Addition of Inhalation Training Devices and Smartphone Application to Verbal Counseling for Asthmatic Patients

Background:One of the main issues with pressurized metered dose inhalers(pMDI)is that some patients find it difficult to use it properly.Methods:This study was carried out to compare the effect of traditional verbal counseling and that of adding an inhalation training device,such as Flo-Tone or Clip-Tone,along with a smartphone application on the incidence of inhalation technique mistakes and the pulmonary function of asthmatic adults and children.Results:The lung function of those in the advanced counseling group significantly improved on the second visit(p<0.001),whereas for those in the verbal counseling group,their lung function only improved on the third visit(p<0.001).For both the groups,the mean number of mistakes in regard to the steps in inhalation technique decreased significantly(p<0.001),with an overall higher percentage in the advanced counseling group.Conclusion:The use of training devices and smartphone applications in addition to traditional verbal counseling for teaching asthmatic adults and children the correct inhalation technique steps using pMDI resulted in a significant improvement in pulmonary function and a significant reduction in the number of inhalation technique mistakes,compared to traditional verbal counseling alone.

A systematic review of magnesium sulfate for acute asthma in adults

In order to provide evidence for making clinical decision, the role of intravenous and nebulized MgSO4 in treatment of adult＇s acute asthma was systematically estimated in the present study. Pubmed, Embase, Web of Sciences, the Cochrane Library and two Chinese literature databases （CNKI, WanFang） were systematically searched up to January 2016. Randomized controlled trails （RCTs） that compared the clinical outcomes of MgSO4 groups and placebo groups were included. The primary outcome was hospital admission. Secondary outcomes included pulmonary function, symptom scores, vital signs and adverse events. The methodological quality of the included studies was evaluated, and the forest plots with meta-analysis were drawn by RevMan 5.2. A total of 24 RCTs derived from 2931 patients were included. Both intravenous MgSO4 and nebulized MgSO4 treatments had no effect upon hospital admission （RR 0.91, 95% CI 0.80 to 1.03, P = 0.14; RR 0.78, 95% CI 0.56 to 1.08, P = 0.14）. Both intravenous MgSO4 and nebulized MgSO4 treatments were associated with significant evidence upon respiratory function （SMD 0.23, 95% CI 0.03 to 0.43, P = 0.02; SMD 0.37, 95% CI 0.11 to 0.64, P = 0.006）, but sensitivity analyses showed that outcomes were changed by omitting studies of less than 100 individuals （SMD 0.05, 95% C1-0.05 to 0.15, P = 0.35; SMD 0.05, 95% C1-0.16 to 0.25, P = 0.64）. There were no statistically significant differences in clinical symptom scores and vital signs （heart or pulse rate; systolic blood pressure; respiratory rate） in either form of MgSO4 compared with placebo groups （P〉0.05）. There were no serious adverse events reported in any literature. Overall, there was no role for intravenous and nebulized MgSO4 in the management of acute asthma in adults. Considering the low risk of serious adverse effects and easy availability, it seemed reasonable to use intravenous or nebulized MgSO4 treatment in adults with life threatening asthma in whom any potential benefit would justify the risks of treatment.