The ADMIT series--issues in inhalation therapy. 5) Inhaler selection in children with asthma.

Many children with asthma do not use their inhalers correctly and consequently gain little or no therapeutic benefit from the treatment. The focus of inhalation therapy should be on those inhalers which are easiest to use correctly by various groups of children and the amount of tuition and training required to obtain a correct technique. It is recommended that clinicians focus on a limited number of inhalers.

The ADMIT series--issues in inhalation therapy. 3) Mild persistent asthma: the case for inhaled corticosteroid therapy.

Mild persistent asthma should be treated with continuous inhaled corticosteroids (ICS), which reduces exacerbations of disease, controls symptoms and reduces bronchial mucosal inflammation. Most patients can be controlled with low dosage ICS ( View Article and Find Full Text PDF

The ADMIT series--issues in inhalation therapy. 2. Improving technique and clinical effectiveness.

Aerosol inhalation is considered the optimal route for administering the majority of drugs for the treatment of obstructive airways diseases. A number of Pressurised Metered-Dose and Dry Powder Inhalers are available for this purpose. However, inhalation of therapeutic aerosols is not without difficulty; it requires precise instructions on the inhalation manoeuvre, which is different from spontaneous normal breathing.

Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD.

Background: Incorrect usage of inhaler devices might have a major influence on the clinical effectiveness of the delivered drug. This issue is poorly addressed in management guidelines.

Methods: This article presents the results of a systematic literature review of studies evaluating incorrect use of established dry powder inhalers (DPIs) by patients with asthma or chronic obstructive pulmonary disease (COPD).

Intravenous magnesium sulphate provides no additive benefit to standard management in acute asthma.

Background: Treatment of acute asthma is based on rapid reversal of bronchospasm and airway inflammation. Magnesium sulphate (MgSO(4)) is known to have a bronchodilator effect on smooth muscle but studies have shown conflicting results on its efficacy in acute asthma, although its use is recommended in national and international guidelines.

Aims: To determine if intravenous MgSO(4), when used as an adjunct to standard therapy, improves the outcome in acute asthma.

How to achieve good compliance with inhaled asthma therapy.

Inability to use inhaler devices correctly is a major source of non-compliance in patients with asthma. The problem of coordinating dose release with inspiration seen with pressurised metered dose inhalers (pMDIs) is overcome by dry powder inhalers (DPIs), since they use inspiratory flow energy to carry the drug dose to the respiratory tract. The first DPIs were not popular because they were single dose devices and inconvenient to use.

Moving from CFC aerosol to HFA aerosol or dry powder inhalers: what do patients think?

Background/objectives: Environmentally friendly hydrofluoroalkane (HFA) pressurised metered-dose inhalers are currently being marketed to replace chlorofluorocarbon (CFC)-driven devices. It is uncertain whether these new formulations with different properties are acceptable to patients. Similarly, switching a patient to a dry powder inhaler (DPI) carries the risk of non-acceptance.