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INTRODUCTION
OF THE DISKUS DELIVERY SYSTEM INTO THE PEDIATRIC ASTHMA COMPLIANCE AND TECHNIQUE
(PACT) CLINIC. A PILOT STUDY
James E. Martin, RRT, Susan
R. Ogrinc, RRT, Robert C. Cohn, MD, Departments of Pediatrics, and Pulmonary
Services, MetroHealth Medical Center, Cleveland, OH
INTRODUCTION: Many forms
of delivery devices are available for the inhalation route. Confusion on proper
inhalation technique may affect medication delivery. Multiple inhalations from
several devices have also been shown to reduce compliance. Our PACT Clinic addresses
the issue of administration and adherence with therapy. For routine therapy,
patients can be prescribed up to 8 puffs/day from multiple MDI’s. To help
with compliance our patients were giving the option of taking one inhalation
BID with the Dry Powder Inhaler (DPI) Advair Diskus. An eight-step approach
to Diskus administration similar to the MDI was developed to determine if the
Diskus is a suitable alternative to MDI.
Methods: Data from twelve
asthma patients average age 10.2 years (range 7-16), 9 male/3 female, 5 African
American/4 Caucasian/3 Hispanic, seen in our PACT clinic were analyzed. All
patients demonstrated their MDI technique a median of 5 times (3-12) before
the introduction of the Diskus. There was an average of 2 (1-4) months between
initial Diskus instruction and follow up evaluation. Administration technique
was tested for both the MDI and Diskus using a placebo if necessary. After allowing
the patient to demonstrate their technique, a thorough review and demonstration
was performed.
Results: 9/12 (75%) patients
performed all 8 steps of the Diskus correctly, where as 5/12 (42%) before and
4/12 (33%) after Diskus introduction performed all 8 MDI step successfully.
Although not statistically significant (p>0.25) failure to perform a slow
deep breath following the actuation of the MDI increased from 4/12 (33%) to
6/12 (50%) following the Diskus introduction.
CONCLUSION: The Diskus delivery
system is easy to teach and easy to learn. Our patients performed the technique
with far fewer reinforced steps than the MDI. A rapid inspiration required for
DPI may have contributed to a more rapid inhalation seen in the MDI group following
Diskus introduction. Continual evaluation and reinforcement maybe necessary
to ensure proper inhalation for each delivery device.
OF-02-116
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