ارزيابي ميزان كاربرد صحيح اسپري هاي استنشاقي توسط سالمندان مبتلا به بيماري هاي انسدادي مزمن تنفسي و آسم

The Assessment of Correct Usage of Inhalers by Elderly Patients with COPD and Asthma

ﺑﯿﻤﺎري اﻧﺴﺪادي ﻣﺰﻣﻦ رﯾﻪ ﺣﺎﻟﺘﯽ اﺳﺖ ﮐﻪ ﻣﺸﺨﺼﻪ آن ﻣﺤﺪودﯾﺖ ﺟﺮﯾﺎن ﻫﻮا ﺑﻮده و ﺑﻄﻮر ﮐﺎﻣﻞ ﺑﺮﮔﺸﺖﭘﺬﯾﺮ ﻧﯿﺴﺖ. اﺳﭙﺮيﻫﺎي اﺳﺘﻨﺸﺎﻗﯽ راﯾﺞﺗﺮﯾﻦ داروﻫﺎي ﺗﺠﻮﯾﺰ ﺷﺪه در اﯾﻦ ﻧﻮع ﺑﯿﻤﺎري ﻫﺴﺘﻨﺪ ﮐﻪ اﺳﺘﻔﺎدهي ﻧﺎﻣﻨﺎﺳﺐ آنﻫﺎ ﺗﻮﺳﻂ ﺑﯿﻤﺎران ﻣﻨﺠﺮ ﺑﻪ ﮐﺎﻫﺶ اﺛﺮﺑﺨﺸﯽ ﺑﺮآﯾﻨﺪﻫﺎي درﻣﺎن اﺳﺘﻨﺸﺎﻗﯽ ﻣﯽﮔﺮدد. ﻫﺪف اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻌﯿﯿﻦ ﻣﯿﺰان ﮐﺎرﺑﺮد ﺻﺤﯿﺢ اﺳﭙﺮيﻫﺎي اﺳﺘﻨﺸﺎﻗﯽ ﺗﻮﺳﻂ ﺳﺎﻟﻤﻨﺪان ﻣﺒﺘﻼ ﺑﻪ ﺑﯿﻤﺎريﻫﺎي اﻧﺴﺪادي ﻣﺰﻣﻦ ﺗﻨﻔﺴﯽ و آﺳﻢ ﻣﯽﺑﺎﺷﺪ. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﯽ 150 ﺑﯿﻤﺎر ﺳﺎﻟﻤﻨﺪ ﻣﺒﺘﻼ ﺑﻪ آﺳﻢ و ﺑﯿﻤﺎري اﻧﺴﺪادي ﻣﺰﻣﻦ رﯾﻪ ﺑﻪ روش ﻧﻤﻮﻧﻪﮔﯿﺮي آﺳﺎن از ﺑﯿﻤﺎرﺳﺘﺎنﻫﺎي آﻣﻮزﺷﯽ درﻣﺎﻧﯽ وﻻﯾﺖ و ﺑﻮﻋﻠﯽ ﺳﯿﻨﺎي ﺷﻬﺮﺳﺘﺎن ﻗﺰوﯾﻦ اﻧﺘﺨﺎب ﺷﺪﻧﺪ. اﺑﺰار ﻣﻮرد اﺳﺘﻔﺎده ﭘﺮﺳﺸﻨﺎﻣﻪ ﺣﺎوي اﻃﻼﻋﺎت ﺟﻤﻌﯿﺖﺷﻨﺎﺧﺘﯽ و ﺑﺎﻟﯿﻨﯽ و ﭼﮏ ﻟﯿﺴﺖ اﺳﺘﺎﻧﺪارد ﮐﺎرﺑﺮد ﺻﺤﯿﺢ اﺳﭙﺮيﻫﺎي اﺳﺘﻨﺸﺎﻗﯽ ﺑﻮد. ﻣﯿﺰان ﮐﺎرﺑﺮد ﺻﺤﯿﺢ داروﻫﺎ ﭘﺲ از ﻣﺸﺎﻫﺪه ﺗﻮﺳﻂ ﭼﮏ ﻟﯿﺴﺖ از ﺻﻔﺮ ﺗﺎ 16 اﻣﺘﯿﺎزدﻫﯽ ﮔﺮدﯾﺪ. ﻧﺘﺎﯾﺞ اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد ﮐﻪ ﮐﻠﯿﻪ ﺑﯿﻤﺎران ﺷﺮﮐﺖ ﮐﻨﻨﺪه در اﯾﻦ ﭘﮋوﻫﺶ )ﺑﺎ ﻣﯿﺎﻧﮕﯿﻦ ﺳﻨﯽ 64/1 ،73/44±7% ﻣﺮد و 79/3% داراي ﺗﺤﺼﯿﻼت اﺑﺘﺪاﯾﯽ( اﺳﭙﺮيﻫﺎي اﺳﺘﻨﺸﺎﻗﯽ را ﺑﻪ ﺻﻮرت ﻧﺎدرﺳﺖ ﺑﮑﺎر ﻣﯽﺑﺮدﻧﺪ ﺑﻄﻮري ﮐﻪ ﺻﺪ در ﺻﺪ ﺑﯿﻤﺎران )150=n( ﺣﺪاﻗﻞ در اﻧﺠﺎم ﯾﮑﯽ از ﻣﺮاﺣﻞ داراي اﺷﺘﺒﺎه ﺑﻮدﻧﺪ. ﻣﯿﺎﻧﮕﯿﻦ اﻣﺘﯿﺎز ﺑﯿﻤﺎران در ﮐﺎرﺑﺮد اﺳﭙﺮي 9/42±2/67 ﺑﻮد. ﮐﻤﺘﺮﯾﻦ ﻣﻬﺎرت ﻣﺮﺑﻮط ﺑﻪ ﺷﺴﺘﻦ دﻫﺎن ﺑﻌﺪ از اﺳﺘﻔﺎده از اﺳﭙﺮي )1/3 درﺻﺪ( ﺑﺮآورد ﺷﺪ. ﺳﺎﯾﺮ ﻣﻬﺎرتﻫﺎﯾﯽ ﮐﻪ ﺑﻪ ﻃﺮز ﺻﺤﯿﺢ اﻧﺠﺎم ﺷﺪ ﺷﺎﻣﻞ ﺑﺎزدم ﻋﻤﯿﻖ ﻗﺒﻞ از اﺳﺘﻨﺸﺎق )18/7 درﺻﺪ(، ﺻﺒﺮ ﮐﺮدن ﺑﻪ ﻣﺪت ﯾﮏ دﻗﯿﻘﻪ ﻗﺒﻞ از ﻋﻤﻞ ﺑﻌﺪي )28/7 درﺻﺪ(، ﺣﺒﺲ ﻧﻔﺲ ﺑﻪ ﻣﺪت 5 ﺗﺎ 10 ﺛﺎﻧﯿﻪ )34 درﺻﺪ(، ﺑﺎزدم آرام از ﻃﺮﯾﻖ دﻫﺎن ﺑﻌﺪ از اﺳﺸﺘﻨﺸﺎق )34 درﺻﺪ(، ﺧﺎرج ﮐﺮدن اﺳﭙﺮي ﻫﻤﺰﻣﺎن ﺑﺎ ﺣﺒﺲ ﻧﻔﺲ )47/3 درﺻﺪ(، اداﻣﻪ ﻋﻤﻞ دم ﺑﻪ ﻣﺪت 5-3 ﺛﺎﻧﯿﻪ )51/3 درﺻﺪ( ﺑﻮد. ارﺗﺒﺎط ﻣﺜﺒﺖ و ﻣﻌﻨﺎدار ﺑﯿﻦ درﯾﺎﻓﺖ آﻣﻮزش ﻗﺒﻠﯽ ﺗﻮﺳﻂ اﻓﺮاد و ﻋﻤﻠﮑﺮد آﻧﻬﺎ در ﮐﺎرﺑﺮد اﺳﭙﺮي )0/001≤P( وﺟﻮد داﺷﺖ. ﺑﯿﻦ ﺳﺎﯾﺮ ﻣﺘﻐﯿﺮﻫﺎ و ﻋﻤﻠﮑﺮد ﻓﺮد در ﮐﺎرﺑﺮد اﺳﭙﺮي ارﺗﺒﺎط ﻣﻌﻨﺎداري ﻣﺸﺎﻫﺪه ﻧﺸﺪ. ﻧﺘﺎﯾﺞ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻧﺸﺎن داد ﮐﻪ اﮐﺜﺮ ﺳﺎﻟﻤﻨﺪان ﺣﺪاﻗﻞ ﯾﮑﯽ از ﻣﺮاﺣﻞ ﮐﺎرﺑﺮد اﺳﭙﺮي اﺳﺘﻨﺸﺎﻗﯽ را ﺑﺼﻮرت ﻧﺎدرﺳﺖ اﻧﺠﺎم ﻣﯽدﻫﻨﺪ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﯾﻨﮑﻪ ﻋﺪم اﻧﺠﺎم ﺻﺤﯿﺢ ﺣﺘﯽ ﯾﮏ ﻣﺮﺣﻠﻪ از ﻣﺮاﺣﻞ ﮐﺎرﺑﺮد ﺻﺤﯿﺢ اﺳﭙﺮي اﺳﺘﻨﺸﺎﻗﯽ ﻣﯽﺗﻮاﻧﺪ ﺑﻪ ﻣﯿﺰان زﯾﺎدي اﺛﺮﺑﺨﺸﯽ داروﻫﺎي اﺳﺘﻨﺸﺎﻗﯽ را ﮐﺎﻫﺶ دﻫﺪ ﺿﺮوري اﺳﺖ ﮐﻪ ﺑﻪ ﻣﻨﻈﻮر ﺑﻬﺒﻮد ﻋﻤﻠﮑﺮد ﺳﺎﻟﻤﻨﺪان در اﺳﺘﻔﺎده از اﯾﻦ دﺳﺘﻪ داروﻫﺎ آﻣﻮزش ﮐﺎﻓﯽ در ارﺗﺒﺎط ﺑﺎ ﻧﺤﻮه ﺻﺤﯿﺢ ﮐﺎرﺑﺮد داروﻫﺎ ﺗﻮﺳﻂ ﮐﺎدر درﻣﺎﻧﯽ اراﺋﻪ ﮔﺮدد.

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation. Inhaled metered dose inhalers (MDI) is commonly prescribed for the treatment of asthma and chronic obstructive pulmonary disease (COPD), but it often not properly used by elderly patients. Older people commonly have poor inhaler technique. If these medications are not used properly, they will not be effective. The purpose of this study was to assess the correct usage of inhalers by elder patients. In this cross-sectional study, 150 elderly patients with asthma and chronic obstructive pulmonary disease were selected by convenience sampling method in Boo-Ali and Velayat Hospital of Qazvin. Data collection was done by use of demographic and clinical questionnaires. Using a standardized inhaler-specific checklist, the inhalation technique was assessed, too. Following observation of the inhalation technique, the check list was scored from 0 to 16. All of the 150 elderly participants (mean age: 73.44±7.23 years, 64.1% male, 79.3% with primary school education) failed to use their inhalers correctly and performed at least one mistake in the inhalation technique. The mean±SD score of the correct usage of inhalers was 9.42±2.67. The least skills was related to rinse mouth with water, following inhaler usage (1.3%). The proper performed skills were exhaling prior to inhalation (18.7%), waiting 1 minute before a needed extra dose (28.7), breath-hold for about 5-10 seconds (34%), breathe out slowly away from mouthpiece (34%), holding breath while remove inhaler from mouth (47.3%) and breathe in slowly through mouth for about 3-5 seconds at start of inspiration (51.3%). Receiving previous training was the most important factor related to inhalation technique (P=0.001). No associations were found between inhalation technique and another demographic and clinical variable. Training elderly patients with COPD and asthma to use MDIs properly is the essential component for their prescription and special attention should be given to education regarding inhaler techniques, in order to increase the effectiveness of medications.