Current medical research and opinion
-
The correct use of inhaler devices is an inclusion criterion for all studies comparing inhaled treatments. However, in real life patients make many errors when inhaling their medication which may negate the benefits observed in clinical trials. A recently published observational study evaluated inhaler handling in 3811 patients for at least 1 month using the Aerolizer, Autohaler, Diskus, pressurised metered dose inhaler (pMDI) or Turbuhaler devices. ⋯ Ninety per cent of GPs felt that participation in the study would improve error detection. Compliance may be improved by educating patients and physicians in the correct use of inhaler devices. Inhalers should be easy to use correctly, and have multiple feedback and control mechanisms which would reduce physician over-estimation of a correct inhalation, allow compliance to be monitored, facilitate patient self-education and give reassurance to patients in the real life setting.
-
Stress-related mucosal disease (SRMD) and subsequent upper gastrointestinal (GI) bleeding remain significant concerns in critically ill patients and place them at a high risk of death. Even under circumstances in which GI bleeding is detected, it is difficult to control. Thus, appropriate preventative therapy is the key to reducing mortality in patients at risk for stress-related ulceration and bleeding. ⋯ However, extemporaneously compounded oral PPI suspensions and the recently approved intravenous formulations of pantoprazole and lansoprazole have eliminated some of the administration issues previously associated with PPIs. Additionally, study data with PPI formulations suggest efficacy in stress ulcer prophylaxis compared with H2RAs. This article provides an overview of SRMD and compares and contrasts the 3 drug classes (i.e., H2RAs, PPIs, and sucralfate) currently used for prevention of this serious complication observed in critically ill patients.