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( June Hong Ahn ),( Kwan Ho Lee ),( Jin Hong Chung ),( Kyeong-cheol Shin ),( Eun Young Choi ),( Hyun Jung Jin ),( Jong Geol Jang ),( Kyung Soo Hong ),( Young Seok Lee ),( Euna Lee ),( Mi Jeong Nam ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Background: The objective of this study was to evaluate inhaler device handling techniques and risk factors associated with critical inhaler errors among patients with chronic obstructive pulmonary disease (COPD) in Korea. Methods: We assessed the handling of 308 devices used for continuous treatment of COPD in 261 patients. We enrolled 143 subjects who used dry power inhaler (DPI), 145 who used soft mist inhaler (SMI) and 20 who used pressured metered-dose inhaler (pMDI) for COPD treatment at Yeungnam University Hospital and visually tested inhaler device handling technique. Results: A total of 308 devices were evaluated. At least one errors were observed in 267 (86.7%). At least one critical inhaler errors were observed in 39.2% (56/143), 45.5% (66/145) and 55.0% (11/20) of inhalation assessment test with DPI, SMI and pMDI. Among DPI, critical errors were respectively observed in 60.0%, 41.0%, 27.8%, 12.5% and 44.4% of inhalation assessment test with Turbuhaler (n=20), Breezhaler (n=61), Ellipta (n=36), Diskus (n=8), and Genuair (n=18). In multivariate analysis, female sex (odds ratio [OR], 10.75; 95% confidence interval [CI], 2.30-50.30; p=0.003), higher inhaler puff burden (OR, 1.58, 95% CI, 1.24-2.02; p<0.001), higher mMRC (OR, 1.46, 95% CI, 1.05-2.03; p=0.025), lower feeling of satisfaction with inhaler (OR, 0.94, 95% CI, 0.88-0.99; p=0.032), and frequent exacerbation in previous one year (OR, 1.94, 95% CI, 1.03-3.66; p=0.040) were associated with critical inhaler errors.Conclusions: Among Korean COPD patients in tertiary hospital settings, inhaler device handling errors are common problem. Careful monitoring and training in inhaler use devices, especially in female, higher inhaler puff burden, higher mMRC, lower feeling of satisfaction with inhaler and frequent exacerbation COPD patients are important part of COPD management.
( June Hong Ahn ),( Kwan Ho Lee ),( Jin Hong Chung ),( Kyeong-cheol Shin ),( Eun Young Choi ),( Hyun Jung Jin ),( Jong Geol Jang ),( Kyung Soo Hong ),( Young Seok Lee ),( Euna Lee ),( Mi Jeong Nam ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Background: Acute exacerbations are significant event of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients. “Frequent exacerbator” phenotypes are considered as a distinct subgroup. The objective of this study was to evaluate risk factors associated with frequent exacerbations of COPD in Korean tertiary university hospital patients. Methods: The study was designed as a cross sectional, case-control study. We prospectively enrolled 261 COPD patients at Yeungnam University Hospital from January 2018 to November 2018. Subjects were tested their inhaler technique at study entry. Frequency of moderate to severe COPD exacerbations were reviewed retrospectively via electronic medical records during 12 months prior to study entry. “Frequent exacerbations” were defined as ≥2 moderate to severe exacerbations in the last 12 months. Multivariate logistic regression was performed to identify the risk factors of frequent exacerbations. Results: Among 261 COPD patients enrolled, 65 (24.9%) patients were “frequent exacerbator”. Frequent exacerbators had lower forced expiratory volume in 1 s (FEV1), lower forced vital capacity (FVC), higher mMRC, longer duration of inhaler usage, lower body mass index (BMI), higher critical inhaler handling error (<0.05). In multivariate analysis, longer duration of inhaler usage (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.00-1.19; p=0.041), lower BMI (OR, 0.91, 95% CI, 0.83-0.99; p=0.032), critical inhaler handling error (OR, 1.92, 95% CI, 1.06-3.48; p=0.032), low FVC (OR, 0.97, 95% CI, 0.95-0.99; p=0.005) were associated with frequent exacerbations. Conclusions: Our data revealed that longer duration of inhaler usage, lower BMI, critical inhaler handling error and low FVC are independent risk factors of frequent exacerbations in COPD patients. Careful monitoring and education in inhaler use devices, especially in “frequent exacerbators” are important part of COPD treatment.