Improved metered dose inhaler technique when a coordination cap is used

Wahida Azouz, Jessica Campbell, John Stephenson, Dinesh Saralaya, Henry Chrystyn

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Patients often experience problems using metered dose inhalers (MDIs), particularly poor coordination between inhalation start and dose actuation (TsIn: time difference between the start of an inhalation and the actuation of a dose), and fast peak inspiratory flow (PIF). We investigated if a coordination cap (CAP), with instruction to prolong inhalation, solved these problems. Methods: Inhalation profiles [PIF, TsIn, inhalation volume (Vi), inhalation time (Ti)] of patients with stable asthma prescribed an MDI were measured using their real-life technique (MDI). Inhalation profiles were then measured with the cap fitted (MDI+CAP). These patients were then instructed to inhale through the MDI+CAP for 5sec, and inhalation profiles measured (MDI+CAP+TRAIN). TsIn was only measured for the MDI. Results: Resistances of MDI and MDI+CAP were 0.0135 and 0.0243 (cm H2O)1/2(L/min), respectively. Seventy-one patients were evaluated, with mean [standard deviation (SD)] forced expiratory volume over 1sec % predicted normal of 78.3% (21.0). Following MDI, MDI+CAP, and MDI+CAP+TRAIN: mean (SD) PIF was 155.6 (61.5), 112.3 (48.4), and 73.8 (34.9) L/min, respectively (p<0.001); mean (SD) Ti was 1.60 (0.60), 1.92 (0.80), and 2.99 (1.03) sec, respectively (p<0.001); and Vi was similar between stages. Twelve patients used a slow flow with the MDI alone, but only two of these patients demonstrated good coordination. With the cap in place (which ensures good coordination), the number of patients using a slow flow increased to 25 for MDI+CAP and to 50 following MDI+CAP+TRAIN. Conclusions: The cap with its effect of increasing resistance to airflow combined with the instruction to prolong inhalation time significantly decreased the inhalation flow.

Original languageEnglish
Pages (from-to)193-199
Number of pages7
JournalJournal of Aerosol Medicine and Pulmonary Drug Delivery
Volume27
Issue number3
DOIs
Publication statusPublished - 1 Jun 2014

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Metered Dose Inhalers
Inhalation
Forced Expiratory Volume

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Azouz, Wahida ; Campbell, Jessica ; Stephenson, John ; Saralaya, Dinesh ; Chrystyn, Henry. / Improved metered dose inhaler technique when a coordination cap is used. In: Journal of Aerosol Medicine and Pulmonary Drug Delivery. 2014 ; Vol. 27, No. 3. pp. 193-199.
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abstract = "Background: Patients often experience problems using metered dose inhalers (MDIs), particularly poor coordination between inhalation start and dose actuation (TsIn: time difference between the start of an inhalation and the actuation of a dose), and fast peak inspiratory flow (PIF). We investigated if a coordination cap (CAP), with instruction to prolong inhalation, solved these problems. Methods: Inhalation profiles [PIF, TsIn, inhalation volume (Vi), inhalation time (Ti)] of patients with stable asthma prescribed an MDI were measured using their real-life technique (MDI). Inhalation profiles were then measured with the cap fitted (MDI+CAP). These patients were then instructed to inhale through the MDI+CAP for 5sec, and inhalation profiles measured (MDI+CAP+TRAIN). TsIn was only measured for the MDI. Results: Resistances of MDI and MDI+CAP were 0.0135 and 0.0243 (cm H2O)1/2(L/min), respectively. Seventy-one patients were evaluated, with mean [standard deviation (SD)] forced expiratory volume over 1sec {\%} predicted normal of 78.3{\%} (21.0). Following MDI, MDI+CAP, and MDI+CAP+TRAIN: mean (SD) PIF was 155.6 (61.5), 112.3 (48.4), and 73.8 (34.9) L/min, respectively (p<0.001); mean (SD) Ti was 1.60 (0.60), 1.92 (0.80), and 2.99 (1.03) sec, respectively (p<0.001); and Vi was similar between stages. Twelve patients used a slow flow with the MDI alone, but only two of these patients demonstrated good coordination. With the cap in place (which ensures good coordination), the number of patients using a slow flow increased to 25 for MDI+CAP and to 50 following MDI+CAP+TRAIN. Conclusions: The cap with its effect of increasing resistance to airflow combined with the instruction to prolong inhalation time significantly decreased the inhalation flow.",
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Improved metered dose inhaler technique when a coordination cap is used. / Azouz, Wahida; Campbell, Jessica; Stephenson, John; Saralaya, Dinesh; Chrystyn, Henry.

In: Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol. 27, No. 3, 01.06.2014, p. 193-199.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Improved metered dose inhaler technique when a coordination cap is used

AU - Azouz, Wahida

AU - Campbell, Jessica

AU - Stephenson, John

AU - Saralaya, Dinesh

AU - Chrystyn, Henry

PY - 2014/6/1

Y1 - 2014/6/1

N2 - Background: Patients often experience problems using metered dose inhalers (MDIs), particularly poor coordination between inhalation start and dose actuation (TsIn: time difference between the start of an inhalation and the actuation of a dose), and fast peak inspiratory flow (PIF). We investigated if a coordination cap (CAP), with instruction to prolong inhalation, solved these problems. Methods: Inhalation profiles [PIF, TsIn, inhalation volume (Vi), inhalation time (Ti)] of patients with stable asthma prescribed an MDI were measured using their real-life technique (MDI). Inhalation profiles were then measured with the cap fitted (MDI+CAP). These patients were then instructed to inhale through the MDI+CAP for 5sec, and inhalation profiles measured (MDI+CAP+TRAIN). TsIn was only measured for the MDI. Results: Resistances of MDI and MDI+CAP were 0.0135 and 0.0243 (cm H2O)1/2(L/min), respectively. Seventy-one patients were evaluated, with mean [standard deviation (SD)] forced expiratory volume over 1sec % predicted normal of 78.3% (21.0). Following MDI, MDI+CAP, and MDI+CAP+TRAIN: mean (SD) PIF was 155.6 (61.5), 112.3 (48.4), and 73.8 (34.9) L/min, respectively (p<0.001); mean (SD) Ti was 1.60 (0.60), 1.92 (0.80), and 2.99 (1.03) sec, respectively (p<0.001); and Vi was similar between stages. Twelve patients used a slow flow with the MDI alone, but only two of these patients demonstrated good coordination. With the cap in place (which ensures good coordination), the number of patients using a slow flow increased to 25 for MDI+CAP and to 50 following MDI+CAP+TRAIN. Conclusions: The cap with its effect of increasing resistance to airflow combined with the instruction to prolong inhalation time significantly decreased the inhalation flow.

AB - Background: Patients often experience problems using metered dose inhalers (MDIs), particularly poor coordination between inhalation start and dose actuation (TsIn: time difference between the start of an inhalation and the actuation of a dose), and fast peak inspiratory flow (PIF). We investigated if a coordination cap (CAP), with instruction to prolong inhalation, solved these problems. Methods: Inhalation profiles [PIF, TsIn, inhalation volume (Vi), inhalation time (Ti)] of patients with stable asthma prescribed an MDI were measured using their real-life technique (MDI). Inhalation profiles were then measured with the cap fitted (MDI+CAP). These patients were then instructed to inhale through the MDI+CAP for 5sec, and inhalation profiles measured (MDI+CAP+TRAIN). TsIn was only measured for the MDI. Results: Resistances of MDI and MDI+CAP were 0.0135 and 0.0243 (cm H2O)1/2(L/min), respectively. Seventy-one patients were evaluated, with mean [standard deviation (SD)] forced expiratory volume over 1sec % predicted normal of 78.3% (21.0). Following MDI, MDI+CAP, and MDI+CAP+TRAIN: mean (SD) PIF was 155.6 (61.5), 112.3 (48.4), and 73.8 (34.9) L/min, respectively (p<0.001); mean (SD) Ti was 1.60 (0.60), 1.92 (0.80), and 2.99 (1.03) sec, respectively (p<0.001); and Vi was similar between stages. Twelve patients used a slow flow with the MDI alone, but only two of these patients demonstrated good coordination. With the cap in place (which ensures good coordination), the number of patients using a slow flow increased to 25 for MDI+CAP and to 50 following MDI+CAP+TRAIN. Conclusions: The cap with its effect of increasing resistance to airflow combined with the instruction to prolong inhalation time significantly decreased the inhalation flow.

KW - Asthma

KW - Device

KW - I-Breathe

KW - Inhalation flow

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