Customizing Inhaled Therapy to Meet the Needs of COPD Patients

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation resulting from emphysema and chronic bronchitis. Inhaled therapy is the major therapeutic approach for treating COPD. Multiple inhaler medications are available in the United States and are delivered by a variety of different devices: metered-dose inhalers, dry powdered inhalers, and nebulizers. Each inhaler device has unique requirements for use that must be correctly performed by the patient for successful drug delivery. Patients with COPD represent a medically diverse population, with each patient having distinct characteristics, such as lung function, comorbidities, cognitive functions, hand strength, and lifestyle. These characteristics impact the patient's ability to properly use specific inhaler devices and therefore affect adherence to therapy, therapeutic outcomes, and quality of life. It is estimated that between 28% to 68% of patients do not use metered-dose inhalers or dry powder inhalers correctly. Worsening symptoms or increased frequency of exacerbations may not always indicate disease progression but may indicate a patient's inability to use their inhaler device properly. This review discusses the patient- and device-specific factors to be considered when choosing an inhaled therapy, which will be concordant with the patient's medical needs, preferences, and lifestyle. The review also considers how the ideas underlying the patient-centered medical home model can be incorporated into the choice and use of inhaler device for a given patient with COPD to improve treatment outcomes.

Estimación del porcentaje de pacientes con EPOC adiestrados en consulta para el manejo de inhaladores. Estudio ADEPOCLE

“…El número de ingresos en los adiestrados fue 2,05 (1,85-2,25) frente a 2,37 (2,12-2,48) en los no adiestrados. El cuestionario CAT para medir la calidad de vida fue 20,12 (12,(24)(25)(26)(27)(28)(29)(30)(31)(32)36) puntos en los adiestrados frente a 23,89 (10,37-37,41) puntos en los no adiestrados, p = 0,308.…”

“…El empeoramiento de los síntomas o aumento de la frecuencia de las exacerbaciones no siempre puede indicar progresión de la enfermedad, pero puede indicar la incapacidad del paciente para utilizar su dispositivo inhalador correctamente (26). Aunque existen muchos tipos de estudios en los que se evalúan distintos tipos de intervenciones educativas con distintas medidas de resultados con resultados contradictorios, en nuestro estudio no existen diferencias significativas del adestramiento en el uso de inhaladores frente a los no adiestrados en función del tabaquismo, gravedad, número de ingresos hospitalarios, ni mejoría en la calidad de vida, obteniendo una reducción significativa del número de agudizaciones (moderadas y graves), siendo de 1,59 (1,12-2,15) reagudizaciones medias en el grupo adiestrado frente a 3,29 (2,50-4,11) en los no adiestrados, p = 0,002.…”

Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil

“…( 1 , 4 , 19 ) Of the two types of inhalers, MDIs are the most readily available in the public health care system, being the most widely used in the present study. …”

“…Although the worsening of symptoms and the frequency of exacerbations do not always indicate disease progression, they can indicate poor treatment adherence or inability to use inhalers, ( 4 ) which is aggravated by the fact that many health professionals do not have enough knowledge to instruct patients on how to use inhaler devices correctly. ( 5 ) According to data from the Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO, Latin-American Project for the Investigation of Pulmonary Obstruction), the proportion of patients receiving inhaled medication is smaller than expected, and the form of administration and frequency of use are not in accordance with the recommendations.…”

Optimizing care of your patients with COPD

“…31 Challenges with MDIs include interposition of the tongue on the mouthpiece, blocking flow, 33 and improper coordination between device actuation and inspiration. 34 Factors such as hand strength and cognitive status in older adults may affect the ability of patients to utilize MDIs properly. 35 Spacer devices may help patients in addressing difficulties using MDIs because of coordination issues, and these devices may improve drug delivery.…”