Comparison of elderly people's technique in using two dry powder inhalers to deliver zanamivir: randomised controlled

Abstract

Objective To determine whether elderly people can learn to use the inhaler used to deliver zanamivir (Relenza Diskhaler) as effectively as the Turbohaler and to identify which aspects of inhaler technique are most problematic. Design Randomised, controlled, intervention study. Setting Wards for acute elderly care in a large district general hospital. Participants 73 patients who were unfamiliar with the use of an inhaler, aged 71 to 99 (mean 83) years. Main outcome measures Initial scores and changes in scores 24 hours later using a 10 point scoring system of five aspects of inhaler technique. Results 38 patients were allocated the Relenza Diskhaler and 35 the Turbohaler. The mean total score was significantly greater in the Turbohaler than Diskhaler groups both initially (8.74 v 7.05) and after 24 hours (8.28 v 5.43). The major difference between inhalers was in loading and priming. After tuition 50% (19 of 38) of patients allocated the Diskhaler were unable to load and prime the device and 65% (24 of 37) were unable to do so 24 hours later. Of those allocated the Turbohaler, two patients were unable to load and prime the device after initial review and one after 24 hours. Conclusion Most elderly people cannot use the inhaler device used to deliver the anti-influenza drug zanamivir. Treatment with this drug is unlikely to be effective in elderly people unless the delivery system is improved.

Inspiratory flow rates at different levels of resistance in elderly COPD patients

“…Similar correlations were found in the present study in addition to a negative correlation between PIF device and age, which could be expected given the age dependency of PIF in prediction equations. Therefore, it is very likely that in an elderly population the optimal use of DPIs decreases with age for reasons of reduced inspiratory muscle force, lower spirometric PIF [17] and the fact that with age the correct use of a DPI becomes more difficult [15,16].…”

“…In addition, many clinicians are nowadays confronted with an important number of COPD patients who are aged .70 yrs. In this subpopulation, DPIs are often preferred to MDIs as the coordination between device and inhalation becomes increasingly difficult with age [1,15,16]. However, elderly subjects are known to have reduced respiratory muscle strength and decreased PIF due to the ageing process itself, which may jeopardise the adequate use of DPI independently of COPD [17].…”

In VitroAntiviral Activity of Favipiravir (T-705) against Drug-Resistant Influenza and 2009 A(H1N1) Viruses

“…Currently, zanamivir is the only drug effective against both adamantaneresistant and/or oseltamivir-resistant influenza viruses, but due to the fact that it has to be inhaled, it is less suitable for use with several high-risk groups, including the severely ill (41), infants (33), and the elderly (22). Furthermore, zanamivir may decrease pulmonary function, so it is not recommended for the treatment of infections in individuals with chronic underlying lung and heart disease conditions (23).…”

Strategies for the Rational Use of Antivirals

“…Many antiviral compounds that are currently available are formulated for only one route of administration, it is therefore important to attempt to use one which can be delivered in a way which ensures adequate drug levels and maximises the likelihood of adherence. Inhalers are often difficult for elderly patients to administer correctly, thus for an elderly patient with influenza, the oral neuraminidase inhibitor oseltamivir may be preferred to inhaled zanamivir (Diggory et al, 2001). Dosage schedule.…”