吸入指導チェックリストを用いたドライパウダー式サルメテロール/フルチカゾン配合剤（ディスカス®製剤）の吸入手技の習得度の検討

Exanlination of the degree of acquisition of inhalation method of salmeterol/fluticasone dry powder inhaler（Diskus®product）using an inhalation instruction check list

　喘息の吸入指導の問題点は，多忙な薬局では吸入指導を行えていない事実や標準化された方法がなく，どのような指導が効率的であるか検証されていないことである。今回ドライパウダー式のサルメテロール/フルチカゾン配合剤（ディスカス®製剤）の使用患者において，吸入指導チェックリストを用いて指導方法によって患者の吸入技術習得度が異なるか検討した。その結果，器具のセットや息止めに関する点は口頭指導のみでもできていたが，水平に持ち，軽く息を吐いてから速く深く吸入できることに関しては実技指導をすることにより吸入技術習得が有意に高くなることが分かった。効率よく吸入指導を行うには特にできにくい点に焦点をしぼって行う方法が良いと思われた。

　In the long-term management of asthma, it is important to continue treatment mainly with inhalational steroids, and adequate instruction is needed for the patient to master correct inhalation techniques. However, the rushed nature of routine operations at pharmacies prevents pharmacists from providing inhalation instruction. Additionally, in the absence of standardized instructional methods for the use of inhalers, efficient instruction has not been evaluated. We examined whether instruction using an inhalation instruction check list could affect the degree of mastering inhalation techniques by patients being treated with salmeterol/fluticasone dry powder inhaler（Advair®, a Diskus®product）. Patients successfully set up the device and held their breath with oral instruction alone, while demonstration significantly improved techniques for holding the device horizontally, exhaling gently, and then inhaling the drug quickly and deeply. To enable asthma patients to achieve proper inhalation, healthcare providers should understand the purposes and methods of inhalation as well as providing instruction irrespective of the patient's age, for example, demonstrating the use of an inhaler, requesting that patients practice inhalation in their presence, and repeating such instruction. Our study suggests that inhalation instruction focusing on low-skill areas for patients should be recommended for efficient instruction at pharmacies.