Logistic analysis has shown that

Logistic analysis has shown that age and the count of inhalation device are significant factors that lead to diminished inhalation technique, even when the type of inhalation device is taken into account (Table 3). Although it apomorphine has been previously reported that the type of the inhalation device, in addition to age, causes a difference in the performance of the inhalation technique, this divergence seems to be attributable to individual patients or to differences in the method of evaluation. In the current study, patients of a variety of ages were recruited without bias to determine the effects of age as primary endpoints. However, in regard to the inhalation device, the secondary endpoint, various inhalation devices including the aforementioned three devices used by many patients are currently available, and the prominent effects of age on inhalation devices could be detected, but it was also possible that the influences of inhalation devices were hardly detected. On the other hand, the count of inhalation device is the significant factor of inhalation technique independent from age. In order to prevent the confusions, we should choose same device for same patient as possible. Thus, it is presumed that confirmation of inhalation technique is important for elderly patients, regardless of the type of inhalation device. In recent years, inhalation devices with simplified operation have become available, and it is expected that the development of inhalation devices associated with fewer operational errors will be further promoted according to advances in pharmaceutical technology.
Table 4 shows the results of comparison between the two groups of patients, i.e., the elderly group (≥66.5 years of age) and the non-elderly group (<66.5 years of age), in regard to the frequencies of specific problems. Similar to the NRS scores, the number of patients who reported some problems on their subjective assessment was significantly greater in the non-elderly group, whereas those with problems were more frequent in the elderly group on the objective assessment of medical professionals, showing a divergence. Thus, these results highlighted the lack of awareness of problems among elderly patients. Medical professionals\’ objective assessment revealed that patients who had problems in inhalation technique were predominant particularly in the elderly group. In contrast, patients\’ subjective assessment showed that there were more patients who had difficulty continuing medication in the non-elderly group. In general, older age in patients is reported to be associated with low adherence to treatment because of decreased cognitive and physical function. On the other hand, Transcribed spacer has been reported that elderly patients have higher respect for medical professionals and are more likely to visit a hospital regularly, and therefore medical professionals play an important role in the patients\’ acceptance of treatment. The results of this study also suggest that tolerance to continuation of medication, i.e., motivation for treatment, remained undiminished. The decrease in resistance to continuation of treatment might also be derived from the fact that elderly patients are more likely to be unemployed and thus have fewer temporal restrictions than non-elderly patients. There are some limitations in this study. (1) Medical professionals\’ assessment was not based on a checklist, and therefore the rating scale might have varied among different raters. However, the variance among individual raters is presumed to be great enough to affect the relationship between age, the primary endpoint, and the technique or knowledge of inhalation. (2) The present study was not complete survey, and therefore there is potential for bias that the participants are likely to be health-conscious patients. Despite those health conscious patients, increasing age spoils their light recognition for inhalation therapy. (3) Because the present study is a questionnaire survey, we could not capture the detailed patients information, such as activities of daily living (ADL) and complications. However, in the present study, patients were not eligible if it was difficult for them to respond to the questionnaire because of decreased cognitive function. Therefore, patients who have extremely low ADL were not included in the present study. Generally, the ADL associates with the age of patient. In the present study, we considered that the influence of ADL on inhalation therapy was included in the influence of age.