Surya Prakash Reddy Yanamala, Aruna Gorthi
BACKGROUND Asthma is a common and potentially serious disease that imposes a substantial burden on patients, their families and the community. It is one of the major non-communicable diseases of the world and in India the prevalence is about 2.38%. The disease is characterized by recurrent attacks of cough, breathlessness and wheeze following exposure to indoor and outdoor allergens. Effective inhaled bronchodilator and steroid therapy is the cornerstone of Asthma management. Inhaled therapy targets drugs directly into the lungs and allows a distinct therapeutic advantage over systemic therapy with less doses needed, more rapid action and few side effects. Among the different types of inhalers that are available – metered dose inhalers (pMDIs), dry powder inhalers (DPI), nebulizers and breath actuated inhalers, DPIs are the cheapest and universally available. This study is an attempt to understand the efficacy, safety and acceptability of three different types of DPIs each having a different chamber size and a different method of puncturing the drug capsule – with needles and small chamber (MACHALER) with a fin and a larger chamber (ROTAHALER) and a levered large chamber (REDIHALER). The aim of the study is to assess the efficacy of different types of dry powder inhalers vis a vis compliance, symptomatic improvement and spirometric improvement. MATERIALS AND METHODS This is a prospective analytical study done in the Department of Pulmonary Medicine, SVRR Govt. General Hospital, Tirupathi between Nov. 2016 to April 2018, over a period of 1½ years. 90 asthmatics (63 males and 27 females) who were above 18 years of age, non-smokers, willing to participate in the study and whose spirometry was consistent with the diagnosis of asthma were recruited into the study. Patients were successively given the three different types of DPI, the needle puncture device (MACHALER), the fin breaking device (ROTAHALER) and the levered device (REDIHALER) along with Formoterol – Budesonide 400mg inhalant capsule (FORACORT 400 mcg) twice daily which is supplied by the institute. Where necessary oral bronchodilators like doxophylline, oral steroid, methyl prednisolone 1 mg/kg body weight for 3 to 5 days and a leukotriene antagonist montelukast-levocetirizine were added. The patients were followed up at 15 days, 1 month and 2 months and improvement in cough, breathlessness, wheeze and chest tightness noted. Predicted Forced Vital Capacity percentage (FVC), predicted forced expiratory volume in 1 second (FEV1) and predicted FEV1/FVC % and predicted peak flow rate (PEFR) were obtained spirometrically. Patient satisfaction was also enquired about.
