Clinical recommendations for dry powder inhaler use in the management of COPD in primary care

Leving, Marika T.; Bosnic‐Anticevich, Sinthia; Cooten, Joyce van; Sousa, Jaime Correia de; Cvetkovski, Biljana; Dekhuijzen, Richard; Dijk, Lars; Pardo, Marina García; Gardev, Asparuh; Gawlik, Radosław; Ham, Iris van der; Janse, Ymke; Lavorini, Federico; Maricoto, Tiago; Meijer, Jiska; Metz, Boyd; Price, David; Román-Rodríguez, Miguel; Schuttel, Kirsten; Stoker, Nilouq; Tsiligianni, Ioanna; Usmani, Omar; Emerson-Stadler, Rachel; Kocks, Janwillem

doi:10.1038/s41533-022-00318-3

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…The prevalence of suboptimal peak inspiratory flow rates in hospitalized patients with COPD is shown to vary according to the internal resistance of DPI inhalers [ 25 ]. As studies of DPI use have shown that suboptimal peak inspiratory flow is associated with poorer health status, increased hospitalization and healthcare resource utilization, [ 26 , 27 ] as well as lower treatment adherence [ 28 ], it is important to assess whether sufficient peak inspiratory flow is consistently achieved by patients to ensure they are matched with an appropriate inhaler [ 26 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Aerosol Plumes of Inhalers Used in COPD

Wachtel,

Emerson-Stadler,

Langguth

et al. 2024

Pulm Ther

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Introduction The selection of inhaler device is of critical importance in chronic obstructive pulmonary disease (COPD) as the interaction between a patient’s inhalation profile and the aerosol characteristics of an inhaler can affect drug delivery and lung deposition. This study assessed the in vitro aerosol characteristics of inhaler devices approved for the treatment of COPD, including a soft mist inhaler (SMI), pressurized metered-dose inhalers (pMDIs), and dry powder inhalers (DPIs). Methods High-speed video recording was used to visualize and measure aerosol velocity and spray duration for nine different inhalers (one SMI, three pMDIs, and five DPIs), each containing dual or triple fixed-dose combinations of long-acting muscarinic receptor antagonists and long-acting β 2 -agonists, with or without an inhaled corticosteroid. Measurements were taken in triplicate at experimental flow rates of 30, 60, and 90 l/min. Optimal flow rates were defined based on pharmacopoeial testing requirements: 30 l/min for pMDIs and SMIs, and the rate achieving a 4-kPa pressure drop against internal inhaler resistance for DPIs. Comparison of aerosol plumes was based on the experimental flow rates closest to the optimal flow rates. Results The Respimat SMI had the slowest plume velocity (0.99 m/s) and longest spray duration (1447 ms) compared with pMDIs (velocity: 3.65–5.09 m/s; duration: 227–270 ms) and DPIs (velocity: 1.43–4.60 m/s; duration: 60–757 ms). With increasing flow rates, SMI aerosol duration was unaffected, but velocity increased (maximum 2.63 m/s), pMDI aerosol velocity and duration were unaffected, and DPI aerosol velocity tended to increase, with a more variable impact on duration. Conclusions Aerosol characteristics (velocity and duration of aerosol plume) vary by inhaler type. Plume velocity was lower and spray duration longer for the SMI compared with pMDIs and DPIs. Increasing experimental flow rate was associated with faster plume velocity for DPIs and the SMI, with no or variable impact on plume duration, whereas pMDI aerosol velocity and duration were unaffected by increasing flow rate. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-023-00249-5.

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Section: Discussionmentioning

confidence: 99%

Aerosol Plumes of Inhalers Used in COPD

Wachtel,

Emerson-Stadler,

Langguth

et al. 2024

Pulm Ther

Self Cite

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“… 37 , 38 However, current smokers with COPD may have a heightened awareness and concern regarding the potential cognitive effects of COPD, as smoking is a well-established risk factor for the development and progression of the disease. 49 The influence of smoking cessation interventions and counseling in healthcare settings may also contribute to increased discussions about cognitive symptoms among current smokers with COPD, 50 highlighting the importance of targeted support for smokers with COPD. Patient-centered communication is crucial to ensuring that patients with chronic respiratory conditions understand their diagnoses and feel supported in self-managing their cognitive health.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing patient-provider communication about subjective cognitive decline in people with COPD: Insights from a national survey

Stellefson,

Wang,

Campbell

2024

Chron Respir Dis

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Objective: While there is a growing body of evidence indicating a relationship between COPD and cognitive impairment, there is a gap in evidence regarding discussions of cognitive symptoms in healthcare settings. This study investigated the extent to which individuals with Chronic Obstructive Pulmonary Disease (COPD) and Subjective Cognitive Decline (SCD) self-reported confusion or memory loss with healthcare professionals. Methods: A secondary analysis of 2019 BRFSS data of US adults aged 45+ with COPD ( N = 107,204), using logistic regression to explore associations between socio-demographic and health-related indicators with discussion of cognitive symptoms with healthcare professionals. Results: Less than half (45.88%) of individuals reporting SCD discussed their cognitive symptoms with their healthcare provider. In the adjusted model, unemployed (AOR = 2.92, 95% CI: 1.70-5.02, p < .005), retired (AOR = 3.16, 95% CI: 1.37-7.30, p < .01), and current smokers (AOR = 1.73, 95% CI: 1.02-2.93, p < .05) were more likely to discuss cognitive decline with a healthcare professional than their counterparts. In contrast, males (AOR = 0.53, 95% CI: 0.32-0.86, p < .05) and binge drinkers (AOR = 0.49, 95% CI: 0.30-0.79, p < .01) were significantly less likely to do so when compared to their counterparts. Discussion: The study highlighted significant disparities in the likelihood of individuals with COPD discussing cognitive symptoms based on socio-demographic and health risk behaviors. Conclusion: Addressing gender disparities, occupational status, and personal health risks is crucial for improving patient-provider communication about SCD among adults with COPD.

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“…This evaluation should include the ability of the patient to perform the required inhalation technique: “slow and steady” for pMDIs and SMIs, forcefully or hard and fast for DPIs, and normal tidal breathing for nebulizers ( Figure 1 ). Other considerations include the continuity of the inhaled delivery system, if possible, as provided by health insurance or an approved formulary as well as the patient’s cognitive function, manual function/dexterity, and PIFr ( Figure 1 ) ( 37 , 56 ). It is important that HCPs prescribe inhaled delivery systems they are familiar with, know how to use, and are able to demonstrate and teach correct technique to patients.…”

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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Clinical recommendations for dry powder inhaler use in the management of COPD in primary care

Cited by 10 publications

References 17 publications

Aerosol Plumes of Inhalers Used in COPD

Aerosol Plumes of Inhalers Used in COPD

Factors influencing patient-provider communication about subjective cognitive decline in people with COPD: Insights from a national survey

Personalizing Selection of Inhaled Delivery Systems in Chronic Obstructive Pulmonary Disease

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