Authors (including presenting author) :
Sit LKJ (1), Cheung KWK (1), Yip CTH (1), Hui NP (1), Wong KKJ (1)
Affiliation :
(1) Occupational Therapy Department (OT Dept.), United Christian Hospital (UCH)
Introduction :
Puff therapies are vital for COPD management including disease control and symptoms relief. However, patients with hand function deficits may have trouble in puff administration which directly affects the treatment outcome and increases the risk of COPD exacerbation and future possible hospitalization (GOLD, 2020). Meta-analysis showed that up to 8% of COPD cases also suffer from Rheumatoid Arthritis (Shirmanesh, 2018). This implies that COPD cases might also be prone to different degrees of hand function deficits.
Pressurized Meter-Dosed Inhaler (pMDI) is one of the commonest puffs prescribed to COPD patients (e.g. Ventolin/ Atrovent/ Becotide etc.). Yet, Shirmanesh and Jones (2018) stated that only 50% of cases with Rheumatoid Arthritis (RA) can achieve all steps in using pMDI. As managing the triggering of puff during “breathing-in” medication is of the utmost importance in maximizing “puff” treatment effect and symptoms control (Melani 2011), certain puff adaptor(s) are indicated to aid those COPD cases with hand deficits to yield similar COPD treatment efficacy with inhalers.
Objectives :
To design and develop puff adaptor device to aid COPD patients with difficulties in administering inhalation therapies.
Methodology :
UCH OT Dept. collaborated with M&G Dept. respiratory nursing since mid-2021 and devised assistive puff adaptors using 3D printing technology. Adaptors of different sizes were designed for different pMDIs (i.e., normal size for Ventolin etc., small size for Atrovent/ Becotide etc.). Gripping action is adopted for inhaler triggering instead of canister depression using fingers pad pinching. Strap loops can also be attached to adaptors for patients with weak fingers strength to further stabilize gripping control.
Result & Outcome :
3D printed adaptors greatly assisted patients in administering pMDIs. The force(s) required to depress the canister has significantly reduced by 73.5% (3.39kgf 0.90kgf) and 69.6% (2.73kgf 0.83kgf) for Ventolin and Atrovent respectively using Newton meter. The requirement for 1st web space length has also reduced by 47.4% (9.5cm to 5cm) for Ventolin and 33.4% (7.5cm to 5cm) for Atrovent. Case trial was also done on a patient having difficulties in puff handing on using Ventolin and Becloforte to alleviate shortness of breath. With comprehensive OT assessment on the use of puff, the patient was found to have weakness on power and pinch grip. Puff adaptor was therefore prescribed owing to patient’s inadequate fingers strength in puff handling. Patient reported that it took her less effort and time to use hand grip to operate the pMDI with adaptor. With OT training, the patient could complete the puff administration easily by using single hand with adaptor instead of bilateral hands. This case trial demonstrated 3D printed assistive puff adaptor could facilitate patients with hand function impairment to increase the compliance and effectiveness of using inhalers. Further studies are warranted to evaluate the effectiveness of the 3D printed assistive puff adaptor.
