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Introduction: The correct method for using inhalation devices (DI) is essential to optimize treatment efficacy., Objective: To evaluate the method of inhalation technique, study the correlations with patient characteristics, disease, treatment and measure the impact of direct and individual educational method, centered on the use of technical DI, on improving this technique and control of the disease., Method: Prospective study of 54 patients. The therapeutic education program included 3 levels of action: identifying errors in the inhalation technique, demonstrating the inhalation technique and evaluation of therapeutic education., Result: The most used DI was metered-dose inhalers (AD) (66.67%). The average error was 4.63 errors/patient for AD and 5.11 for dry powder inhalers. The main factors related to the misuse of DI were lower advanced level of education and age. The therapeutic education has significantly improved the number of errors/patient with improved asthma control (P<0.05) and COPD assessment test (CAT) in the case of COPD., Conclusion: Our study confirms the important role of therapeutic education focused on inhalation techniques in improving the use of DI technology and the evolution of asthma and COPD., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Résumé Introduction La prévalence croissante de l’allergie et son impact sur la qualité de vie individuelle soulignent la nécessité d’une amélioration des options de traitement afin de modifier le cours naturel des maladies allergiques. La désensibilisation reste le seul traitement étiologique des maladies allergiques. Le développement de la voie sublinguale représente une approche actuellement disponible pour réorienter la réponse immunitaire inappropriée chez les patients atopiques et a un meilleur profil de tolérance que la voie sous-cutanée. But Étudier l’intérêt de l’immunothérapie allergénique par voie sublinguale dans le traitement des allergies respiratoires et d’évaluer l’observance, l’efficacité et la tolérance de cette voie en suivant le protocole ultra Rush. Méthodes Étude prospective longitudinale incluant 200 patients atteints d’une maladie allergique chez qui un traitement sublingual a été démarré selon le protocole ultra Rush et a été poursuit pendant 3 à 5 ans. Résultats L’âge moyen de nos patients était de 18 ans avec des extrêmes allant de 3 à 44 ans. L’indication de la désensibilisation a été retenue devant une rhinite allergique persistante sévère isolée (25 %) ou associé à un asthme persistant léger à modéré associé (75 % des cas). La sensibilité aux acariens a été objectivée chez tous nos patients confirmée par TCA (100 % des cas). Les effets secondaires locaux notés étaient à type de prurit buccal (12 % des cas). Aucun effet systémique grave n’a été noté notamment aucun cas de choc anaphylactique, œdème de Quincke, ou crise d’asthme modérée ou sévère. L’efficacité a été évaluée sur l’amélioration de scores de symptômes et sur la quantification de la consommation médicamenteuse qui a diminué de 55 %. Aucun passage de la rhinite à l’asthme n’a été noté. Aucune nouvelle allergie n’est apparue. Conclusion L’immunothérapie allergénique sublinguale est efficace dans la rhinite allergique et l’asthme stable. Elle constitue le seul traitement étiologique disponible. L’efficacité et la tolérance de cette voie dépend cependant du strict respect des règles de prescription, des indications et contre-indications. Background Allergen immunotherapy is currently the only treatment likely to impact the natural history of allergic disease. The sublingual route appears to exhibit better safety and has confirmed clinical efficacy. However, further research is required on aspects such as patient selection, use of optimal dosing, long-term effects, and management of adverse reactions. In addition, the widely heterogeneous nature of studies on sublingual allergen immunotherapy (SLIT) performed to date and variations in the application of the subcutaneous immunotherapy make it difficult for the prescribing clinician to draw accurate and useful conclusions. Study objectives In this study, we aim to describe the treatment regimens for sublingual allergen immunotherapy practiced routinely in Tunisia. The secondary objectives include description of the respiratory allergies leading to treatment and evaluation of the efficacy and safety of treatment, patient satisfaction and compliance, and patient management practices. Methods This was a longitudinal prospective study in 200 patients presenting allergic disease in whom sublingual immunotherapy was initiated in accordance with the ultra rush protocol. Results The average patient age was 18 years (range: 3 to 44 years). Specific immunotherapy was selected for severe persistent allergic rhinitis, either alone (25%) or associated with mild-to-moderate persistent asthma (75%). Sensitivity to dust mites was established in all our patients and confirmed by ACT (100%). The local adverse effects noted consisted of oral pruritus (12% of cases). No serious systemic effects such as anaphylactic shock, angioedema, or moderate or severe asthma attack, were observed in our study. Assessment of symptom intensity during SLIT showed a 77% decrease in symptoms score and a 55% decrease in medication score. No transition from rhinitis to asthma occurred and no new allergies emerged. Conclusion Our study demonstrated that SLIT is effective and tolerable in Tunisian patients presenting allergic rhino-conjunctivitis and/or asthma. Further long-term controlled trials are required to reinforce the present results. [ABSTRACT FROM AUTHOR]