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

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

World Allergy Organization Journal (Jan 2019)

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

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

Affiliations

M. Milanese: Department of Medicine, Respiratory Unit, ASL2 Savonese, Savona, Italy; Corresponding author.
S. Terraneo: Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
I. Baiardini: Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova, Azienda Policlinico IRCCS San Martino, Genoa, Italy
F. Di Marco: Department of Health Sciences, Università degli Studi di Milano, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
A. Corsico: Department of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
A. Molino: Department of Respiratory Diseases, Division of Pneumology, University of Naples Federico II, Napoli, Italy
N. Scichilone: Department of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy
F. Albicini: Department of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
A. Benfante: Department of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy
F. Braido: Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova, Azienda Policlinico IRCCS San Martino, Genoa, Italy
M. Caminati: Unità Operativa di Allergologia Azienda Ospedaliero-Universitaria Integrata di Verona, Verona, Italy
M.T. Costantino: Internal Medicine and Rheumatology Department, Azienda Sanitaria Romagna, Rimini, Italy
M. Cottini: Allergy and Pneumology Outpatient Clinic, Bergamo, Italy
M. Crivellaro: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
R. De Tullio: Ospedale consorziale Policlinico di Bari, Unità di Pneumologia, Bari, Italy
E. Gini: Department of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
A. Grosso: Department of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
G. Guarnieri: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
C. Lombardi: Departmental Unit of Allergology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
V. Patella: Unità Operativa di Allergologia ed Immunologia, Dipartimento di Discipline Mediche, Battipaglia SA, Italy
P. Pirina: Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
M. Polverino: Department of Pneumology and Endoscopic Unit, Ospedale Scarlato, Scafati SA, Italy
R. Raccanelli: Fondazione Salvatore Maugeri, Istituto Scientifico di Milano, IRCCS, Milano
E. Ridolo: Department of Medicine and Surgery, University of Parma, Parma, Italy
G. Rolla: Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, Italy
G. Steinhilber: AO Spedali Civili di Brescia, Divisione di Pneumologia, Brescia, Italy
A. Vianello: Department of Cardiologic, Thoracic, and Vascular Science, University of Padua, Padua, Italy

Journal volume & issue: Vol. 12, no. 6

Abstract

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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

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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