in the pharmacological treatment of asthma, the most suitable way is by inhalation, since this enables us to achieve a greater concentration of medicine in the affected organ than systemic medication, and besides the latter？s secondary effects are minimized. the suitable use of inhalers and hence their efficacy depends on very different factors. some of those of a merely technical kind are as follows: - a suitable volume of inhalation. - the rhythm of inhalation. - the length of the inspiratory apnea following administration of the medicine. - the coordination between the inspiration of the aerosol and activation of the device, in the case of the metered dose inhaler (mdi). one of the reasons for the incorrect use of mdi aerosols is the lack of coordination between activation of the device and inspiration. this has led to the design of different devices that avoid the need for this coordination, such as: inhalation chambers and devices for inhaling dry dust. it has also been suggested in the literature that the causes of these mistakes are to be found in the health professionals not knowing, or not suitably teaching the patients how to handle the devices. in spite of being designed to facilitate correct administration, suitable knowledge of the technique of their use by the patient is required.
The traditional belief in clinical psychology, psychoanalisis, behavior therapy, and behavior modification ís that behavioral problems like sexual disorders, phobics disorders, impotence, psychotic behavior, alcoholism, etc., are the only problems that may affect a particular client. The purpose of thís paper is to show that, besides these problems (which in this paper are ca1led funelamental problems), there exísts two addítional problems that may also affeet the client: (1) different ínter, pretations or definitions in relation to the same fundamental problem (which ís ca1led problem 01 interpretation), and (2) the use of different techniques or treatments in controlling the same fundamental problem (which is ca1led problem o[ effective treatment). Kuhn′s assumptions on the paradigm coneept are used in arder to show that both problema of ínterpretatíon and effeetive treatment eould be explained in terms of the multiparadigmatic period of a scienee of behavior
COPD trials lasting longer than six months often have large numbers of people leaving the trial early. In INSPIRE, the largest trial in our review comparing fluticasone/salmeterol to tiotropium, there were seven to eleven times more people leaving the trial early than the number who died; a number that swamps the death rate. Therefore we felt unable to draw a reliable conclusion as to which treatment has the lowest mortality rate. This uncertainty also left us unable to reliably say which drug was better in terms of reducing COPD exacerbations, hospitalisations, serious adverse events or improving quality of life and health status.