哮喘联盟

   摘要
   背景：哮喘仍然是严重的全球性健康问题。哮喘症状控制不佳的部分原因是哮喘吸入装置使用不正确，如不良的吸入方法或在推荐使用次数完毕后继续使用定量吸入器 (MDI)。
   目的：回顾已发表文献中关于哮喘急救用药因使用无剂量-计数装置的MDI而导致高估或低估吸入剂量的可能性。
   方法：我们以“剂量计数与哮喘”和“剂量计数与计量吸入器”为检索词在Pubmed和EMBASE检索截至2012年7月的英文文献，人工检索相应文献的参考文献。
   结果：有40%的患者以为自己正确用药时，其实他们拿的几乎是个空瓶。吸入器的设计使MDI可以准确结束药物供应，MDI实际可以按动的次数可能是标注值的两倍。一旦推荐次数使用完毕，之后的气雾剂中活性药物的含量下降，推进剂和赋型剂的含量升高。这种称为“终末结束”的现象在药物形式为悬浮液，或作为控制急性支气管痉挛时抢救性用药时尤为明显。可靠的急救药物吸入可以降低哮喘相关死亡率。
   结论：为了确保患者得到准确的急救性哮喘药物剂量以扩张支气管，计量器可以改善哮喘患者管理。

 

（苏楠 审校）
J Asthma. 2013 Apr 2. [Epub ahead of print]

 

Improving Asthma Management: The Case for Mandatory Inclusion of Dose Counters on All Rescue Bronchodilators.
 

Conner JB, Buck PO.
 

Abstract
BACKGROUND: Asthma remains a serious global health challenge. Poor control of asthma symptoms is due in part to incorrect use of oral inhaler devices that deliver asthma medications, such as poor inhalation technique or use of a metered dose inhaler (MDI) after the recommended number of doses is expelled.
OBJECTIVE: To review published research on the potential for patients to overestimate or underestimate the amount of asthma rescue medication in MDIs without integrated dose-counting mechanisms.
METHODS: We searched PubMed and EMBASE using search terms "dose counter and asthma" and "dose counter and metered dose inhaler" for English language publications up to July, 2012, with a manual search of references from relevant articles.
RESULTS: Up to 40% of patients believe they are taking their asthma medication when they actually are activating an empty or nearly empty MDI. Device design makes it impossible for an MDI to cease delivering drug doses at an exact point, and the number of actuations in an MDI may be twice the nominal number of recommended medication doses. Once the recommended number of medication doses is expelled, remaining actuations deliver decreasing concentrations of active medication and increasing concentrations of propellants and excipients. This phenomenon, called "tail-off," is particularly problematic when medications are formulated as suspensions, as are rescue medications to control acute bronchospasm. Reliable inhalation of rescue medication could reduce asthma-related morbidity.
CONCLUSION: By helping ensure that patients receive accurate metered doses of asthma rescue medication to relieve bronchoconstriction, dose counters may help improve asthma management.

J Asthma. 2013 Apr 2. [Epub ahead of print]