Tiago Maricoto1,2, Luís Monteiro2,3, Jorge M R Gama4, Jaime Correia-de-Sousa5,6, Luís Taborda-Barata7,8,9. 1. Aveiro-Aradas Family Health Unit Aveiro Healthcare Centre, Aveiro, Portugal. 2. Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal. 3. Esgueira + Family Health Unit Aveiro Healthcare Centre, Aveiro, Portugal. 4. Centre of Mathematics and Applications, Faculty of Sciences, University of Beira Interior, Covilhã, Portugal. 5. Life and Health Sciences Research Institute/3B's-PT Government Associate Laboratory, University of Minho, Braga, Portugal. 6. Horizonte Family Health Unit, Unidade Local de Saúde, Matosinhos, Portugal. 7. CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal. 8. NuESA-Environment and Health Study Group, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal. 9. Department of Allergy and Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal.
Abstract
OBJECTIVES: To evaluate the effect of inhaler education programs on clinical outcomes and exacerbation rates in older adults with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Older adults with asthma or COPD, either in primary or secondary health care and pharmacy setting. MEASUREMENTS: We searched the Medline, Embase, and Central databases according to the main eligibility criteria for inclusion: systematic reviews, meta-analysis, clinical trials and quasi-experimental studies; participants aged 65 and older; education on inhaler technique and reporting of disease control and exacerbation rates. We used the Grading of Recommendations, Assessment, Development and Evaluations scale for quality assessment and used a random-effect model with Mantel-Haenszel adjustment to perform a meta-analysis. RESULTS: We included 8 studies (4 randomized, 4 quasi-experimental) with a total of 1,812 participants. The most frequent type of intervention was physical demonstration of inhaler technique, training with placebo devices. Five studies showed significant reduction in exacerbation rates (pooled risk ratio=0.71, 95% confidence interval=0.59-0.86; p < .001), although effect on disease control and quality of life showed high discrepancy in the reported results, and all randomized studies revealed uncertainty in their risk of bias assessment. CONCLUSION: All interventions seemed to improve inhaler performance and clinically relevant outcomes, but a placebo device could be the most effective. There is evidence that interventions reduce exacerbation risk in older adults, although to an overall moderate degree. J Am Geriatr Soc 67:57-66, 2019.
OBJECTIVES: To evaluate the effect of inhaler education programs on clinical outcomes and exacerbation rates in older adults with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Older adults with asthma or COPD, either in primary or secondary health care and pharmacy setting. MEASUREMENTS: We searched the Medline, Embase, and Central databases according to the main eligibility criteria for inclusion: systematic reviews, meta-analysis, clinical trials and quasi-experimental studies; participants aged 65 and older; education on inhaler technique and reporting of disease control and exacerbation rates. We used the Grading of Recommendations, Assessment, Development and Evaluations scale for quality assessment and used a random-effect model with Mantel-Haenszel adjustment to perform a meta-analysis. RESULTS: We included 8 studies (4 randomized, 4 quasi-experimental) with a total of 1,812 participants. The most frequent type of intervention was physical demonstration of inhaler technique, training with placebo devices. Five studies showed significant reduction in exacerbation rates (pooled risk ratio=0.71, 95% confidence interval=0.59-0.86; p < .001), although effect on disease control and quality of life showed high discrepancy in the reported results, and all randomized studies revealed uncertainty in their risk of bias assessment. CONCLUSION: All interventions seemed to improve inhaler performance and clinically relevant outcomes, but a placebo device could be the most effective. There is evidence that interventions reduce exacerbation risk in older adults, although to an overall moderate degree. J Am Geriatr Soc 67:57-66, 2019.
Authors: M Milanese; S Terraneo; I Baiardini; F Di Marco; A Corsico; A Molino; N Scichilone Journal: World Allergy Organ J Date: 2019-06-20 Impact factor: 4.084
Authors: Lotte F Westbroek; Margot Klijnsma; Philippe Salomé; Lidewij M Sekhuis; Emiel Rolink; Erny Korsmit; Huib A M Kerstjens Journal: Int J Chron Obstruct Pulmon Dis Date: 2020-09-30
Authors: Xiao Rui Catherine Chen; Sau Nga Fu; Wing Kit Leung; Sze Wing Catherine Ng; Wing Yan Wendy Kwan; Tseng Kwong Wong; Pang Fai Chan; Man Ying Michelle Wong; Wai Kit Welchie Ko; Jun Liang; Ming Tung Eric Hui; Yim Chu Li; Wan Luk; V K David Chao Journal: Int J Chron Obstruct Pulmon Dis Date: 2021-06-23