소아 천식환자에서 에어로졸제제의 사용방법에 대한 평가

Abstract

[한글]

기관지 천식의 치료에 aeroseL제제의 효과가 입증되면서, 그 동안 큰 관심을 받지 못했던 aerosol제제가 널리 쓰이게 되었다.

AeroseL제제는 경구용제제에 비하여 병변부위에만 국소적으로 작용하므로 소량으로 최대의 효과를 얻을 수 있고, 효과발현시간이 짧으며, 전신적인 부작용이 적고, 정량가압 분무장치는 휴대하기 편리하다는 장점이 .있다. 그러나, 이처럼 간편한 정량가압 분무장

치는 사용방법상의 어려움으로 인하여 소아에서는 그 사용이 제한을 받고 있다.

이에 연구자는 소아 천식환자가 정량가압 분무장치 (Metered-Doseinhaler; MDI)를 올바르게 사용하는지 평가하고, 또, 잘못이 있다면, 이를 교정함으로서 더 큰 효과를 얻도록 하기 위하여 본 연구를 실시하였다.

소아 천식환아 115례를 대상으로 하여 106례에게는 MDI의 일반적 흡입방법을, 9례에서는 재호흡 방법을 이용하여 올바른 사용방법을 가르쳐준 후에 사용하는 모습을 상세히 관찰하고 평가한 뒤 다음과 같은 결과를 얻었다.

1. 대상환아의 연령별 분포를 살펴보면, 일반적 흡입방법을 사용한 환아는 97례(91.5%)가 5세이상으로 이들의 평균연령은 8년1개월이었고, 재호흡 방법의 경우는 7례 (77%)가 5세미만으로 이들의 평균연령은 4년 7개월이었다.

2. 일반적 흡입방법을 실시한 환아의 사용결과를 살펴보면, 1차평가에서 76례(71.7%)가 사용상 잘못을 범하였는데, 가장 흔했던 것은 숨을 들여마신 뒤에야 MDI를 눌렀던 경우로 58.5%를 차지하였다. 그러나, 이러한 잘못들은 2-3회 반복하여 교육을 실시한 결과 59.6 및 42.1 %로 감소하였다.

3. 일반적 흡입방법을 실시한 환아에서 흡입제의 효과가 심히 감소되었을 것으로 생각되는 잘못은 1차평가에서 106례중 31례 (29.2%)였는데, 숨을 완전히 들여마신 뒤에야 MDI를 눌렀던 경우가 21례 (19.8%)로 가장 많았다. 그러나, 이러한 잘못들은 3차례의 반복교육을 실시하는 동안에 완전히 교정되었다.

4. 일반적 흡입방법을 실시한 환아에서의 연령별 성공율을 살펴보면, 1차평가시 5세미만에서는 성공율이 11.1 %뿐이었으나, 5-7세에서는 21.2%,그리고 7세이상에서는 37.5%로 늘어나, 연령이 증가하면서 성공율이 높아지는 것을 알 수 있다.

5. 일반적 흡입방법을 실시한 경우, 환아가 범한 잘못의 수가 1차평가시에는 3가지 잘못을 범한 경우가 36.8%로 가장 많았으나, 반복교육후 2차 및 3차평가시에는 1가지 잘못을 범한 경우가 각각 46.5% 및 37.5%로 가장 많았다.

6. 일반적 흡입방법시 aerosol제제의 효과를 심히 감소시켰을 것으로 생각되는 환자의 경우는 1차 및 2차평가시 1가지 잘못을 범한 경우가 각각 74.2% 및 90.7%로 가장 많았다.

7.재호흡 방법을 실시한 환아는 9례중 4례 (44%)가 올바로 사용하지 못했는데, 이는 비닐봉지속에 너무 많거나 혹은 너무 적은 양의 공기를 넣었던 경우, 너무 빨리 재호흡을 했던 경우 그리고 호스를 입에 물고 비호흡을 했던 경우였다. 결론적으로, 정량가압 분무장치의 사용은 반복적이고도 지속적인 교육을 실시한 뒤 성공율이 현저히 증가하였으므로, aerosel제제를 처방한 환아를 그대로 둘 것이 아니라, 올바른 사용방법을 가르쳐준 뒤에 일정한 간격으로 그 결과를 평가하고 필요한 경우에는 재교육을 실시함으로서, 환자가 aerosol제제의 효과를 최대로 볼 수 있도록 도와주는 것이 바람직한 일이라고 생각된다.

Evaluation of the adequacy of aerosol inhalation in asthmatlc children

Dong Kun Hyun

Department of Medical Science The Graduate School Yonsei University

(Directed by Professor Ki Young Lee, M.D.)

Recently, the effect of aerosol therapy is warranted in the prevention and

treatment of bronchial asthma arid the aerosols that had not been interested for a

long period, are widely used and recommanded by many doctors. Because the aerosols

act locally in the airway, they are more rapid action with smaller dosage and less

systemic side effects than the oral regimens. But the usage of these aerosol

inhaler had been limited in the children because of the technical difficulties.

This study was designed to evaluate whether the patients use metered-dose inhaler

(MDI) correctly and make them more effect by correcting errors, if present.

Of 115 asthmatic children, I applied ordinary method of MDI to 106 patients and

rebreathing method to 9 patients and after the instruction of correct inhalation

techniquei, Invaluated the adequacy of inhalation of aerosol from MDI.

The results were as follows:

1. According to the distribution of age, 97 patients (91.5%) of which ordinary

method was applied, were over 5 years of age and all patients applied rebreathing

method were less than 7 years of age.

2. 71.7% of patients applied ordinary method, have used MDI incorrectly, but it

was reduced to 59.6% & 42.1% in the 2nd & 3rd test by continuous, repetitive

instruction.

And the most common error was the actuation of the canister after a period of

inspiration.

3. 29.2% of patients applied ordinary method, had no therapeutic effect owing to

the inadequate use of MDI and the most common error in these patients was the

actuation of canister after full inspiration.

4. On the ordinary method, although the success rate was 11.1% in the patients

less than 5 years of age, it was increased according to the age.

5. According to the number of errors which the most patients had taken three was

36.8% in the 1st test, but one was 46.5% & 37.5% in the 2nd & 3rd test.

6. The most patients who had no therapeutic effect from MDI took an error in the

1st & 2nd test and each rate was 74.2% & 90.7% respectively.

7. In spite of the age younger than the former, the patients applied rebreathing

method had the relatively high success rate. But the errors in the inadequate

patients were too large or small amount of air in the vinyl bag, too rapid

breathing and nasal breathing on biting the mouthpiece.

I found that all physicians who recommend the aerosol medication to asthmatic

children should teach each patient the correct technique when aerosol therapy is

started and should check again on follow-up examination to assure that the patient

obtains maximum effect from aerosoL therapy.

[영문]

Recently, the effect of aerosol therapy is warranted in the prevention and treatment of bronchial asthma arid the aerosols that had not been interested for a long period, are widely used and recommanded by many doctors. Because the aerosols act locally in the airway, they are more rapid action with smaller dosage and less systemic side effects than the oral regimens. But the usage of these aerosol inhaler had been limited in the children because of the technical difficulties.

This study was designed to evaluate whether the patients use metered-dose inhaler (MDI) correctly and make them more effect by correcting errors, if present.

Of 115 asthmatic children, I applied ordinary method of MDI to 106 patients and rebreathing method to 9 patients and after the instruction of correct inhalation techniquei, Invaluated the adequacy of inhalation of aerosol from MDI.

The results were as follows:

1. According to the distribution of age, 97 patients (91.5%) of which ordinary method was applied, were over 5 years of age and all patients applied rebreathing method were less than 7 years of age.

2. 71.7% of patients applied ordinary method, have used MDI incorrectly, but it was reduced to 59.6% & 42.1% in the 2nd & 3rd test by continuous, repetitive instruction.

And the most common error was the actuation of the canister after a period of inspiration.

3. 29.2% of patients applied ordinary method, had no therapeutic effect owing to the inadequate use of MDI and the most common error in these patients was the actuation of canister after full inspiration.

4. On the ordinary method, although the success rate was 11.1% in the patients less than 5 years of age, it was increased according to the age.

5. According to the number of errors which the most patients had taken three was 36.8% in the 1st test, but one was 46.5% & 37.5% in the 2nd & 3rd test.

6. The most patients who had no therapeutic effect from MDI took an error in the 1st & 2nd test and each rate was 74.2% & 90.7% respectively.

7. In spite of the age younger than the former, the patients applied rebreathing method had the relatively high success rate. But the errors in the inadequate patients were too large or small amount of air in the vinyl bag, too rapid breathing and nasal breathing on biting the mouthpiece.

I found that all physicians who recommend the aerosol medication to asthmatic children should teach each patient the correct technique when aerosol therapy is started and should check again on follow-up examination to assure that the patient

obtains maximum effect from aerosoL therapy.