الفهرس 
? Chronic Obstructive Pulmonary Disease (COPD)Only 14 pages are availabe for public view
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Abstract
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation causes an associated increase in airway hyper responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment
Treatment for COPD and asthma can be administered in different ways: inhaled, orally or parenterally (by subcutaneous, intramuscular or intravenous injection). The major advantage of inhaled therapy is that drugs are delivered directly into the air ways, producing higher local concentrations with significantly less risk of systemic side effects.
When treatment is given by the inhaled route, attention to effective drug delivery and training in inhaler technique is essential. The choice of inhaler device will depend on availability, cost, the prescribing physician, and the skills of the patient.
Fifty physicians and fifty patients were surveyed to study and evaluate the prescription practices of inhalers in chronic obstructive pulmonary disease and bronchial asthma at Ain Shams University Hospitals:
As for the physicians, Forty three were from chest department and the other seven were from Internal Medicine Department. Their qualification were MB.B.Ch (17 physicians, 34.0%), Master (19 physicians, 38.0%) and M.D (14 physicians, 28.0%).
As for the patients, the study was conducted on 50 patients receiving care in chest and Internal Medicine outpatient clinics at Ain Shams University.
from that survey the following were obtained:
Thirty percent of physicians considered text books as a main source of information about inhalers. Most of M.D and Master physicians depended on text books, while most of MB.B.CH physicians depended on pharmaceutical companies.
Almost fifty six percent of the physicians considered the presence of co-morbid diseases during inhaler prescription, as most of the physicians considered the cardiac disease as the most important co-morbid disease affecting the inhalers prescription.
Almost all of the physicians used to teach the patient the proper method of usage of inhaler device, thirty three percent of them were using the actual device. Only twenty four percent of the physicians revised the usage technique at each visit.
Forty percent of the physicians depended on the patient comfort and clinical assessment as parameters for assessing the efficacy of inhaler and majority of them check the usage technique in case the patient did not improve.
Oral candidiasis was the most common side effect reported by the physicians especially in the patients using inhaled corticosteroid. On the contrary, throat dryness was the most common side effect reported by the patients themselves.
The study showed that the majority of the physicians used to prescribe the MDIs considering the price of inhaler device before prescription. On the other hand, sixty eight percent of the patients preferred the MDIs, as it was the cheapest and the most effective. Forty six percent of them could easily check the remnant.
The most frequently prescribed medication in mild COPD was inhaled short acting B2 agonist, while in moderate COPD was combination of inhaled short acting B2agonist and inhaled corticosteroid, on the other hand, the most frequently prescribed medication in severe COPD was combination of inhaled long acting B2-agonist and inhaled corticosteroid and in very severe COPD was inhaled long acting B2 agonist or all types of medication together.
The most frequently prescribed medication in intermittent asthma was inhaled short acting B2 agonist, while in mild persistent asthma was combination of inhaled short acting B2 agonist and inhaled corticosteroid; on the other hand, the most frequently prescribed medication in moderate persistent asthma was combination of inhaled long acting B2 agonist and inhaled corticosteroid and in severe persistent asthma was inhaled long acting B2 agonist inhaled corticosteroid.
Most of patients were taking inhalers by doctors advice, only ten percent of them used the inhaler device without doctors advice.
Majority of the patients were kept on using the inhalers, but about fourteen percent of them were non compliant due to fear of dependence.
Twenty four percent of the patients were leaving their homes without the inhaler device, as they get embarrassed from it’s usage in public.
from this study, it was concluded that:
• Inhaler prescription practices need to be well evaluated in order to formulate an acceptable rationale aiming at improving the global situation of inhalers use.
• Many points have to be taken into consideration like increasing awareness of physicians about different widely accepted guidelines.
• Other items include patient compliance, patient demand, financial causes, pharmaceutical companies’ pressure and drug therapy use monitoring.