Abstract:
BACKGROUND:Current treatment strategies for asthma and chronic obstructive pulmonary disease (COPD) emphasize the inhalation route, yet patients often misuse metered-dose inhalers (MDI). To address this problem, patient education by medical personnel has been recommended and a variety of alternate inhaler devices have been developed. METHODS:We surveyed medical personnel to assess their knowledge of and ability to use three widely used inhaler devices; MDI, MDI with a spacing chamber (Aerochamber, Trudell Medical, Canada), and a breath-actuated multidose dry powder inhaler (Turbuhaler, Astra Pharmacy, Inc., Conada). Thirty respiratory therapists (RT), 30 registered nurses (RN), and 30 medical house staff physicians (MD) were asked to demonstrate the use of each device using placebo inhalers and to answer 11 clinically relevant questions related to the use and maintenance of the tested devices. RESULTS:The RT's percent mean knowledge score (67 +/- 5 percent) was significantly higher than those achieved by either the RNs (39 +/- 7 percent) or the MDs (48 +/- 7 percent) (for all p < 0.0001). Similarly, percent mean demonstration scores for each device were significantly higher for RTs than either RN or MD groups; for MDI, 97 +/- 3 percent versus 82 +/- 13 percent and 69 +/- 24 percent, respectively (p < 0.0001); for the Aerochamber, 98 +/- 2 percent versus 78 +/- 20 percent and 57 +/- 31 percent (p < 0.0001); and for the Turbuhaler, 60 +/- 30 percent versus 12 +/- 23 percent and 21 +/- 30 percent (p < 0.0001). Knowledge of and practical skills with the devices were roughly proportional to the length of time the device had been in clinical use, Turbuhaler demonstration scores being lower than either MDI or Aerochamber scores (p = 0.05 and p = 0.09, respectively). More RTs (77 percent) had received formal instruction on the use of devices at school than either RNs (30 percent) or MDS (43 percent) (p < 0.05). CONCLUSION:We conclude that (1) many medical personnel responsible for monitoring and instructing patients in optimal inhaler use lack rudimentary skills with these devices, (2) nurses and physicians seldom receive formal training in the use of inhaling devices, and (3) newer inhaling devices designed to obviate problems of technique are at present less likely to be used well by medical personnel soon after their introduction.
journal_name
Chestjournal_title
Chestauthors
Hanania NA,Wittman R,Kesten S,Chapman KRdoi
10.1378/chest.105.1.111subject
Has Abstractpub_date
1994-01-01 00:00:00pages
111-6issue
1eissn
0012-3692issn
1931-3543pii
S0012-3692(15)43829-2journal_volume
105pub_type
杂志文章相关文献
CHEST文献大全abstract:BACKGROUND:Cystic fibrosis (CF) airway secretions are abnormal, contributing to decreased clearance and a cycle of infection and inflammation. CF sputum properties may predict disease progression. We hypothesized that sputum viscoelasticity and clearance abnormalities would inversely correlate with pulmonary function d...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2018.03.005
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Strong evidence exists for clinically relevant night-to-night variability of respiratory events in patients with suspected OSA. RESEARCH QUESTION:How many sleep study nights are required to diagnose OSA accurately? STUDY DESIGN AND METHODS:Patients with suspected OSA underwent up to 14 nights of pulse oxim...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2020.09.098
更新日期:2020-09-25 00:00:00
abstract:STUDY OBJECTIVES:Inspiratory capacity (IC) has been proposed as a simple method to assess acute changes in functional residual capacity (FRC) with bronchodilation, assuming that total lung capacity (TLC) is unchanged. This assumption is based on studies using body plethysmography, which may not accurately measure TLC i...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.122.6.2009
更新日期:2002-12-01 00:00:00
abstract::A 48-year-old man with unipolar depression and a psychosexual problem concerning his body image was injecting his scrotum repeatedly with olive oil to increase the size of his genitals. He developed respiratory failure following accidental intravenous injection of olive oil and was found to have lipogranulomatous lesi...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.107.3.875
更新日期:1995-03-01 00:00:00
abstract::Pneumothorax is a rare presentation of congenital cystic adenomatoid malformation (CCAM) in the newborn period and is presumed to be due to resuscitative measures. A previously well three-week-old baby presented with spontaneous tension pneumothorax due to CCAM. In the lung resection specimen, a malformation was seen,...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.99.5.1292
更新日期:1991-05-01 00:00:00
abstract:BACKGROUND:Pulse pressure (PP) has been shown to predict risk for cardiovascular events in men; however, this association has not been well established in women. Hormone replacement therapy may improve arterial compliance, but findings from cross-sectional and prospective studies report inconsistent results. We sought ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.127.5.1498
更新日期:2005-05-01 00:00:00
abstract:STUDY OBJECTIVES:We designed and performed a survey to assess the roles and knowledge level of physicians, by specialty, in the management of non-small cell lung cancer (NSCLC). The primary objective was to evaluate the potential variability of physician perceptions of prognosis, recommended treatments, and the impact ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.114.2.593
更新日期:1998-08-01 00:00:00
abstract::False-negative supine M-mode echocardiograms occur in some patients with proved mitral valve prolapse. To investigate further, we performed M-mode echocardiography (MME) during standing and after the inhalation of amyl nitrite in 17 patients (group 1) selected for auscultatory evidence of mitral valve prolapse (MVP) b...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.82.2.158
更新日期:1982-08-01 00:00:00
abstract::The management of intractable hemoptysis, short of surgery, is poorly defined. A technique is described utilizing a bronchofiberscope and a Fogarty catheter that not only provides visualization of the source of bleeding, but also furnishes a means of controlling the bleeding. This technique can also be used through a ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.67.4.482
更新日期:1975-04-01 00:00:00
abstract:STUDY OBJECTIVE:Oral theophylline treatment may be helpful in controlling severe asthma during pregnancy. This treatment, however, has been suspected of causing both complications and malformations. The objective of this investigation was to study the influence of theophylline treatment on the course of pregnancy and d...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.107.3.642
更新日期:1995-03-01 00:00:00
abstract:OBJECTIVE:To compare the efficacy of noninvasive positive pressure ventilation (NPPV) by helmet and face mask in immunocompromised patients with hypoxemic acute respiratory failure (ARF). DESIGN:Case-control study. SETTING:The general ICU of a university hospital. PATIENTS:Nineteen immunocompromised patients (hemato...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.126.5.1508
更新日期:2004-11-01 00:00:00
abstract:STUDY OBJECTIVES:Salmeterol (S) and montelukast (M) individually inhibit the obstructive consequences of thermal stimuli such as exercise and hyperventilation (HV), but there is no information on whether these drugs can interact positively. DESIGN:Randomized trial. SETTING:University teaching hospital. PARTICIPANTS:...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.127.5.1572
更新日期:2005-05-01 00:00:00
abstract::An amputation neuroma is a nerve's attempt at repair following amputation. While many are asymptomatic, some present as a painful mass. We describe a patient who, following a forequarter amputation for sarcoma, developed a stump neuroma that was unusual because it was first discovered on a routine chest roentgenogram....
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.95.3.684
更新日期:1989-03-01 00:00:00
abstract::We report the findings in a patient known to have olivopontocerebellar atrophy who developed respiratory distress, inspiratory stridor, and maximum inspiratory and expiratory flow volume loops. Treatment with carbidopa-levodopa gave symptomatic relief. ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.102.4.1291
更新日期:1992-10-01 00:00:00
abstract::In a double-blind crossover controlled study, intravenous (IV) or nebulized terbutaline was given to eight patients with moderately severe asthma on two separate days. Four incremental doses of terbutaline were given by each route to establish a maximal effect. Both routes of administration produced significant increa...
journal_title:Chest
pub_type: 临床试验,杂志文章
doi:10.1378/chest.79.5.506
更新日期:1981-05-01 00:00:00
abstract::Prior antibiotic therapy, size of the infiltrate, and the person who performed the technique were the three factors that we studied to assess their influence on the effectiveness of transthoracic needle aspiration (TNA). Ninety-one patients with a diagnosis of severe bacterial pneumonia, who underwent TNA, have been i...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.107.1.96
更新日期:1995-01-01 00:00:00
abstract::Hemianomalous pulmonary venous connection is a rare congenital abnormality that leads to significant left-to-right shunt and complications related to that. Earlier surgical correction of this disorder was associated with the problem of stenosis at the anastomotic site with the left atrium. We describe the diagnosis of...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.101.6.1718
更新日期:1992-06-01 00:00:00
abstract::Coronary bypass patients less than 40 years of age were identified and compared with a control group previously studied at our hospital. In patients less than 40 years, the average age was 35 years. Men comprised 90.1 percent of group 1, and 83.4 percent of group 2. Operative mortality was 2.89 percent for group 1 and...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.94.6.1138
更新日期:1988-12-01 00:00:00
abstract::A radioaerosol procedure using 99mcTc-DTPA (diethylene triamine penta acetate) was used to evaluate the permeability of the pulmonary epithelium in smokers and nonsmokers. The average clearance of this indicator from the lungs of smokers without significant airway obstruction exceeded that found in normal subjects by ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.83.1.6
更新日期:1983-01-01 00:00:00
abstract:BACKGROUND:Infused and inhaled treprostinil are effective for treatment of pulmonary arterial hypertension (PAH), although their administration routes have limitations. This study assessed the efficacy and safety of bid oral sustained-release treprostinil in the treatment of PAH with a concomitant endothelin receptor a...
journal_title:Chest
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1378/chest.11-2212
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:alpha(1)-Antitrypsin (AAT)-Z deficiency is a risk factor for the development of COPD. Compared to wild-type M, AAT-Z has an increased tendency to polymerize, rendering it inactive as a serine proteinase inhibitor. It has been demonstrated that wild-type M- and Z-deficiency AAT polymers are chemotactic for hu...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.129.6.1683
更新日期:2006-06-01 00:00:00
abstract::Ten patients undergoing pneumonectomy were evaluated with the lateral position test (LPT) in addition to routine pulmonary function tests (PFTs). On the basis of the percentage of ventilation estimated to be contributed by each lung on LPT, predictions were made for expected values for each patient's post-pneumonectom...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.77.1.24
更新日期:1980-01-01 00:00:00
abstract::Ventilation and gas exchange were studied during sleep and incremental treadmill exercise in 19 patients with severe stable COPD with the primary aim of comparing the pathophysiology of oxygen desaturation in the two conditions. A secondary aim was to determine whether exercise studies could aid in the prediction of s...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.109.2.387
更新日期:1996-02-01 00:00:00
abstract::Since publication of the seventh American College of Chest Physicians (ACCP) supplement on antithrombotic and thrombolytic therapy, the results of clinical trials have provided important new information on the management of thromboembolic disorders, and the science of developing recommendations has advanced. In the ac...
journal_title:Chest
pub_type: 杂志文章,实务指引
doi:10.1378/chest.08-0652
更新日期:2008-06-01 00:00:00
abstract::Complications following open chest massage in patients with porcine xenografts in the mitral location have not been previously described. The authors report a case of cardiac resuscitation following mitral valve replacement with a stented porcine valve. The patient died following brief closed chest, and then, prolonge...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.77.2.216
更新日期:1980-02-01 00:00:00
abstract:OBJECTIVES:Primary pulmonary hypertension (PPH) is a pulmonary vasculopathy resulting in exercise intolerance, usually due to dyspnea. We hypothesized that ventilation is increased during exercise in PPH relative to normal because the ventilated lung is underperfused, cardiac output increase is restricted, and arterial...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.127.5.1637
更新日期:2005-05-01 00:00:00
abstract::Respiratory rate is a sensitive clinical parameter in a multitude of pulmonary diseases, especially in the critical care setting. In order to validate the routine recording of the respiratory rate in the intensive care unit, we compared the values obtained from the nursing records with the breathing frequency continuo...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.90.5.632
更新日期:1986-11-01 00:00:00
abstract:STUDY OBJECTIVES:The objectives of this study are as follows: (1) to determine the incidence of complications from thoracentesis performed under ultrasound guidance by interventional radiologists in a tertiary referral teaching hospital; (2) to evaluate the incidence of vasovagal events without the use of atropine prio...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.123.2.418
更新日期:2003-02-01 00:00:00
abstract:BACKGROUND:Cough is a common symptom prompting patients to seek medical care. Like patients in the general population, patients with compromised immune systems also seek care for cough. However, it is unclear whether the causes of cough in immunocompromised patients who are deemed unlikely to have a life-threating cond...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1016/j.chest.2017.07.039
更新日期:2017-11-01 00:00:00
abstract::Diagnosis of the hereditary disorder alpha 1-antitrypsin (alpha 1AT) deficiency is critically dependent on quantification of serum levels of alpha 1AT, a 52-kDa antiprotease that serves to protect the lung from destruction by neutrophil elastase. Although the measurement of serum alpha 1AT levels is not difficult, the...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.100.3.703
更新日期:1991-09-01 00:00:00