Is Improper Use of the Inhaler Related To Poor Asthma Control?

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The control of asthma in both adults and children has proven to be a challenge owing to the intricacy involved in the management of the disease. According to the Global Initiative for Asthma (GINA 1), the term refers to a clinical syndrome of “intermittent respiratory symptoms triggered by viral upper respiratory infections, environmental allergens or other stimuli and is characterized by nonspecific bronchial hyperesponsiveness and airways inflammation.” The severity of the disease is measured based on an individual’s lung function (FEV1), the number of times a patient uses a bronchodilator, and the symptoms a patient portrays at night (GINA 1).
The pathophysiology of Asthma includes bronchoconstriction which is the first step; refers to the narrowing of the airway as an immediate response to exposure stimuli such as allergens, aerosols or irritants. Allergen-induced acute bronchoconstriction occurs when an IgE-dependent initiate the release of mediators from mast cells including histamine, tryptase, leukotrienes, and prostaglandins which cause the contraction of airway smooth muscle (Busse and Lemanske 363). Other stimuli include cold air, irritants and exercise. Also, stress may be an exacerbating factor to an asthma attack. The next step of the disease involves the inflammation and oedema of the airway as an attack further progresses. The other changes that take place include hyper secretion of mucus, formation of “inspissated mucus plugs”, hypertrophy and hyperplasia of the smooth muscle of the airway. An attack may also be characterized by airway hyperresponsiveness which is a severe response of bronchoconstriction as a response to multiple stimuli. In very severe cases, airway remodelling may occur leading to progressive lu...

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...thma. Web. December 2012. 3 October 2013
Holgate, Stephen, and Riccardo Polosa. The Mechanisms, Diagnosis, and Management of Severe Asthma in Adults. Lancet 368.9537 (2006): 780–93. Print.
Jahdali Hamdan, Anwar Ahmed and Al-Harbi Abdullah et al. Improper Inhaler Technique is Associated with Poor Asthma Control and Frequent Emergency Department Visits. AACI 9.1 (2013) :8. Print.
Lenney, J., Innes, J.A. and Crompton, G.K. Inappropriate inhaler use: assessment of use and patient preference of seven inhalation devices. EDICI Respiratory Medicine 94.5 (2000):496-500. Print.
Melani, Andrea et al. Inhaler mishandling remains common in real life and is associated with reduced disease contro. Respiratory Medicine 105.6 (2011): 930-8. Print.
Dolvich Myrna et al. Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines. Chest 127.1 (2005): 335-371. Print.

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