Mehmet KABAK, Barış ÇİL, Mahşuk TAYLAN, Ayşe Füsun TOPÇU, Cengizhan SEZGİ

Üçüncü basamak bir hastanede doğru inhaler kullanımı ve bunun tedaviye etkisi: Özgün Çalışma

Giriş: Astımlı hastaların doğru teknikle inhaler kullanma oranları %10-60 arasında değişmektedir. Uygunsuz inhaler tekniği; ilacın kötü kullanımına, azalmış hastalık kontrolüne ve artmış ilaç kullanımına neden olur. Bu çalışmamızda doğru inhaler kullanımının astımın tedavisine ve kontrolüne etkisini ve doğru inhaler kullanımın hastane yatışı üzerindeki etkisini bulmayı amaçladık. Yöntemler: Bu çalışmada bir üniversitede Göğüs Hastalıkları Kliniğinde yatarak tedavi gören veya polikliniğine ayaktan başvuran, The Global Initiative for Asthma (GINA)’ya göre astım tanısı almış remisyon döneminde 18 yaş ve üzeri olan 165 hasta değerlendirildi. Hastalara inhalerleri kullandırılarak ilaçlarını doğru mu yanlış mı kullandığı kayıt edildi. Hastaların astım atağından üzerinden en az 1 ay geçmesi ve atak dışı dönemde olması koşuluyla hastalara Astım kontrol testi (AKT) yapıldı. Hastaların solunum fonksiyon testleri yapılıp zorlu vital kapasite(FVC), zorlu ekspiratuvar volüm 1. Saniye (FEV1) ve zirve akım hızı (PEF) değerleri kayıt edildi ve hastaların son 1 yıl içinde astım atak nedeniyle hastaneye yatışları sorgulanıp kaydedildi. Bulgular: Hastaların doğru ilaç kullanımıyla AKT skoru, FEV1 yüzdesi, PEF yüzdesi, son bir yıl içinde hastaneye yatış sayısı istatistiksel olarak karşılaştırıldı. Hastaların 100'ü astım ilacını doğru kullanıyorken, 65 hasta ilacını yanlış kullanıyordu. İlacını doğru kullanan grupta AKT (p=0.0001), FEV1 yüzdesi (p=0.001), PEF yüzdesi (p=0.014) anlamlı olarak daha yüksek bulundu. Sonuç: Hastalar inhaler ilaçlar konusunda mutlaka bilgilendirilmeli ve eğitilmelidir. Tüm inhaler ilaç formları için ciddi kullanım hataları mevcut olup hastalar açısından önemli bilgi eksikliği de söz konusudur. Doğru inhaler kullanımıyla beraber hastanın astımı kontrol altına alınıp daha az sayıda ve düşük doz ilaç kullanması, hastane yatışlarının daha az olması sağlanabilir ve böylece astımda maliyet de düşürülebilir.

The Proper use of Inhalers in a Third Step Hospital and its Effect on Treatment: Original Study

Objective: The percentage of asthma patients that use their inhalers with the correct technique ranges between 10and 60. Inappropriate use of inhaler leads to disuse of drug, diminished disease control and increased drug use. In thisstudy, we aimed to determine the effect of proper inhaler therapy on the treatment and control of asthma and theeffect of proper inhaler use on hospitalization due to asthma.Method: One hundred and sixty five asthma patients over 18 years of age that applied to either in- or out-patientclinics of a university hospital, that had a diagnosis of asthma according to the criteria of the Global Initiative forAsthma (GINA) and had been attack-free for at least one month were included. Patients were told to use their inhalersand any misuse were noted. Patients were put through the Asthma Control Test (ACT). Their forced vital capacity(FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) values were also noted. Theirhospitalization status for asthma in the last year was assessed and recorded.Results: One hundred patients used their asthma inhalers correctly, while 65 did not. Those that used their inhalerscorrectly had significantly higher ACT (p=0,0001), FEV1% (p=0,001) and PEF% (p=0,014).Discussion: Patients must be informed and trained for the correct use of their inhaler drugs. Patients seem to beunder-informed on this subject and there are serious mistakes of use for all inhaler types. Correct use of inhalers leadsto better control of disease, lower rate of asthma-related hospitalization, less drug waste and decreased treatmentcost.

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