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Inhalation instruction for asthma and COPD patients in the community -An attempt at an inhalation instruction network-

A book has been published for the inhalation instruction network, which was launched in collaboration with our department, the pharmacy department, the Kita Ward Pharmacists Association, and insurance pharmacies. The book includes inhalation methods for the latest inhalation devices, Q&A on inhalation instruction, and a checklist.

• Inhalation method, inhalation instruction Q&A, checklist

Characteristics and Initiatives

1. Bronchoscopy
   In recent years, there have been remarkable advances in bronchoscopy technology. Bronchoscopy combined with ultrasound (EBUS-TBNA, EBUS-GS) has made it possible to collect and diagnose tissue from lymph nodes around the bronchi and lesions deep in the lungs, which were previously difficult to diagnose. In the future, we also plan to introduce cryobiopsies (a method of collecting lung tissue by freezing it) to improve the diagnosis of lung cancer and interstitial lung disease.
2. Multidisciplinary treatment of lung cancer
   Treatment methods for lung cancer include surgery, radiation therapy, anti-cancer drug treatment (chemotherapy), and immunotherapy. It is important to combine these methods to provide the optimal treatment for each patient. Every week, we hold a joint conference with the Thoracic Surgery, Radiology, and Medical Oncology departments to discuss each patient.
3. Inhalation Guidance Network　Inhalation instruction materials are available for download
   The mainstay of drug treatment for asthma and COPD (chronic obstructive pulmonary disease) is inhalation therapy using steroids and bronchodilators. In recent years, many inhalation devices have appeared, but the different usage methods for each device have led to confusion and difficulty in inhaling properly, which has become a problem. In response to this issue, in 2006, our hospital's respiratory medicine department and pharmacy department, the Kita Ward North Branch Pharmacists Association, and local insurance pharmacies launched an "Inhalation Guidance Network." We have been holding seminars and other events for over 10 years, with the aim of ensuring that standardized inhalation guidance is provided regularly at all local pharmacies.
4. Diagnosis and treatment of interstitial pneumonia
   Interstitial pneumonia is a disease in which the walls of the alveoli thicken and harden due to inflammation, making it difficult for oxygen to be absorbed. Idiopathic interstitial pneumonia is a condition of unknown etiology. Meanwhile, chronic hypersensitivity pneumonitis, such as avian-associated hypersensitivity pneumonitis, is gaining attention. For example, trace amounts of avian antigens contained in down comforters and down jackets have been found to cause lung inflammation over time, resulting in a condition indistinguishable from idiopathic interstitial pneumonia. Mold (fungi) lurking in homes can also be a cause. For patients with interstitial pneumonia of unknown etiology, rather than immediately administering drug therapy, we first consider the possibility of chronic hypersensitivity pneumonitis and advise them to eliminate potential causes of hypersensitivity pneumonitis, such as feather products. In many patients, this alone results in improved imaging and a decrease in markers such as KL-6. If improvement is limited, we have achieved success by hospitalizing patients to isolate them from home antigens or by conducting environmental surveys of their home and workplace to improve their environment.
   • Explanation of interstitial pneumonia and hypersensitivity pneumonitis on YouTube
5. Chronic Respiratory Failure and Monitoring
   For patients with chronic respiratory diseases who have become more severely ill, such as shortness of breath, we conduct continuous monitoring of oxygen saturation (SpO2), nighttime transcutaneous carbon dioxide partial pressure measurement, and polysomnography to closely examine whether oxygen levels are decreasing during exertion or ventilation (respiratory movement) is decreasing during sleep. If abnormalities are found, we introduce home oxygen therapy or home ventilator therapy to improve the situation.
6. Chronic respiratory diseases and comprehensive care
   Patients with chronic respiratory diseases often experience imbalances in mind and body, and a decline in their nutritional status and physical activity. In response to these issues, we strive to provide a holistic approach, actively incorporating traditional Chinese medicine such as herbal medicine, in addition to respiratory rehabilitation and individual nutritional guidance. We also actively collaborate with local medical and nursing care providers.

About treatment

1. New treatment for lung cancer
   Recent years have seen remarkable progress in chemotherapy and immunotherapy for lung cancer. Various genetic abnormalities have been found in lung adenocarcinoma, and numerous molecularly targeted drugs that act on these abnormalities have been developed and are already standard treatments. Meanwhile, immunotherapy, which has attracted worldwide attention since Dr. Honjo was awarded the Nobel Prize in Physiology or Medicine, has already been introduced into lung cancer treatment and is showing great results. By blocking the PD-1/PD-L1 system, which suppresses the immune system's ability to attack cancer cells, immunity against cancer is greatly enhanced. However, unexpected side effects can occur, and we work in collaboration with various medical departments to address these.
2. New treatment for bronchial asthma
   The mainstay of asthma treatment is inhaled steroids. This has led to a significant reduction in asthma deaths. However, there are some patients with intractable asthma whose symptoms are difficult to control even with inhaled steroids, bronchodilators, and anti-allergy drugs. In these cases, molecular targeted drugs are now available that directly suppress IgE and eosinophils, which are deeply involved in the pathology of asthma. Chinese herbal medicines can also be extremely effective.
3. New treatments for chronic respiratory failure
   It has been discovered that patients with the above-mentioned chronic respiratory failure experience a significant decrease in ventilation during sleep, particularly during REM sleep, when dreaming occurs. Patients with hypoventilation during REM sleep are also known to frequently experience acute exacerbations and develop pulmonary hypertension. Recently, ventilators have been developed that can assist ventilation by increasing pressure only when ventilation decreases, helping to reduce the discomfort associated with artificial ventilation therapy using a nasal mask.

Medical Treatment Results