Possible errors in inhaler use

Astma i KOPB su upalne bolesti respiratornog sustava. Kronična opstruktivna bolest pluća je jedna od najraširenijih bolesti i jedna od vodećih uzroka smrtnosti u svijetu. Nepravilno liječenje astme povećava morbiditet, mortalitet i povisuje troškove liječenja koje snosi pojedinac i zajednica. Ispravno liječenje astme i KOPB-a je ključno za pravilnu skrb nad pacijentom i pad smrtnosti. Inhalatori su uobičajena i široko primijenjena metoda liječenja u astmi i KOPB-u. Farmakološke skupine lijekova koje se propisuju su: agonisti beta-2-receptora, antagonisti muskarinskih receptora i kortikosteroidi. Postoje brojne vrste uređaja dostupne za dostavu lijeka: inhaleri koji sadrže suhi prašak, aerosol ili maglicu te inhalacijski uređaj. Svaki uređaj ima svoje prednosti i mane koje utječu na način korištenja, sklonost nastavku terapije te na klinički ishod liječenja. Željeni ishod liječenja može se postići samo pravilnom primjenom i točno određenom tehnikom inhaliranja. U ovom radu naglasak je na greškama koje se javljaju rijekom korištenja različitih vrsta inhalera koji su registrirani u Republici Hrvatskoj. Tijekom korištenja inhalera aerosola uočene greške su: nedovoljno protresivanje inhalera, korištenje inhalera bez skinutog poklopca, nepotpun izdisaj prije inhaliranja, prebrz udah, nedovoljno zadržavanje daha, pritisak pumpice više puta, nedovoljno obuhvaćen nastavak za usta i držanje uređaja naopačke. Učestalost i značenje svake pogreške je objašnjena u radu. Tipične greške koje vežemo uz uređaje koji sadrže suhi prašak su: protresanje DPI, nepotpuni izdisaj prije inhaliranja, izdisanje u uređaj ili neposrednu blizinu, sporo udisanje, pogrešna priprema uređaja za inhaliranje, krivo namještanje doza ili nemogućnost dubokog udisaja. Pogreška koja je najčešća i zajednička svim vrstama inhalera je nepotpun izdisaj prije inhaliranja koja dovodi do poddoziranja lijeka. Pacijenti često dolaze ljekarnicima po svoju terapiju. Ljekarnici koji su dovoljno kompetentni i stručni mogu podići kvalitetu skrbi za pacijenta te imaju važnu ulogu u sanaciji problema i troškove koje ima društvo zbog oboljelih.Asthma and COPD are inflammatory diseases of respiratory system. Chronic obstructive pulmonary disease is one of the most prevalent diseases and the leading cause of disability and death worldwide. Improper asthma management leads to increased morbidity as well as economic burden to individuals and societies. Better asthma and KOPB management and care is essential for effective patient care reducing the morbidity and mortality of the disease overall in the country. Inhalers are the common and widely used treatment modality in the asthma and KOPB management. Pharmacological groups which are prescribed are:beta-2-receptor agonists, muscarinic receptor antagonists and corticosteroids. There are numerous inhaler devices available for the drug delivery in patients with asthma and chronic obstructive pulmonary disease: dry-powder inhalers (DPIs), pressurized metered-dose inhalers, soft mist inhalers and nebulizers. Each inhaler has advantages and disadvantages that may influence a patient’s use, satisfaction and compliance with therapy, and ultimately affect clinical outcomes. Desired effects can only be achieved by proper usage with correct technique. In this paper, the emphasis is on the errors that occur while patients use different commercially available inhaler in Croatia. Detected errors while using MDI include: not shaking inhaler before use, not removing the recover peace, incomplete gasp before inhalation, breading too fast, insufficient retention of breath, pressure pump more times, insufficiently covered the mouthpiece and hold the device upside down. The frequency and importance of each error is listed in the paper. Typical mistakes that we associate with DPI are: shaking DPI, incomplete gasp before inhaling, exhaling into the device, slow inhalation, wrong preparation of the inhaler device, the wrong dose adjustment or inability of deep breaths. The most common error and common to all types of inhaler is incomplete gasp before inhalation. All pharmacists encounter patients with respiratory diseases often during their professional career. Competent and knowledgeable pharmacists can raise the standards of patient care and satisfaction within the community and may play an important role to overall disease burden in the society