Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta-Analysis

被引:41
作者
Maricoto, Tiago [1 ,2 ]
Monteiro, Luis [2 ,3 ]
Gama, Jorge M. R. [4 ]
Correia-de-Sousa, Jaime [5 ,6 ]
Taborda-Barata, Luis [7 ,8 ,9 ]
机构
[1] Aveiro Healthcare Ctr, Aveiro Aradas Family Hlth Unit, Aveiro, Portugal
[2] Univ Beira Interior, Fac Hlth Sci, Covilha, Portugal
[3] Aveiro Healthcare Ctr, Esgueira Family Hlth Unit, Aveiro, Portugal
[4] Univ Beira Interior, Fac Sci, Ctr Math & Applicat, Covilha, Portugal
[5] Univ Minho, Life & Hlth Sci Res Inst, PT Govt Associate Lab 3Bs, Braga, Portugal
[6] Horizonte Family Hlth Unit, Unidade Local Saude, Matosinhos, Portugal
[7] Univ Beira Interior, CICS Hlth Sci Res Ctr, Covilha, Portugal
[8] Univ Beira Interior, Fac Hlth Sci, NuESA Environm & Hlth Study Grp, Covilha, Portugal
[9] Cova da Beira Univ Hosp Ctr, Dept Allergy & Clin Immunol, Covilha, Portugal
基金
美国国家卫生研究院;
关键词
asthma; chronic obstructive pulmonary disease; inhalers; METERED-DOSE INHALER; INHALATION TECHNIQUE; MEDICATION ADHERENCE; DEVICE SELECTION; COPD PATIENTS; MANAGEMENT; CARE; INTERVENTIONS; ASSOCIATION; PREDICTORS;
D O I
10.1111/jgs.15602
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
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.
引用
收藏
页码:57 / 66
页数:10
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