The use of inhaled and related respiratory medications in Christchurch rest homes.
OBJECTIVE
To describe the use of inhaled and related respiratory medications ('asthma medications') and associated management amongst Christchurch rest-home residents.


METHODS
Fifty per cent of Christchurch rest homes were randomly selected. All residents on asthma medications, the rest-home managers, care-giving staff, and the residents' general practitioners were interviewed using specific questionnaires.


RESULTS
All of the rest homes, residents using asthma medications and senior staff members participated. Seventy five per cent of caregivers and 73% of general practitioners took part. Asthma medications were used by 13% of 1416 rest-home residents. Eighty four per cent of these used a preventer medication, mostly inhaled steroids. Some daily doses exceeded current treatment guidelines. One third of residents using inhalers had an inadequate technique. Some staff and residents chose the wrong inhaler to manage 'shortness of breath'. Regular bronchodilator dosing, rather than 'as required', was common. Those using a spacer device usually had a good technique. Residents appreciated non-pharmacological strategies for breathlessness. Staff identified a need for clear written management plans.


CONCLUSIONS
There were significant deficiencies in the staff and residents' knowledge of obstructive airways management and medications. Regular review of inhaler technique, greater use of spacers, and regular staff education may improve residents' respiratory management. Inhaled corticosteroids may be used in too high a dose. Inconsistent management of acutely deteriorating asthma/chronic obstructive pulmonary disease may be addressed by greater use of written management plans in residents' notes.
Botting
Calder
C
Department of Public Health and General Practice, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand. calder.botting@chmeds.ac.nz
Sutherland
Margaret
M
Wells
Elisabeth
E
Town
Ian
I
Sainsbury
Richard
R
Toop
Les
L
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy; D001507:Beclomethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006801:Humans; D009241:Ipratropium; D008297:Male; D009330:Nebulizers and Vaporizers; D009520:New Zealand; D009735:Nursing Homes; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D013726:Terbutaline / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D009241:Ipratropium; D001507:Beclomethasone; D013726:Terbutaline; D000420:Albuterol