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Aim: Wrong use of an inhaler arising from a lack of knowledge can negatively affect treatment management. Therefore, this study was performed with the aim of determining the effects on treatment management of inhaler training carried out under the leadership of a nurse in individuals with medium and advanced stage chronic obstructive pulmonary disease (COPD). Methods: This was an experimentally designed pre‐test post‐test study with a control group. Participants were interviewed four times in 1 year. The experimental group performed inhaler training. A Patient Description and Follow‐Up Form, an Inhaler Drug Use Skill Chart, the Morisky eight‐item Medication Adherence Scale, the COPD Assessment Test, and the St. George Respiration Questionnaire were used to collect data. Data analysis was performed by SPSS, using nonparametric tests. Results: Although there was no significant difference between the groups, a reduction in hospital visits and admissions because of attacks was seen in the experimental group (p =.239, p =.492). It was found there was a greater increase in the correct use of the inhaler in the experimental group than in the control group, and that correct use of the handihaler increased significantly (p =.008). Also, the increases in adherence to treatment (p =.006) and quality of life (p =.010) in the experimental group were significantly different from the control group. In the control group, the annual decline in forced expiratory volume in 1 s increased significantly (p =.016). Conclusions: It was seen that long‐term inhaler training given by nurses at regular intervals made a significant contribution to treatment management. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the characteristics of patients who developed tuberculosis while receiving tumor necrosis factor‐alpha (TNF‐α) antagonists and the related factors with tuberculosis. Methods: Patient's demographics, tuberculin skin test (TST), isoniazid prophylaxis and type of TNF‐α antagonist were recorded. TST conversion (≥5 mm increase) was evaluated for patients who had baseline and 1‐year TST. Results: Files of 1887 patients who were receiving TNF‐α antagonists between August 2005 and June 2015 were evaluated. TST significantly increased at the end of 1 year (n = 748 baseline:7.36 ± 7.2 mm vs. 1 year:9.52 ± 7.5 mm, P < 0.001). One‐third of patients (31.2%) who had negative TST at baseline had positive TST at 1 year. Tuberculosis developed in 22 patients (1.16%). The annual incidence of tuberculosis was 423/100 000 patient‐year. TNF‐α antagonist indications were ankylosing spondylitis (n = 8), inflammatory bovel diseases (n = 7) and rheumatoid arthritis (n = 4). Ten (45.5%) patients received infliximab, six (27.3%) patients received etanercept and six (27.3%) patients received adalimumab. Nineteen (86.4%) patients were under isoniazid prophylaxis. Twelve patients had extrapulmonary tuberculosis (54.5%; four lymph node, three pleura, two periton, one pericarditis, one intestinal, one joint). Atypical mycobacterium was detected in one patient. Adalimumab treatment (9.5× increase), male sex (15.6× increase) and previous tuberculosis disease history (11.5× increase) were risk factors for active tuberculosis. Conversion of TST was not found related with tuberculosis. Conclusions: Despite the high proportion of isoniazid prophylaxis, the incidence of tuberculosis in our patients receiving TNF‐α antagonist was higher than the literature. Adalimumab treatment, male sex and previous tuberculosis disease history were found as risk factors for tuberculosis. [ABSTRACT FROM AUTHOR]