2000 Volume 49 Issue 4 Pages 573-581
[Introduction] Fluticasone propionate (FP), an inhaled corticosteroid, has almost twice as much clinical efficacy as Beclomethasone dipropionate (BDP) in the management of asthma. The inhalation of FP dry powder by using a handy and portable inhalator is effective for young and middle-aged patients with bronchial asthma. However, the inhalator are not always easy for elderly patients to operate because it requires some manual dexterity and a knack for quick inhalation.
[Methods] A total of 47 outpatients aged 65 years or above who had achieved a stable asthmatic condition were enrolled for this study, and changed the drugs from BDP to FP. The amount of FP to be taken at one time was equivalent to half the dose of BDP. Twelve check points of inhalation skills were repeatedly taught until patients understoodfully. We checked these points after 2-4 weeks and 8 weeks. We used a questionnaire to survey the patients' impression of FP and its adverse effects. We also evaluated peak flow values (PEF) in the morning and at night, results of pulmonry function tests and asthmatic grades.
[Results] We found clear weak points for the 12 skills in the elderly patients. PEF both in the morning and at night significantly improved after 2-4 week treatment with FP, but pulmonary function tests found no statistically significant change. Eventually 71.4% of the patients in the 65-74 year age range and 50.0% of those of 75 years or above hoped to continue to receive FP therapy. The total number of the patients with adverse effects was 14 (29.8%): These were 7 cases of dryness in the mouth, 5 cases of hoarseness and 2 cases of nausea and vomiting.
[Discussion] Although we confirmed the clinical usefulness of FP in elderly patients with asthma, we must recognize that it requires much time and labor for the eldrely to get used to FP inhalation and that it is important to give them repeated instruction.
