Disuss about the Use of Inhaler with and without spacer.
The work conducted by Berger et al. has shown that the use of inhaler with or without spacer rarely has any significant effect on the patients. He had conducted an experiment to study the bronchodilator effects by the use of MF/F 100/10 µg with the use of spacer or without spacer. In comparison to placebo, it was found that indeed the medication had better broncho-dialatory effects in the participants in comparison to placebo but the presence of spacer did not make a significant impact. It was seen that when MF/F was used with spacer, it resulted in larger change in mean FEV1 AUC0–12hr versus placebo that provided a mean difference of about 124 ml. Again when MF/F was used without spacer, it also brought successful effects over placebo and there was ultimately a main difference of 102 mL in mean adjusted FEV1 AUC0–12hr . Therefore, the author had suggested that it did not bring out any difference with or without the use of spacer as the difference that had been noticed are not statistically significant. The difference is so small that it cannot be suggested to make a difference if used. However, the author had not denied any works which have showed that spacers are indeed more helpful than without the use of spacer with inhalers. In such explanations, he has provided data where he believed that modern spacers bring out more effects the non conventional spacers. However in his work, he had got the results that broncho-dialation was larger in patients with the addition of spacers than without the use of spacer but without any significant effect. He had suggested that proper clinical teaching of the patients to correctly use inhalers also has positive effects reducing the chances of use of inhalers.
The authors had conducted an extensive study where they used the pressurized metered dose inhalers called pMDIs with the presence of spacers. It was earlier beloved that these combined methods are very much helpful for coordinating inhalation with actuation. The method that they selected here mainly consisted of using of the spacer with that of either extra-fine or fine articles inhaled corticosteroids called ICSs. Experiments were conducted by the use of extra-fine particles ICS with and without spacer in about 2090 participants. The next set of experiments used the 2 arms of fine particles ICS cohort study using 444 participants. In the previous case of the use of extra-fine particles no differences in rate was observed between spacer as well as non spacer arms and similar such occurrence also took in case of the fine particles ICS. These made them to conclude that no evidence is found which would support the fact that the use of spacers improved asthma outcomes for both the extra-fine as well as fine particles of the ICS administered by the pMDI. These had helps the researchers to stand against the long standing assumptions that spacers are able to improve the pMDI effectiveness. They also reject the thinking that there is also a need of pragmatic trials of spacers in clinical practices.
Work or Levi et al. (2013) had a different take on the entire scenario for the experiment that he conducted had separate set of results which were not in lieu of the findings of the above two articles proposed by famous researchers. The scientists have actually selected participants where certain portion was taking pressurized metered dose inhalers after a good amount of training. Separations of the participants were done where they used pMDIS alone and the other groups used breath actuated pMDIs with the use of spacers. They had analyzed the results which have shown a striking result different for the other two. It showed that a greater proportion of the patients who have utilized the spacers along with their pMDIS have much better control over their conditions in comparison to those who have used the pMDIs alone. Another important fact that came out, which although not important in the assignment, is that breath actuated pMDS brings better result than conventional pMDIs. They have found that although patients who used breath-actuated pMDIs and spacers are low, a statistically significant difference in the numbers attaining asthma control is noted that proves the efficiency of the intervention. Therefore, researchers are of the opinion that those patients, who are not being benefitted from the training of using pMDIs alone, should definitely use spacers with them to increase the efficiency.
Rahmati, H., Ansarfard, F., Ghodsbin, F., Ghayumi, M. A., & Sayadi, M. (2014). The effect of training inhalation technique with or without spacer on maximum expiratory flow rate and inhaler usage skills in asthmatic patients: a randomized controlled trial. International journal of community based nursing and midwifery, 2(4), 211.
Rahamati et al., have stated in the year 2014 that the utilization of proper inhaling technique and proper knowledge of the patients about the rise of the inhalers are far much important that the controversy of the use of Metered Dose Inhaler (MDI) with or without the use of spacers. He mainly conducted a very simple research where he took patients suffering from asthmatic attacks often and grouped them into three. The first group was the control group, the second groups had people where training was given to handle only MDIs and the other the third group were the patients whom training was given to use MDIs and spacer together. After assessing their knowledge and functional skills in handling the techniques if inhalation of medication, they were given three training sessions. After that, their ability to use MDI was assessed. A quantitative data analysis showed striking results which still carried in the confusion of the efficiency if the use of spacers. It showed that the process to take education through inhalers developed to a large extent due to the training and therefore the results shown by the second and third group was much higher than the control groups who showed poor efficiency rate in the skilled taking of the medication. No difference between the second and third group in the health of the patient was noticed. The intervention providing skills developed in the two groups but both the methods showed similar results which means that the combined provision of MDI with spacer did not bring any additional benefit than the use of MDI alone when both the groups become skilled enough to use the inhalers properly.
This study conducted by Crane et al. (2014) has revealed that the participants who were mainly aged and over 55 years old, it was helpful for them to use spacer along with that pMDIs. This is because the results from the study have shown that patients who only took education in using pMDIs did not do better than those who used the device along with the spacer. The study also showed that dry powdered devices brought the best results after training programs. However, in the context of the discussion, the researcher had clearly stated that spacer use along with pMDIs bring out more additional benefits and are therefore more advantageous to the older citizens.
The use of PICO framework is immensely helpful in finding the right types of articles which will provide us with the best and authentic information. This framework basically acts as a filtering media which helped me to correctly choose the articles which were proper covering the criteria that I wanted to include in the bibliographies. I also got a large amount of help from the framework as it helps me to clearly understand and note down what my main motive was to incorporate in the study and helped me to develop a mind map about how to include all the specific details that were needed to support the scenario provided to us. It helped me to set p a comparative mode of discussion where the articles were searched entirely in a way which matched with the search question set by the Pico. In short, it narrowed my search, clearly depicted what I needed to check out for and how I could find the correct articles with the help of the question set.
References:
Levy, M. L., Hardwell, A., McKnight, E., & Holmes, J. (2013). Asthma patients’ inability to use a pressurised metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the global initiative for asthma (GINA) strategy: a retrospective analysis. Primary Care Respiratory Journal, 22, 406-411.
Guilbert, T. W., Colice, G., Grigg, J., van Aalderen, W., Martin, R. J., Israel, E., … & Evans, J. M. (2017). Real-Life Outcomes for Patients with Asthma Prescribed Spacers for Use with Either Extrafine-or Fine-Particle Inhaled Corticosteroids. The Journal of Allergy and Clinical Immunology: In Practice.
Berger, W. E., Bensch, G. W., Weinstein, S. F., Skoner, D. P., Prenner, B. M., Shekar, T., … & Teper, A. A. (2014). Bronchodilation with mometasone furoate/formoterol fumarate administered by metered?dose inhaler with and without a spacer in children with persistent asthma. Pediatric pulmonology, 49(5), 441-450.
Berger, W. E., Bensch, G. W., Weinstein, S. F., Skoner, D. P., Prenner, B. M., Shekar, T., … & Teper, A. A. (2014). Bronchodilation with mometasone furoate/formoterol fumarate administered by metered?dose inhaler with and without a spacer in children with persistent asthma. Pediatric pulmonology, 49(5), 441-450.
Crane, M. A., Jenkins, C. R., Goeman, D. P., & Douglass, J. A. (2014). Inhaler device technique can be improved in older adults through tailored education: findings from a randomised controlled trial. NPJ primary care respiratory medicine, 24, 14034.
Guilbert, T. W., Colice, G., Grigg, J., van Aalderen, W., Martin, R. J., Israel, E., … & Evans, J. M. (2017). Real-Life Outcomes for Patients with Asthma Prescribed Spacers for Use with Either Extrafine-or Fine-Particle Inhaled Corticosteroids. The Journal of Allergy and Clinical Immunology: In Practice.
Levy, M. L., Hardwell, A., McKnight, E., & Holmes, J. (2013). Asthma patients’ inability to use a pressurised metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the global initiative for asthma (GINA) strategy: a retrospective analysis. Primary Care Respiratory Journal, 22, 406-411.
Rahmati, H., Ansarfard, F., Ghodsbin, F., Ghayumi, M. A., & Sayadi, M. (2014). The effect of training inhalation technique with or without spacer on maximum expiratory flow rate and inhaler usage skills in asthmatic patients: a randomized controlled trial. International journal of community based nursing and midwifery, 2(4), 211.
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