Advancing Digital Solutions to Overcome Longstanding Barriers in Asthma and COPD Management

Bosnic‐Anticevich, Sinthia; Bakerly, Nawar Diar; Chrystyn, Henry; Hew, Mark; Palen, Job van der

doi:10.2147/ppa.s385857

Cited by 16 publications

(13 citation statements)

References 75 publications

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“…In addition to the proposed intervention, digital technologies could be useful aids in improving the use of inhalers in future years. Various devices that can assess inhalation technique, PIF, and adherence to treatment are currently on the market [14,35].…”

Section: Discussionmentioning

confidence: 99%

An in-hospital intervention to reduce the proportion of misused inhalers at hospital discharge among patients with COPD: a non-randomised intervention study

2024

Swiss Med Wkly

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AIMS OF THE STUDY: Misuse of inhalers during chronic obstructive pulmonary disease (COPD) treatment is common and may result from errors in inhalation technique or insufficient peak inspiratory flow (PIF). We aimed to evaluate the impact of an in-hospital intervention to reduce inhaler misuse at hospital discharge among patients with COPD.METHODS: We conducted a monocentric, non-randomised intervention study to compare the proportion of misused inhalers at hospital discharge by patients with COPD between a group with standard care and a group receiving an in-hospital intervention. The control group successively included all patients hospitalised between March and June 2022, and the intervention group included patients hospitalised between August and December 2022. The intervention consisted of (a) an evaluation of inhalation technique and PIF at admission, (b) the provision of a written guide to assist in the selection of an inhaler, and (c) therapeutic education. The primary outcome was the proportion of misused inhalers, defined as an inhaler used with a critical error and/or insufficient PIF, at hospital discharge. The primary outcome was assessed by observing inhalation technique and measuring PIF using the In-Check DIAL G16® .RESULTS: The study included 93 patients: 46 in the control group and 47 in the intervention group. Mean age was 70.5 years (SD 10.9 years), 56 patients (60.2%) were men, and 57 patients (62%) were hospitalised for a COPD exacerbation. Patients used an average of 1.9 inhalers at hospital discharge; 98 inhalers were assessed in the control group and 81 in the intervention group. The proportion of misused inhalers at discharge was 61.2% in the control group and 21.0% in the intervention group (absolute risk reduction 40.2% [95% CI 25.5-55.0]; p <0.01). In the intervention group, the proportion of inhalers used with at least one critical error was reduced by 38.6% (95% CI 24.3-52.3%) and that of inhalers used with insufficient PIF by 13.9% (95% CI 4.2-23.6%).CONCLUSIONS: An in-hospital intervention was associated with a reduction in the proportion of misused inhalers at hospital discharge. This intervention should be considered for hospitalised patients with COPD.The trial was registered with ClinicalTrials.gov (NCT05207631).

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Section: Discussionmentioning

confidence: 99%

An in-hospital intervention to reduce the proportion of misused inhalers at hospital discharge among patients with COPD: a non-randomised intervention study

2024

Swiss Med Wkly

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“…Assessment of inhaler technique and adherence together with patient outcomes/satisfaction at each visit is essential to determine whether the inhaled medication delivery system is providing benefits. Although digital inhalers can provide information about patient adherence and technique, this technology is not widely used in clinical practice at the present time ( 57 ). Continued and repeated education on device features and correct technique is warranted for both patients and HCPs to optimize treatment outcomes ( 7 , 40 ).…”

Section: Discussionmentioning

confidence: 99%

Personalizing Selection of Inhaled Delivery Systems in Chronic Obstructive Pulmonary Disease

Mahler

Halpin

2023

Annals ATS

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It can be challenging for healthcare professionals (HCPs) to prescribe inhaled therapy for patients with chronic obstructive pulmonary disease (COPD) because of the multiple individual and combinations of inhaled medications available in numerous delivery systems. Guidance on the selection of an inhaled delivery system has received limited attention compared with the emphasis on prescribing the class of the inhaled molecule(s). Although numerous recommendations and algorithms have been proposed to guide the selection of an inhaled delivery system for patients with COPD, no specific approach has been endorsed in COPD guidelines/strategies or by professional organizations. To provide recommendations for an inhaler selection strategy at initial and follow-up appointments, we examined the impact of patient errors using handheld inhalers on clinical outcomes and performed a focused narrative review to consider patient factors (continuity of the inhaled delivery system, cognitive function, manual function/dexterity, and peak inspiratory flow) when selecting an inhaled delivery system. On the basis of these findings, five questions are proposed for HCPs to consider in the initial selection of an inhaler delivery system and three questions to consider at follow-up. We propose that HCPs consider the inhaled medication delivery system as a unit and to match appropriate medication(s) with the unique features of the delivery system to individual patient factors. Assessment of inhaler technique and adherence together with patient outcomes/satisfaction at each visit is essential to determine whether the inhaled medication delivery system is providing benefits. Continued and repeated education on device features and correct technique is warranted to optimize efficacy.

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“…In our regression analyses, we did not include FEV 1 because of missing data, but especially because FEV 1 only has a poor relationship with clinical symptoms. 37 The fact that patients in Spain have to see their GP before they can officially call in sick may have had an effect on the incidence of work absence, people may sometimes just take some days of instead of calling in sick. The median and mean number of days with work absence may also be influenced by this.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding inhalers, three main types of hand-held inhalers can be identified: 36 (i) dry powder inhalers (DPI), which get the medication into the lungs in the form of dry powder, (ii) aerosol-based inhalers commonly known as pressurised metereddose inhalers (pMDI) which allow patients with a limited inhalation power to inhale their medication easily using a spacer and (iii) soft mist inhalers (SMI) which release the medication slowly in a nebulizer-like way. 37 Different properties of the inhalers make them suitable for different patient groups. 38 It is important to note, however, that the use of inhalers is more difficult than it seems and it requires a lot of time and energy from healthcare providers to help patients use their inhaler drugs properly.…”

Section: Pharmacological Inhaled Treatment Of Asthma and Copdmentioning

confidence: 99%

“…[32][33][34] Moreover, within these economic studies, large diversity in applied methods and outcomes was observed. 35 The discrepancy between, on the one hand, the fragmented "per-disease" approach used in earlier studies and, on the other hand, the enhanced awareness of the interconnectivity 36 and multimorbidity 37 of Th2 related diseases and their (pharmacological) treatment, calls for an holistic overview of the burden and socioeconomic effects of atopic diseases.…”

Section: Introductionmentioning

confidence: 99%

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Digital strategies to support adherence to medication in asthma and COPD

Dierick

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Chapter 1 History, definitions and prevalence of obstructive lung diseasesAsthma is derived from the Greek word ασθμαινω which means "to gasp for breath". The word "asthma" did initially not refer to a specific disease, but was used to describe various symptoms relating to lack of air for the patient. It was not until the early 20th century that asthma was seen as a specific condition in which the airways are pinched. 1 Chronic bronchitis as a major component of these respiratory diseases was first described by Badham in 1814. 2 After the second world war, a distinction was slowly made between respiratory diseases associated with chronic bronchitis and emphysema. In 1960, Orie et al. described what was called the 'Dutch hypothesis': the symptoms are explained by a partly genetically determined bronchial hyperreactivity. 3 At the same time, the British hypothesis was posited that repeated chest infections and air pollution were the cause of chronic bronchitis. 4 Until well into the 1990s, the acronym "CARA" was used in the Netherlands: Chronische Aspecifieke Respiratoire Aandoeningen (Chronic Aspecific Respiratory Diseases). 5 Progressive insight has ultimately differentiated the two diseases: chronic obstructive pulmonary disease (COPD) and asthma. Around 2010 the idea of asthma-COPD overlap (ACO), 6 was postulated, but in the 2021 GOLD strategy report it was stated that: "we no longer refer to asthma-COPD overlap (ACO), instead we emphasize that asthma and COPD are different disorders" that may coexist in an individual patient. 7 Worldwide, the prevalence of COPD ranges from 3.9% to 11.7% 8 9 10 while the prevalence of asthma ranges from 1.3 to 20.7% depending on the country. 11 Although asthma and COPD's pathophysiology is increasingly unravelled and treatment is improved, still many people all over the world suffer from these diseases. According to the Global Burden of Disease study, worldwide, 174 million people suffer from COPD and 358 million people from asthma, of whom 3.2 million and 0.4 million die each year respectively. AsthmaThe Global Initiative for Asthma (GINA) was founded in 1993. The aim of the organisation is to improve asthma treatment, to reduce ambiguity in its treatment and, in so doing, to reduce morbidity and mortality. Every year, GINA publishes a report with the latest developments in the field of asthma. For most caregivers of asthma patients, the GINA report is leading. In the 2022 GINA report, the following definition of asthma was formulated: "Asthma is a heterogeneous disease, usually characterized by chronic inflammation. It is defined by the history of respiratory symptoms, such as wheeze, shortness of breath, chest tightness and cough, that vary over time and in intensity, together with variable expiratory airflow limitation". 12 This definition shows that asthma is defined in part by its associated symptoms. These include periods of shortness of breath, coughing and mucus production alternating with periods with fewer or even no such complaints. Shortness of breath c...

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Advancing Digital Solutions to Overcome Longstanding Barriers in Asthma and COPD Management

Cited by 16 publications

References 75 publications

An in-hospital intervention to reduce the proportion of misused inhalers at hospital discharge among patients with COPD: a non-randomised intervention study

An in-hospital intervention to reduce the proportion of misused inhalers at hospital discharge among patients with COPD: a non-randomised intervention study

Personalizing Selection of Inhaled Delivery Systems in Chronic Obstructive Pulmonary Disease

Digital strategies to support adherence to medication in asthma and COPD

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