title: Understanding and use of inhaler medication by asthmatics in specialty care in Trinidad: a study following development of Caribbean guidelines for asthma management and prevention.
abstract: OBJECTIVE
  Following the development of the Caribbean Guidelines for Asthma Care, we examined the utilization of inhaled medications in asthmatic patients in Trinidad, West Indies.
  
  
  METHODS
  Chest Clinic, Ministry of Health, Trinidad.
  
  
  METHODS
  Physician-diagnosed asthmatic patients who attended the Chest Clinic between July 1998 and August 2000.
  
  
  RESULTS
  A consecutive sample of patients who were > 7 years of age (n = 402) was interviewed about compliance with, understanding of, and use of inhaler medication. The inhaler technique of these patients was directly observed. Inhaled steroid therapy was prescribed in 83% of patients but were prescribed the least in elderly patients (63%) and children (62%). Salbutamol was prescribed in 98% of patients, and ipratropium and sodium cromoglycate were selectively prescribed in elderly men and children, respectively. Only 33% of patients used the inhaler correctly, and children and the elderly were the least efficient in its use. The use of a spacer device was advised in 19% of patients, including only 6% of the elderly patients. Explanations for different inhaler therapies were given to 62% of patients, and 53% of patients could describe these reasons. The reported 40% noncompliance rate among patients in the sample was primarily a result of long waiting periods at the pharmacy (58%) and the personal cost incurred on purchasing the medication (52%).
  
  
  CONCLUSIONS
  Educating patients, with a focus on children and the elderly, in inhaler techniques and reinforcing understanding of asthma medications can improve asthma management in Trinidad. Asthma caregivers in the Caribbean should ensure the appropriate dissemination of the guidelines and should outline strategies for their implementation.
authors.affiliation: Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago. berardo@wow.net
authors.forename: Lexley M
authors.initials: LM
authors.lastname: Pinto Pereira
authors.forename: Yuri
authors.initials: Y
authors.lastname: Clement
authors.forename: Cecil K
authors.initials: CK
authors.lastname: Da Silva
authors.forename: Duane
authors.initials: D
authors.lastname: McIntosh
authors.forename: Donald T
authors.initials: DT
authors.lastname: Simeon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy* / Q000517:prevention & control*; D002648:Child; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D014300:Trinidad and Tobago
chemical_list: D005938:Glucocorticoids