Improving Inhaler Instruction

Many of us have never been properly trained on how to do or use certain things we really should be good at. Putting on condoms and wearing seat belts are just two that come to mind.  And when we get them wrong, the health consequences can be serious.

The same goes for asthma inhaler use.  Do you shake the device first? Did you breathe in with sufficient force? Did you press the canister at the right time?

Improper use of inhalers is a serious and expensive problem. In the US, 3 patients are admitted to the emergency room with asthma every minute, that’s >5,000 people a day!  Worse still, according to the Asthma and Allergy Foundation of America, 11 people die from asthma every day.

One study estimated up to 94% of patients use their inhalers incorrectly.  The most common mistakes include failure to exhale before actuation, failure to breath-hold after inhalation, incorrect positioning of the inhaler, incorrect rotation sequence, and failure to execute a forceful and deep inhalation. Those of us in healthcare have even seen patients who fail to take the cap off the inhaler before use, and others who use it nasally rather than orally.

This is hardly surprising given that many patients never receive instructions on how to use their inhalers and even those that do, are not routinely followed.  And let’s face it, some of these devices could use training wheels.

Enter the T-Haler, a digital asthma inhaler training device  developed by researchers at Cambridge Consultants.

Patients with asthma can use the inhaler and, via interactive software linked to the wireless device, get real-time visual feedback on the areas that need improving.

Specifically, whether patients have shaken the device before breathing in; whether they use sufficient force when breathing in; and whether they press down the canister that releases the drug at the optimal time. Click here to see a video of the T-haler in action.

Although still a conceptual product, the company says it has been designed as a training device to be available at pharmacies, schools, and clinics for children and adults alike.

They performed a study on 50 people aged 18 – 60 who had no prior experience with either asthma or inhalers and were given no instruction on how to use an inhaler. When tested, about 80% of the participants used an inhaler incorrectly.

They were then given the T-Haler with no further instruction and told to begin. A three-minute on-screen tutorial guided them through the proper use of an inhaler, and the success rate tripled to more than 60%.

“Without any human direction beyond the word ‘go’, participants went from around a 20% success rate without training to a success rate of more than 60% after only three minutes with the T-Haler device,” said Kate Farrell, a senior design engineer, in a news release. “This is more than twice the compliance rate we have seen in other studies with trained participants. Interestingly, a week later, 55 percent were still correctly using the device-showing that they retained what they learned.”

Whether the T-Haler itself will ever make it to market remains to be seen, but the concept of a 3-minute training device seems a no-brainer when it comes to properly using a device that may very well save the lives of the estimated 235 million asthma sufferers worldwide.

Sound Waves to the Scrotum Subdue Sperm

Imagine a contraceptive that could provide months of protection from pregnancy. Imagine achieving that without pills, injections, creams or inserted devices, but with just one or two painless 15-minute non-surgical treatments. And imagine that the equipment needed was already in physical therapists’ offices around the world.

Sound too good to be true? Well that, it seems, all depends on your gender perspective. You see, the thing is, that this treatment would be exclusively aimed at men.  And while it would give guys the first new option since condoms and vasectomies were introduced more than a century ago and give women a break from the burden of birth control, the treatment involves zapping the testicles with ultrasound!

Gentlemen, if you need to, please take a second or two to readjust before we explain how it works.

As most of our adolescent and adult readers know a man’s testicles need to be kept slightly cooler than the rest of the body to properly produce sperm. Hence the countless jokes and warnings about Jacuzzis, laptops, and tight pants. Even though hot tubs and tight pants can reduce a man’s sperm count, such methods are not reliable enough for contraception.

Which led scientists to explore, what if this heat effect could be enhanced?
And that’s where ultrasound comes in. Relatively inexpensive and already in use in physical therapists’ offices around the world, therapeutic ultrasound uses deep heat to increase circulation to injured joints. Now it seems that ultrasound can be used on other body parts too.

According to research headed by Dr. James Tsuruta  at the University of North Carolina-Chapel Hill scientists were able to achieve a contraceptive effect in rats that lasted more than 2 1/2 months with just two 15-minute sessions of ultrasound, two days apart.

During the sessions, the testes were placed in a cup of saline to provide conduction between the ultrasound transducer and skin.
The researchers were not able to continue their study for long enough to see when, or whether, fertility would return. But they knew it was effective: microscopic examination showed dramatic changes after just two weeks. Normally, testes are full of many layers of cells developing into sperm, but now the tubes of the testes were almost empty. “Sperm production is very robust; this ensures the survival of a species. It’s really difficult to find a way to turn off the production of sperm, but ultrasound seems to do the trick,” Dr. Tsuruta continues. “There is something special about heating with ultrasound – it caused 10 times lower sperm counts than just applying heat.”

“This is an interesting development in a challenging indication,” says regulatory consultant Gary Gamerman of Seraphim Life Sciences. “The only concern is proof of safety and durability of response. As long as it prevents fertile sperm, is overall safe and doesn’t cause secondary safety or adverse sexual effects, there wouldn’t necessarily be anything that would hold it back. You just have to do the studies.”

But some men aren’t waiting for the results of years of studies. They have a scientific background – they know enough scientific jargon to read the papers and understand exactly what the risks are – and are willing to take a chance.

In a long-term relationship and looking for an option other than condoms or vasectomy, Dr. Chris Jenks decided to give the heat methods a try. With a simple modification to his underwear, Dr. Jenks was able to keep his testes closer to his body, too warm to properly produce sperm. Sure enough, within a month his sperm count dropped below the fertility cutoff. The method worked well – so well that he continued using it for nearly 12 years.
But Dr. Jenks knew that being a pioneer, there might be surprises. In 2010 he discontinued the heating, wondering how his system was doing. By two months later the sperm numbers seemed to be climbing back up, and he thought he was regaining fertility as in the 2-year studies. But there was a catch: even a year later, most of the sperm were not swimming.

So, maybe ultrasound will provide the answers, maybe not.  Either way, there is still much to be learned about the procedure. Don’t expect a scrotal boombox to hit stores any time soon, and as we’ve said before “Do not try this one at home!”

Something for the weekend Sir? Now we have an app for that!

In New York and need to find a condom in a hurry?

Starting this week, the city’s health department‘s has you covered.

To coincide with Valentine’s Day, the city’s health department unveiled a free iPhone app that allows users to find five places close by where they can pick up a free male or female condom.

“We are trying to reach everyone having sex,” said Monica Sweeney of the department’s HIV/AIDS Prevention and Control division. “The younger generation uses their iPhone and we want to make it convenient for them to access condoms.”

New Yorkers can also download the application on the Android or go to www.nyc.gov/health and type in their zip code to find locations with free NYC Condoms. They’re available at many community centers, health clinics, neighborhood stores – even tattoo parlors and barber shops. With the aid of GPS, the app will even give walking, driving and subway directions to the site.

The city gave out more than 36 million NYC Condoms in 2010 and is prepared to hand out “as many as people need this year” says Sweeny.