老年慢性阻塞性肺疾病病人吸入器操作正確性及相關因素

Rate of Correct Inhaler Usage and Related Factors in Elderly Patients With Chronic Obstructive Pulmonary Disease

背景：慢性阻塞性肺疾病控制不良與病人吸入器使用錯誤有關。
目的：探討老年慢性阻塞性肺疾病病人操作吸入器正確性及相關因素。
方法：橫斷調查性研究設計，以南部某醫學中心65歲以上且使用吸入器治療的慢性阻塞性肺疾病病人。用自擬問卷與吸入器操作檢核表收集資料及評估吸入器操作正確性。用多變量邏輯迴歸分析吸入器操作正確性相關因素。
結果：150位病人平均年齡75.0歲（SD = 7.5），多數病人僅用一種吸入器（86.0%）。吸入器操作正確者佔40.7%（n = 61），操作乾粉吸入器正確者比率最高（64%）、加壓計量吸入器正確者比率最低（1.6%）。使用軟霧吸入器者（adjusted odds ratio, AOR = 23.29; 95% confidence interval, 95% CI [2.84, 191.07]）與乾粉吸入器者（AOR = 15.60, 95% CI [1.99, 122.26]）操作正確勝算比顯著高於使用加壓計量吸入器者；對吸入器滿意度分數越高者，操作正確勝算比越高（AOR = 1.94, 95% CI [1.09, 3.44]）。
結論／實務應用：吸入器操作正確性的重要相關因素為吸入器種類及對吸入器滿意度。醫護人員應定期確認老年病人能正確使用吸入器並對吸入器感到滿意。

Background: Poor disease control in patients with chronic obstructive pulmonary disease (COPD) is associated with suboptimal inhaler use.
Purpose: This study was designed to explore the accuracy of inhaler use and related factors in elderly patients with COPD.
Methods: A cross-sectional survey design was used to recruit patients with COPD from a medical centre in southern Taiwan who were over 65 years old and used inhalers regularly. All of the data as well as information on inhaler use accuracy were collected using a self-designed questionnaire and inhaler operation checklist. Multivariable logistic regression was used to analyse significant correlates of correct inhaler operation.
Results: The average age of the 150 participants was 75.0 years (SD = 7.5) years. Most used one type of inhaler only (86.0%). The rate of accurate inhaler operation was 40.7% (n = 61) for the sample, with dry powder inhalers associated with the highest accuracy (64%) and pressurized metered-dose inhalers associated with the lowest accuracy (1.6%). Multivariate logistic regression analysis showed that using a soft mist inhaler (adjusted odds ratio, AOR = 23.29; 95% confidence interval, 95% CI [2.84, 191.07]), using a dry powder inhaler (AOR =15.60, 95% CI [1.99, 122.26]), and higher satisfaction with the inhaler were positively and independently associated with accurate inhaler use (AOR = 1.94, 95% CI [1.09, 3.44]).
Conclusion/ Implications for Practice: Important factors related to inhaler use accuracy include inhaler type and level of patient satisfaction with their inhaler. Healthcare professionals should regularly confirm that older patients are able to use their inhalers correctly and are satisfied with their inhalers.