-37132009000900002
7- Wieshammer S, Dreyhaupt, J. Dry Powder Inhalers: Which Factors Determine the Frequency of Handling Errors? Respiration. 2007 Oct; 75(1): 18-25. http://dx.doi.org/10.1159/000109374
8- Posada WA. Doença pulmonar obstrutiva crônica (DPOC): revisão sobre a relação da educação com a adesão ao tratamento e a qualidade de vida de pacientes [trabalho de conclusão de curso]. Porto Alegre: Universidade Federal Do Rio Grande Do Sul Faculdade de Farmácia; 2011
9- Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonar disease: GOLD executive summary. Am J Respir Crit Care Med. 2013 Feb; 187(4): 347-65. http://dx.doi.org/10.1164/rccm.201204-0596PP
10- Barnestein-Fonseca P, Leiva-Fernández J, Vidal-España F, García-Ruiz A, Prados-Torres D, Leiva-Fernández F. Efficacy and safety of a multifactor intervention to improve therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD): protocol for the ICEPOC study. Trials. 2011 Feb; 14: 12-40. http://dx.doi.org/10.1186/1745-6215-12-40
11- Maciel PP. Efeito Da Intervenção Educativa Sobre A Técnica De Administração De Medicamentos Inalatórios Por Profissionais De Enfermagem. [trabalho de conclusão de curso]. Porto Alegre: Universidade Federal do Rio Grande do Sul Escola de Enfermagem; 2009.
12- Goris S, Tasci T, Elmali F. The effects of training on inhaler technique and quality of life in patients with COPD. J Aerosol Med Pulm Drug Deliv. 2013 Dec; 26(6): 336-44. http://dx.doi.org/10.1089/jamp.2012.1017
13- Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999; 54(7): 581-6. http://dx.doi.org/10.1136/thx.54.7.581
14- Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N: Development and first validation of the COPD Assessment Test. Eur Respir J 2009; 34(3): 648-4. http://dx.doi.org/10.1183/09031936.00102509
15- Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults: United States, 1992, and changes in the definition of current cigarette smoking. MMWR Morb Mortal Wkly Rep. 1994 May; 43(19): 342-6.
16- Dalcin PTR, Grutcki DM, Laporte PP, Lima PBL, Menegotto SM, Pereira RP. Fatores relacionados ao uso incorreto dos dispositivos inalatórios em pacientes asmáticos. J Bras Pneumol. 2014; 40(1): 13-20. http://dx.doi.org/10.1590/S1806-37132014000100003
17- Burge S, Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J Suppl. Jun 2003; 41: 46s-53s. http://dx.doi.org/10.1183/09031936.03.00078002
18- Lwanga SK, Lemeshow S. Sample size determination in health studies: a pratical manual. World Health Organization, Geneva. 1991.
19- Molimard M, Raherison C, Lignot S, Depont F, Abouelfath A, Moore N. Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care. J Aerosol Med. 2003; 16(3): 249-54. http://dx.doi.org/10.1089/089426803769017613
20- Rootmensen, GN, Van Keimpema AR, Jansen HM, Haan RJ. Predictors of incorrect inhalation technique in patients with asthma or COPD: a study using a validated videotaped scoring method. J Aerosol Med Pulm Drug Deliv. 2010 Oct; 23(5): 323-8. http://dx.doi.org/10.1089/jamp.2009.0785
21- Espanhol, RLP. DPOC - Doença Pulmonar Obstrutiva Crónica [tese de mestrado em ciências farmacêuticas]. Porto: Universidade Fernando Pessoa Departamento de Ciências Farmacêuticas; 2011.
22- Petro W, Schuppenies A. Inhalation therapy by dose-inhalers: analysis of patients performance and possibilities for improvement. Pneumologie. 2005 May; 59(5): 316-20. http://dx.doi.org/10.1055/s-2004-830213
23- Stelmach R, Robles-Ribeiro PG, Ribeiro M, Oliveira JC, Scalabrini A, Cukier A. Incorrect application technique of metered dose inhalers by internal medicine residents: impact of exposure to a practical situation. J Asthma. 2007 Nov; 44(9): 765-8. http://dx.doi.org/10.1080/02770900701645694
24- Muchão FP, Perín SL, Rodrigues JC, Leone C, Silva Filho LV. Evaluation of the knowledge of health professionals at a pediatric hospital regarding the use of metered-dose inhalers. J Bras Pneumol. 2008 Jan; 34(1): 4-12. http://dx.doi.org/10.1590/S1806-37132008000100003
25- Plaza V, Sanchis J. Medical personnel and patient skill in the use of metered dose inhalers: a multicentric study. CESEA Group. Respiration. 1998; 65(3): 195-8. http://dx.doi.org/10.1159/000029259
26- Lavorini F, Magnan A, Dubus JC, Voshaar T, Corbetta L, Broeders M, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008 Apr; 102(4): 593-604. http://dx.doi.org/10.1016/j.rmed.2007.11.003
27- Van Der Palen J, Klein JJ, Van Herwaarden CL, Zielhuis GA, Seydel ER. Multiple inhalers confuse asthma patients. Eur Respir J. 1999 Nov; 14(5): 1034-7. http://dx.doi.org/10.1183/09031936.99.14510349
28- Leiva-Fernández J, Leiva-Fernández F, García-Ruiz A, Prados-Torres D, Barnestein-Fonseca P. Efficacy of a multifactorial intervention on therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled trial. BMC Pulm Med. 2014 Apr; 14(70): 1-12. http://dx.doi.org/10.1186/1471-2466-14-70
29- Takemura M, Mitsui K, Itotani R, Ishitoko M, Suzuki S, Matsumoto M, et al. Relationships between repeated instruction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2011; 6: 97-104. http://dx.doi.org/10.2147/COPD.S1617.
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2015-12-15
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