Original Articles
Inhaled Drug Use in Elderly Patients and Limitations in Association With Geriatric Assessment Scores
Ventura Rabell-Santacanaa,
, Esther Pastor-Ramonb, Juan Pujol-Ribóc, Juan Solà-Genovésd, Montserrat Díaz-Egeac, Miquel Layola-Briasb, María Dolores Fernández-Campie
Corresponding author
verabell.ics@gencat.net
Correspondence: Dr V. Rabell-Santacana Unidad de Neumología, Nivel hospitalario, CAP II, Institut Català de la Salut Museu, 19, 1.º 08400 Granollers, Barcelona, Spain
Correspondence: Dr V. Rabell-Santacana Unidad de Neumología, Nivel hospitalario, CAP II, Institut Català de la Salut Museu, 19, 1.º 08400 Granollers, Barcelona, Spain
a Unidad de Neumología, Nivel hospitalario, CAP II Granollers, Granollers, Barcelona, Spain
b Unidad de Farmacia, Servicio de Atención Primaria Granollers-Mollet del Vallès, Granollers, Barcelona, Spain
c Unidad de Neumología, Nivel hospitalario, CAP II Mollet, Mollet del Vallès, Barcelona, Spain
d Programa de Atención Domiciliaria Estructura Soporte Mollet, Mollet del Vallès, Barcelona, Spain
e Centro de Salud Montornès, Equipo de Atención Primaria, Área Básica de Salud Montornés-Montmeló, Barcelona, Spain
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Rabell-Santacana Unidad de Neumología, Nivel hospitalario, CAP II, Institut Català de la Salut Museu, 19, 1.º 08400 Granollers, Barcelona, Spain" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-09-17" "fechaAceptado" => "2008-02-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec155039" "palabras" => array:3 [ 0 => "Inhaler use" 1 => "Geriatric assessment" 2 => "Inhaler technique" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155038" "palabras" => array:3 [ 0 => "Uso de inhaladores" 1 => "Evaluación geriátrica" 2 => "Técnica de administración" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The study of the association between geriatric profile and the use of inhaled respiratory drugs would help to identify age-related factors that might indicate poor inhaler use and technique.</p> <span class="elsevierStyleSectionTitle">Patients and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">We selected 117 patients older than 74 years receiving chronic treatment with inhaled respiratory drugs to participate in this descriptive, cross-sectional, multicenter study. The following variables were analyzed: age, sex, institutionalization, carer assistance, inhaled drugs, prescribed regimen, actual regimen followed by the patient, initial indication, concomitant use of drugs that could exacerbate the underlying disease, adverse effects, basic geriatric assessment scores, treatment adherence, inhalation technique, and spirometric variables.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">In all, 5.4% of the patients had moderate to severe cognitive impairment; 2.2%, considerable or total dependency in terms of activities of daily living; and, 14%, considerable or total dependency in terms of instrumental activities of daily living. Twenty-three percent had symptoms of depression and 5.4% (all men) were depressed. Forty percent of the patients analyzed were considered to be at psychosocial risk.</p><p class="elsevierStyleSimplePara elsevierViewall">Inhalation technique scores were not correlated with any of the other variables analyzed. Higher scores were obtained when dry powder inhalers were used to administer anticholinergic agents and when capsule-based inhalers were used to administer corticosteroids concomitantly with long-acting β<span class="elsevierStyleInf">2</span>-agonists.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Tests readily administered in daily practice to detect age-related deterioration may not accurately predict optimal use of inhaler devices.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El estudio de la asociación entre perfil geriátrico y uso de medicación respiratoria inhalada permitiría conocer qué factores relacionados con el envejecimiento pueden condicionar la utilización y la técnica de administración de estos fármacos.</p> <span class="elsevierStyleSectionTitle">Pacientes Y Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio multicéntrico, descriptivo y transversal en que se incluyó a 117 pacientes mayores de 74 años, en tratamiento crónico con fármacos respiratorios por vía inhalada. Se analizaron las siguientes variables: edad, sexo, institucionalización, cuidador, fármacos inhalados de acción respiratoria, pauta prescrita y realizada por el paciente, diagnóstico que originó la prescripción, fármacos concomitantes que pudieran agravar la enfermedad de base, efectos adversos, valoración geriátrica básica, cumplimiento terapéutico, valoración de la técnica de inhalación y variables espirométricas.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El 5,4% de los pacientes presentaba un deterioro cognitivo moderado-grave, el 2,2% una dependencia funcional importante-total y el 14% una dependencia instrumental importante-total. El 23% tenía depresión leve y el 5,4% depresión establecida, siendo todos los pacientes varones. El 40% presentaba riesgo social.</p><p class="elsevierStyleSimplePara elsevierViewall">La valoración de la técnica no se correlacionó con ninguna de las variables analizadas.</p><p class="elsevierStyleSimplePara elsevierViewall">Los dispositivos Aerolizer-Handihaler mejoraban la valoración de la técnica en la aplicación de los anticolinérgicos y los dispositivos Accuhaler-Turbuhaler, la aplicación de la asociación de corticoides con agonistas adrenérgicos β<span class="elsevierStyleInf">2</span> de acción larga.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los tests de fácil aplicación en consulta para detectar el deterioro asociado al envejecimiento no parecen ser un buen elemento predictivo para determinar un mejor uso de los dispositivos de inhalación.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deposition of pressurised aerosols in the human respiratory tract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "SP Newman" 1 => "D Pavia" 2 => "D Moren" 3 => "NF Seahan" 4 => "SW Clarke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "1981" "volumen" => "36" "paginaInicial" => "52" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7292382" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The local side effects of inhaled corticosteroids – Current understanding and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "NJ Roland" 1 => "RK Bhalla" 2 => "J Earis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.126.1.213" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2004" "volumen" => "126" "paginaInicial" => "213" "paginaFinal" => "219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15249465" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asma bronquial y broncodilatadores en aerosol:empleo correcto en nuestro medio" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "AGN Agustí" 1 => "P Useti" 2 => "J Roca" 3 => "JM Montserrat" 4 => "R Rodríguez Roisin" 5 => "A Agustí Vidal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "1983" "volumen" => "81" "paginaInicial" => "893" "paginaFinal" => "894" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Técnica de inhalación en los pacientes con enfermedades respiratorias crónicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F Carrión" 1 => "M Maya" 2 => "I Fontana" 3 => "J Díaz" 4 => "J Marín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2000" "volumen" => "36" "paginaInicial" => "236" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10916662" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Terapia inhalada sin educación, un fracaso anunciado" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F Burgos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2002" "volumen" => "38" "paginaInicial" => "297" "paginaFinal" => "299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12199927" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0213485310700530" "estado" => "S300" "issn" => "02134853" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled therapy in elderly COPD patients;time for re-evaluation?" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 5 | 10 |
| 2024 October | 35 | 18 | 53 |
| 2024 September | 21 | 16 | 37 |
| 2024 August | 47 | 34 | 81 |
| 2024 July | 28 | 23 | 51 |
| 2024 June | 37 | 35 | 72 |
| 2024 May | 63 | 41 | 104 |
| 2024 April | 21 | 23 | 44 |
| 2024 March | 17 | 18 | 35 |
| 2024 February | 21 | 23 | 44 |
| 2023 March | 2 | 3 | 5 |
| 2023 February | 16 | 21 | 37 |
| 2023 January | 18 | 29 | 47 |
| 2022 December | 19 | 26 | 45 |
| 2022 November | 24 | 27 | 51 |
| 2022 October | 31 | 50 | 81 |
| 2022 September | 25 | 26 | 51 |
| 2022 August | 21 | 40 | 61 |
| 2022 July | 23 | 39 | 62 |
| 2022 June | 19 | 30 | 49 |
| 2022 May | 27 | 34 | 61 |
| 2022 April | 20 | 26 | 46 |
| 2022 March | 18 | 43 | 61 |
| 2022 February | 28 | 21 | 49 |
| 2022 January | 18 | 30 | 48 |
| 2021 December | 21 | 47 | 68 |
| 2021 November | 21 | 50 | 71 |
| 2021 October | 24 | 59 | 83 |
| 2021 September | 13 | 56 | 69 |
| 2021 August | 17 | 38 | 55 |
| 2021 July | 12 | 28 | 40 |
| 2021 June | 31 | 44 | 75 |
| 2021 May | 21 | 32 | 53 |
| 2021 April | 40 | 67 | 107 |
| 2021 March | 31 | 25 | 56 |
| 2021 February | 20 | 21 | 41 |
| 2021 January | 9 | 10 | 19 |
| 2020 December | 19 | 20 | 39 |
| 2020 November | 21 | 14 | 35 |
| 2020 October | 22 | 7 | 29 |
| 2020 September | 11 | 8 | 19 |
| 2020 August | 18 | 11 | 29 |
| 2020 July | 24 | 14 | 38 |
| 2020 June | 23 | 7 | 30 |
| 2020 May | 18 | 16 | 34 |
| 2020 April | 23 | 20 | 43 |
| 2020 March | 19 | 14 | 33 |
| 2020 February | 23 | 14 | 37 |
| 2020 January | 16 | 21 | 37 |
| 2019 December | 23 | 12 | 35 |
| 2019 November | 24 | 13 | 37 |
| 2019 October | 14 | 11 | 25 |
| 2019 September | 11 | 15 | 26 |
| 2019 August | 23 | 14 | 37 |
| 2019 July | 23 | 21 | 44 |
| 2019 June | 12 | 10 | 22 |
| 2019 May | 21 | 29 | 50 |
| 2019 April | 52 | 40 | 92 |
| 2019 March | 16 | 25 | 41 |
| 2019 February | 24 | 16 | 40 |
| 2019 January | 15 | 14 | 29 |
| 2018 December | 17 | 18 | 35 |
| 2018 November | 30 | 25 | 55 |
| 2018 October | 21 | 10 | 31 |
| 2018 September | 20 | 12 | 32 |
| 2018 May | 4 | 1 | 5 |
| 2018 April | 14 | 5 | 19 |
| 2018 March | 8 | 4 | 12 |
| 2018 February | 4 | 7 | 11 |
| 2018 January | 2 | 11 | 13 |
| 2017 December | 10 | 10 | 20 |
| 2017 November | 4 | 5 | 9 |
| 2017 October | 9 | 8 | 17 |
| 2017 September | 7 | 15 | 22 |
| 2017 August | 9 | 11 | 20 |
| 2017 July | 16 | 9 | 25 |
| 2017 June | 7 | 10 | 17 |
| 2017 May | 8 | 5 | 13 |
| 2017 April | 8 | 6 | 14 |
| 2017 March | 14 | 36 | 50 |
| 2017 February | 3 | 4 | 7 |
| 2017 January | 5 | 6 | 11 |
| 2016 December | 9 | 5 | 14 |
| 2016 November | 15 | 17 | 32 |
| 2016 October | 21 | 12 | 33 |
| 2016 September | 22 | 14 | 36 |
| 2016 August | 17 | 4 | 21 |
| 2016 July | 17 | 4 | 21 |
| 2016 March | 3 | 0 | 3 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 66 | 14 | 80 |
| 2015 September | 76 | 13 | 89 |
| 2015 August | 55 | 7 | 62 |
| 2015 July | 40 | 6 | 46 |
| 2015 June | 65 | 12 | 77 |
| 2015 May | 68 | 15 | 83 |
| 2015 April | 33 | 11 | 44 |
| 2015 March | 36 | 5 | 41 |
| 2015 February | 28 | 5 | 33 |
| 2015 January | 41 | 5 | 46 |
| 2014 December | 36 | 5 | 41 |
| 2014 November | 47 | 5 | 52 |
| 2014 October | 64 | 7 | 71 |
| 2014 September | 51 | 6 | 57 |
| 2014 August | 39 | 9 | 48 |
| 2014 July | 50 | 8 | 58 |
| 2014 June | 51 | 7 | 58 |
| 2014 May | 111 | 8 | 119 |
| 2014 April | 139 | 1 | 140 |
| 2014 March | 63 | 9 | 72 |
| 2014 February | 68 | 9 | 77 |
| 2014 January | 37 | 7 | 44 |
| 2013 December | 43 | 7 | 50 |
| 2013 November | 41 | 10 | 51 |
| 2013 October | 36 | 8 | 44 |
| 2013 September | 34 | 7 | 41 |
| 2013 August | 48 | 7 | 55 |
| 2013 July | 51 | 14 | 65 |
| 2013 June | 43 | 8 | 51 |
| 2013 May | 39 | 8 | 47 |
| 2013 April | 19 | 9 | 28 |
| 2013 March | 6 | 1 | 7 |
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