Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects

Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects

Background: Adherence to inhaled drugs is linked to patients’ satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects. Aim: We performed a national pre-post interventional...

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Main Authors: M. Milanese, S. Terraneo, I. Baiardini, F. Di Marco, A. Corsico, A. Molino, N. Scichilone, F. Albicini, A. Benfante, F. Braido, M. Caminati, M.T. Costantino, M. Cottini, M. Crivellaro, R. De Tullio, E. Gini, A. Grosso, G. Guarnieri, C. Lombardi, V. Patella, P. Pirina, M. Polverino, R. Raccanelli, E. Ridolo, G. Rolla, G. Steinhilber, A. Vianello
Format: Article
Language:English
Published: Elsevier 2019-01-01
Series:World Allergy Organization Journal
Online Access:http://www.sciencedirect.com/science/article/pii/S1939455119306696
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author M. Milanese
S. Terraneo
I. Baiardini
F. Di Marco
A. Corsico
A. Molino
N. Scichilone
F. Albicini
A. Benfante
F. Braido
M. Caminati
M.T. Costantino
M. Cottini
M. Crivellaro
R. De Tullio
E. Gini
A. Grosso
G. Guarnieri
C. Lombardi
V. Patella
P. Pirina
M. Polverino
R. Raccanelli
E. Ridolo
G. Rolla
G. Steinhilber
A. Vianello
spellingShingle M. Milanese
S. Terraneo
I. Baiardini
F. Di Marco
A. Corsico
A. Molino
N. Scichilone
F. Albicini
A. Benfante
F. Braido
M. Caminati
M.T. Costantino
M. Cottini
M. Crivellaro
R. De Tullio
E. Gini
A. Grosso
G. Guarnieri
C. Lombardi
V. Patella
P. Pirina
M. Polverino
R. Raccanelli
E. Ridolo
G. Rolla
G. Steinhilber
A. Vianello
Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects
World Allergy Organization Journal
author_facet M. Milanese
S. Terraneo
I. Baiardini
F. Di Marco
A. Corsico
A. Molino
N. Scichilone
F. Albicini
A. Benfante
F. Braido
M. Caminati
M.T. Costantino
M. Cottini
M. Crivellaro
R. De Tullio
E. Gini
A. Grosso
G. Guarnieri
C. Lombardi
V. Patella
P. Pirina
M. Polverino
R. Raccanelli
E. Ridolo
G. Rolla
G. Steinhilber
A. Vianello
author_sort M. Milanese
title Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects
title_short Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects
title_full Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects
title_fullStr Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects
title_full_unstemmed Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects
title_sort effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects
publisher Elsevier
series World Allergy Organization Journal
issn 1939-4551
publishDate 2019-01-01
description Background: Adherence to inhaled drugs is linked to patients’ satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects. Aim: We performed a national pre-post interventional multicentre study, enrolling moderate-to-severe asthmatic subjects aged ≥65 ​years treated with fixed inhaled combination drugs by dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Adherence and critical errors were evaluated by means of validated questionnaires at first visit (V1) and after 3–6 months (V2). At V1, subjects underwent intensive training on the correct use of their device by physical demonstration. Results: A total of 411 asthmatics (F/M: 238/173, mean age±SD: 72 ​± ​5 ​years) participated to the study. At V1, 50% of the study subjects showed an Asthma Control Test (ACT) score ≤19 despite GINA step 3 and 4 treatment, and 40% had experienced at least one severe asthma exacerbation in the previous year. Poor adherence to treatment was recorded in 43% of subjects, and at least one error in using the device was registered in 56% of subjects. At V2, available for 318 patients, both the percentage of individuals with poor adherence and with at least one critical error significantly decreased (from 46% to 25%, and from 49% to 25%, respectively; p ​< ​0.001 for both comparisons) with a significant increase of the ACT score (from 19 ​± ​4.9 to 20 ​± ​4.0, p ​< ​0.001). Conclusions: Asthma in the elderly is characterized by low levels of symptom control. Educational interventions are strongly advocated in this age group in order to increase adherence to treatment and inhaler techniques. Keywords: Elderly, Asthma, Device misuse, Education
url http://www.sciencedirect.com/science/article/pii/S1939455119306696
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spelling doaj-d0a63844a70f43de91c602adfba6040f2020-11-24T22:01:18ZengElsevierWorld Allergy Organization Journal1939-45512019-01-01126Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjectsM. Milanese0S. Terraneo1I. Baiardini2F. Di Marco3A. Corsico4A. Molino5N. Scichilone6F. Albicini7A. Benfante8F. Braido9M. Caminati10M.T. Costantino11M. Cottini12M. Crivellaro13R. De Tullio14E. Gini15A. Grosso16G. Guarnieri17C. Lombardi18V. Patella19P. Pirina20M. Polverino21R. Raccanelli22E. Ridolo23G. Rolla24G. Steinhilber25A. Vianello26Department of Medicine, Respiratory Unit, ASL2 Savonese, Savona, Italy; Corresponding author.Respiratory Unit, ASST Santi Paolo e Carlo, Milan, ItalyDepartment of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova, Azienda Policlinico IRCCS San Martino, Genoa, ItalyDepartment of Health Sciences, Università degli Studi di Milano, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, ItalyDepartment of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, ItalyDepartment of Respiratory Diseases, Division of Pneumology, University of Naples Federico II, Napoli, ItalyDepartment of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, ItalyDepartment of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, ItalyDepartment of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, ItalyDepartment of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova, Azienda Policlinico IRCCS San Martino, Genoa, ItalyUnità Operativa di Allergologia Azienda Ospedaliero-Universitaria Integrata di Verona, Verona, ItalyInternal Medicine and Rheumatology Department, Azienda Sanitaria Romagna, Rimini, ItalyAllergy and Pneumology Outpatient Clinic, Bergamo, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyOspedale consorziale Policlinico di Bari, Unità di Pneumologia, Bari, ItalyDepartment of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, ItalyDepartment of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyDepartmental Unit of Allergology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, ItalyUnità Operativa di Allergologia ed Immunologia, Dipartimento di Discipline Mediche, Battipaglia SA, ItalyDepartment of Clinical and Experimental Medicine, University of Sassari, Sassari, ItalyDepartment of Pneumology and Endoscopic Unit, Ospedale Scarlato, Scafati SA, ItalyFondazione Salvatore Maugeri, Istituto Scientifico di Milano, IRCCS, MilanoDepartment of Medicine and Surgery, University of Parma, Parma, ItalyAllergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, ItalyAO Spedali Civili di Brescia, Divisione di Pneumologia, Brescia, ItalyDepartment of Cardiologic, Thoracic, and Vascular Science, University of Padua, Padua, ItalyBackground: Adherence to inhaled drugs is linked to patients’ satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects. Aim: We performed a national pre-post interventional multicentre study, enrolling moderate-to-severe asthmatic subjects aged ≥65 ​years treated with fixed inhaled combination drugs by dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Adherence and critical errors were evaluated by means of validated questionnaires at first visit (V1) and after 3–6 months (V2). At V1, subjects underwent intensive training on the correct use of their device by physical demonstration. Results: A total of 411 asthmatics (F/M: 238/173, mean age±SD: 72 ​± ​5 ​years) participated to the study. At V1, 50% of the study subjects showed an Asthma Control Test (ACT) score ≤19 despite GINA step 3 and 4 treatment, and 40% had experienced at least one severe asthma exacerbation in the previous year. Poor adherence to treatment was recorded in 43% of subjects, and at least one error in using the device was registered in 56% of subjects. At V2, available for 318 patients, both the percentage of individuals with poor adherence and with at least one critical error significantly decreased (from 46% to 25%, and from 49% to 25%, respectively; p ​< ​0.001 for both comparisons) with a significant increase of the ACT score (from 19 ​± ​4.9 to 20 ​± ​4.0, p ​< ​0.001). Conclusions: Asthma in the elderly is characterized by low levels of symptom control. Educational interventions are strongly advocated in this age group in order to increase adherence to treatment and inhaler techniques. Keywords: Elderly, Asthma, Device misuse, Educationhttp://www.sciencedirect.com/science/article/pii/S1939455119306696

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