Impacto de la educación enfermera en la técnica inhalatoria sobre control sintomático en patologías respiratorias crónicas
DOI:
https://doi.org/10.56183/iberojhr.v6i2.895Palavras-chave:
Educación en Salud; Enfermedades Pulmonares Obstructivas Crónicas; Asma; Nebulizadores y Vaporizadores; Rol de la EnfermeraResumo
Introducción: Las enfermedades respiratorias crónicas representan una carga sanitaria global significativa. En Ecuador, las tasas de hospitalización por asma superan los 278 por millón, y solo el 25% de los pacientes demuestra una técnica inhalatoria correcta. La ausencia de programas estructurados de educación enfermera agrava el uso inadecuado de dispositivos inhalatorios. Objetivo: Evaluar la efectividad de la educación enfermera en el uso correcto de inhaladores sobre el control de síntomas en pacientes con patologías respiratorias crónicas. Metodología: Estudio cuantitativo, exploratorio, con diseño cuasi-experimental pre-post test. Muestra de censal (n=30), conformada por adultos de 18 a 75 años con diagnóstico confirmado y uso regular de inhaladores. Se aplicaron el Test de Adherencia a Inhaladores (TAI) y el cuestionario Morisky-Green, junto con listas de verificación de técnica inhalatoria. La intervención consistió en cuatro sesiones semanales de 60 minutos de educación teórico-práctica. Resultados: La técnica inhalatoria correcta aumentó del 3,3% al 100%, y el cumplimiento del vaciado pulmonar previo con retención respiratoria pasó del 6,7% al 100%. En cuanto a la adherencia farmacológica, la mala adherencia medida por TAI se redujo del 100% al 3,3%, mientras que el Morisky-Green evidenció la eliminación completa de conductas críticas como el abandono de la medicación al sentirse mejor, presente inicialmente en el 86,7% de los participantes. Conclusión: La educación enfermera estructurada y culturalmente adaptada mejoró de forma significativa la técnica inhalatoria y la adherencia farmacológica, lo que fundamenta la necesidad de implementar programas nacionales estandarizados en el sistema de salud público ecuatoriano.
Referências
sAlexandre-Sousa, P., Sousa, N., Bento, J., Azevedo, F., Assis, M., y Mendes, J. (2024). Nurses' role in the control and treatment of asthma in adults: A systematic literature review. Advances in Respiratory Medicine, 92(3), 175–189. https://doi.org/10.3390/arm92030019
Al-Kharouf, M. S., Abdeljalil, M. H., Obeidat, N. M., Oweidat, K. A., y Awwad, O. (2023). Video-based teach-to-goal intervention on inhaler technique on adults with asthma and COPD: A randomized controlled trial. PLOS ONE, 18(6), e0286870. https://doi.org/10.1371/journal.pone.0286870
Aranburu-Imatz, A., López-Carrasco, J. de la C., Moreno-Luque, A., Jiménez-Pastor, J. M., Valverde-León, M. D. R., Rodríguez-Cortés, F. J., et al. (2022). Nurse-led interventions in chronic obstructive pulmonary disease patients: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(15), 9101. https://doi.org/10.3390/ijerph19159101
Asociación Médica Mundial. (2024). Declaración de Helsinki. https://www.wma.net/es/que-hacemos/etica-medica/declaracion-de-helsinki/
Bhattarai, A., Shakya, R., y Bista, D. (2024). Impact of pharmacist-led intervention on adherence to inhalers, inhalation technique, and disease control among asthma/COPD patients in a resource limited center: An interventional study. Patient Preference and Adherence, 18, 1395–1408. https://doi.org/10.2147/PPA.S460810
Binda, C., Bianchi, C. M., Vigna, M., Crimi, C., Mossolani, S., Bucoveanu, V., et al. (2024). Effectiveness of an educational intervention on different types of errors occurring during inhaler therapy use in COPD patients during a pulmonary rehabilitation program. Multidisciplinary Respiratory Medicine, 19. https://doi.org/10.5826/mrm.2024.1000
Cabrera, A., Rodriguez, A., Romero-Sandoval, N., Barba, S., y Cooper, P. J. (2021). Trends in hospital admissions and mortality rates for asthma in Ecuador: A joinpoint regression analysis of data from 2000 to 2018. BMJ Open Respiratory Research, 8(1), e000773. https://doi.org/10.1136/bmjresp-2020-000773
GBD Chronic Respiratory Disease Collaborators. (2020). Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet Respiratory Medicine, 8(6), 585–596. https://doi.org/10.1016/S2213-2600(20)30105-3
Gómez-García, A. R., Cevallos Paz, A. L., Delgado-Garcia, D., y Jimbo, D. M. (2024). Ecuadorian provinces with high morbidity and mortality rates due to asthma among the working-age population: An ecological study to promote respiratory health. International Journal of Environmental Research and Public Health, 21(7), 909. https://doi.org/10.3390/ijerph21070909
Gregoriano, C., Dieterle, T., Breitenstein, A.-L., Dürr, S., Baum, A., Maier, S., et al. (2018). Use and inhalation technique of inhaled medication in patients with asthma and COPD: Data from a randomized controlled trial. Respiratory Research, 19(1), 237. https://doi.org/10.1186/s12931-018-0936-3
Izquierdo-Condoy, J. S., Salazar-Santoliva, C., Salazar-Duque, D., Palacio-Dávila, Y.-D.-C., Hernández-Londoño, J. M., Orozco-Gonzalez, R., et al. (2024). Challenges and opportunities in COPD management in Latin America: A review of inhalation therapies and advanced drug delivery systems. Pharmaceutics, 16(10), 1318. https://doi.org/10.3390/pharmaceutics16101318
Klijn, S. L., Hiligsmann, M., Evers, S. M. A. A., Román-Rodríguez, M., van der Molen, T., y van Boven, J. F. M. (2017). Effectiveness and success factors of educational inhaler technique interventions in asthma and COPD patients: A systematic review. npj Primary Care Respiratory Medicine, 27(1), 24. https://doi.org/10.1038/s41533-017-0022-1
Köksal, N., y Durgun, H. (2025). Impact of telecounselling, home monitoring and exercise on hospital readmissions and quality of life in chronic obstructive pulmonary disease: A randomized controlled trial. International Journal of Nursing Practice, 31(3), e70021. https://doi.org/10.1111/ijn.70021
Liu, Y.-R., Wang, Y., Chen, J., Luo, S., Ji, X., Wang, H., et al. (2024). Developing and validating a nomogram for non-adherence to inhaler therapy among elderly chronic obstructive pulmonary disease patients based on the social ecological model. Patient Preference and Adherence, 18, 1741–1753. https://doi.org/10.2147/PPA.S472625
Lundell, S., Modig, M., Holmner, Å., y Wadell, K. (2020). Perceptions of home telemonitoring use among patients with chronic obstructive pulmonary disease: Qualitative study. JMIR mHealth and uHealth, 8(6), e16343. https://doi.org/10.2196/16343
Alexandre-Sousa, P., Sousa, N., Bento, J., Azevedo, F., Assis, M., y Mendes, J. (2024). Nurses' role in the control and treatment of asthma in adults: A systematic literature review. Advances in Respiratory Medicine, 92(3), 175–189. https://doi.org/10.3390/arm92030019
Al-Kharouf, M. S., Abdeljalil, M. H., Obeidat, N. M., Oweidat, K. A., y Awwad, O. (2023). Video-based teach-to-goal intervention on inhaler technique on adults with asthma and COPD: A randomized controlled trial. PLOS ONE, 18(6), e0286870. https://doi.org/10.1371/journal.pone.0286870
Aranburu-Imatz, A., López-Carrasco, J. de la C., Moreno-Luque, A., Jiménez-Pastor, J. M., Valverde-León, M. D. R., Rodríguez-Cortés, F. J., et al. (2022). Nurse-led interventions in chronic obstructive pulmonary disease patients: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(15), 9101. https://doi.org/10.3390/ijerph19159101
Asociación Médica Mundial. (2024). Declaración de Helsinki. https://www.wma.net/es/que-hacemos/etica-medica/declaracion-de-helsinki/
Bhattarai, A., Shakya, R., y Bista, D. (2024). Impact of pharmacist-led intervention on adherence to inhalers, inhalation technique, and disease control among asthma/COPD patients in a resource limited center: An interventional study. Patient Preference and Adherence, 18, 1395–1408. https://doi.org/10.2147/PPA.S460810
Binda, C., Bianchi, C. M., Vigna, M., Crimi, C., Mossolani, S., Bucoveanu, V., et al. (2024). Effectiveness of an educational intervention on different types of errors occurring during inhaler therapy use in COPD patients during a pulmonary rehabilitation program. Multidisciplinary Respiratory Medicine, 19. https://doi.org/10.5826/mrm.2024.1000
Cabrera, A., Rodriguez, A., Romero-Sandoval, N., Barba, S., y Cooper, P. J. (2021). Trends in hospital admissions and mortality rates for asthma in Ecuador: A joinpoint regression analysis of data from 2000 to 2018. BMJ Open Respiratory Research, 8(1), e000773. https://doi.org/10.1136/bmjresp-2020-000773
GBD Chronic Respiratory Disease Collaborators. (2020). Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet Respiratory Medicine, 8(6), 585–596. https://doi.org/10.1016/S2213-2600(20)30105-3
Gómez-García, A. R., Cevallos Paz, A. L., Delgado-Garcia, D., y Jimbo, D. M. (2024). Ecuadorian provinces with high morbidity and mortality rates due to asthma among the working-age population: An ecological study to promote respiratory health. International Journal of Environmental Research and Public Health, 21(7), 909. https://doi.org/10.3390/ijerph21070909
Gregoriano, C., Dieterle, T., Breitenstein, A.-L., Dürr, S., Baum, A., Maier, S., et al. (2018). Use and inhalation technique of inhaled medication in patients with asthma and COPD: Data from a randomized controlled trial. Respiratory Research, 19(1), 237. https://doi.org/10.1186/s12931-018-0936-3
Izquierdo-Condoy, J. S., Salazar-Santoliva, C., Salazar-Duque, D., Palacio-Dávila, Y.-D.-C., Hernández-Londoño, J. M., Orozco-Gonzalez, R., et al. (2024). Challenges and opportunities in COPD management in Latin America: A review of inhalation therapies and advanced drug delivery systems. Pharmaceutics, 16(10), 1318. https://doi.org/10.3390/pharmaceutics16101318
Klijn, S. L., Hiligsmann, M., Evers, S. M. A. A., Román-Rodríguez, M., van der Molen, T., y van Boven, J. F. M. (2017). Effectiveness and success factors of educational inhaler technique interventions in asthma and COPD patients: A systematic review. npj Primary Care Respiratory Medicine, 27(1), 24. https://doi.org/10.1038/s41533-017-0022-1
Köksal, N., y Durgun, H. (2025). Impact of telecounselling, home monitoring and exercise on hospital readmissions and quality of life in chronic obstructive pulmonary disease: A randomized controlled trial. International Journal of Nursing Practice, 31(3), e70021. https://doi.org/10.1111/ijn.70021
Liu, Y.-R., Wang, Y., Chen, J., Luo, S., Ji, X., Wang, H., et al. (2024). Developing and validating a nomogram for non-adherence to inhaler therapy among elderly chronic obstructive pulmonary disease patients based on the social ecological model. Patient Preference and Adherence, 18, 1741–1753. https://doi.org/10.2147/PPA.S472625
Lundell, S., Modig, M., Holmner, Å., y Wadell, K. (2020). Perceptions of home telemonitoring use among patients with chronic obstructive pulmonary disease: Qualitative study. JMIR mHealth and uHealth, 8(6), e16343. https://doi.org/10.2196/16343
Manterola, C., Hernández-Leal, M. J., Otzen, T., Espinosa, M. E., y Grande, L. (2023). Estudios de corte transversal: Un diseño de investigación a considerar en ciencias morfológicas. International Journal of Morphology, 41(1), 146–155. https://doi.org/10.4067/s0717-95022023000100146
Marko, M., y Pawliczak, R. (2025). Inhalation technique-related errors after education among asthma and COPD patients using different types of inhalers: Systematic review and meta-analysis. npj Primary Care Respiratory Medicine, 35(1), 15. https://doi.org/10.1038/s41533-025-00422-0
Mendoza-Cano, O., y Murillo-Zamora, E. (2024). Assessing the asthma-related burden of disease in Latin American and Caribbean countries: A sociodemographic perspective. Public Health, 227, 163–168. https://doi.org/10.1016/j.puhe.2023.12.016
Pagès-Puigdemont, N., y Valverde-Merino, M. I. (2018). Métodos para medir la adherencia terapéutica. Ars Pharmaceutica, 59(3), 163–172. https://revistaseug.ugr.es/index.php/ars/article/view/7387
Plaza, V., Fernández-Rodríguez, C., Melero, C., Cosío, B. G., Entrenas, L. M., de Llano, L. P., et al. (2016). Validation of the "Test of the Adherence to Inhalers" (TAI) for asthma and COPD patients. Journal of Aerosol Medicine and Pulmonary Drug Delivery, 29(2), 142–152. https://doi.org/10.1089/jamp.2015.1212
Plaza, V., Giner, J., Curto, E., Alonso-Ortiz, M. B., Orue, M. I., Vega, J. M., et al. (2021). Assessing adherence by combining the Test of Adherence to Inhalers with pharmacy refill records. Journal of Investigative Allergology and Clinical Immunology, 31(1), 58–64. https://doi.org/10.18176/jiaci.0461
Šajnić, A., Kelly, C., Smith, S., Heslop-Marshall, K., Axelsson, M., Padilha, J. M., et al. (2022). Need and baseline for harmonising nursing education in respiratory care: Preliminary results of a global survey. Breathe, 18(3), 210172. https://doi.org/10.1183/20734735.0172-2021
Sánchez-Nieto, J. M., Bernabeu-Mora, R., Fernández-Muñoz, I., Carrillo-Alcaraz, A., Alcántara-Fructuoso, J., Fernández-Alvarez, J., et al. (2022). Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma. npj Primary Care Respiratory Medicine, 32(1), 1. https://doi.org/10.1038/s41533-021-00262-8
Şanlıtürk, D., y Ayaz-Alkaya, S. (2021). The effect of a theory of planned behavior education program on asthma control and medication adherence: A randomized controlled trial. Journal of Allergy and Clinical Immunology: In Practice, 9(9), 3371–3379. https://doi.org/10.1016/j.jaip.2021.03.060
Suh, H.-S., Chang, M.-S., Yu, I., Park, S., Lee, J.-H., Lee, S. J., et al. (2022). Adherence to long-acting inhaler use for initial treatment and acute exacerbation of chronic obstructive pulmonary disease: A retrospective cohort study. Journal of Personalized Medicine, 12(12), 2073. https://doi.org/10.3390/jpm12122073
Vauterin, D., Van Vaerenbergh, F., Grymonprez, M., Vanoverschelde, A., y Lahousse, L. (2024). Medication adherence to inhalation therapy and the risk of COPD exacerbations: A systematic review with meta-analysis. BMJ Open Respiratory Research, 11(1), e001964. https://doi.org/10.1136/bmjresp-2023-001964
Vázquez-García, J.-C., Salas-Hernández, J., Pérez Padilla, R., y Montes de Oca, M. (2014). Salud respiratoria en América Latina: Número de especialistas y formación de recursos humanos. Archivos de Bronconeumología, 50(1), 34–39. https://doi.org/10.1016/j.arbres.2013.07.011
World Health Organization. (2024). Chronic respiratory diseases. https://www.who.int/health-topics/chronic-respiratory-diseases
Zwar, N. A., Bunker, J. M., Reddel, H. K., Dennis, S. M., Middleton, S., van Schayck, O. C. P., et al. (2016). Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: A cluster randomized trial. Family Practice, 33(6), 663–670. https://doi.org/10.1093/fampra/cmw077
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Copyright (c) 2026 Jennifer Michelle Toapanta Yanchatipan, Grace Pamela López Pérez
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