Inhaled therapy in elderly COPD patients; time for re-evaluation?

Jarvis, Sheba; Ind, Philip W.; Shiner, Robert J.

doi:10.1093/ageing/afl174

Cited by 130 publications

(108 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Advanced age may also independently affect lung function and predict the ability to generate the peak inspiratory flow (PIF) rate required for optimal outcomes from certain DPIs, particularly the Turbuhaler, potentially affecting the type of error made [36,37]. As many as 75% of older adults may be unable to generate the minimum recommended PIF of 30 L·min −1 for a clinical response from the Turbuhaler [36], potentially leading to an inferior clinical response [38].…”

Section: Results Validitymentioning

confidence: 99%

“…As many as 75% of older adults may be unable to generate the minimum recommended PIF of 30 L·min −1 for a clinical response from the Turbuhaler [36], potentially leading to an inferior clinical response [38]. This may be difficult to rectify in practice, with changes subsequent to counselling considered too minor to be cost-effective [39].…”

Section: Results Validitymentioning

confidence: 99%

See 1 more Smart Citation

Inhaler technique: does age matter? A systematic review

2017

View full text Add to dashboard Cite

Poor inhaler technique and inferior asthma outcomes are evident in older adults. Reviews comparing metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques across older adults and younger cohorts are scarce. This systematic review aimed to determine whether differences exist between such cohorts with regards to the number and type of MDI and DPI errors made. A systematic literature search was conducted in Embase, Medline and PubMed from July 1 to December 31, 2016. Studies were selected in accordance with preset inclusion criteria, relevant data were extracted, and quality was assessed with validated checklists. 14 studies were identified. Evidence suggests a negative correlation between advancing age and correct technique across MDI and varying DPI devices when examined collectively. Differences appear to exist between older adult and younger cohorts prescribed MDIs in error types. There is evidence of age-associated differences in the number and type of inhaler technique errors. Further research is required to assess outcomes in individual DPIs, reproducibility and the effects of confounders.

show abstract

Section: Results Validitymentioning

confidence: 99%

Section: Results Validitymentioning

confidence: 99%

Inhaler technique: does age matter? A systematic review

2017

View full text Add to dashboard Cite

show abstract

“…85 The patient's age and ability to complete the required steps for inhalation are important factors in the process of choosing the right device. 86,87 Practitioners have to be cognizant of pediatric and geriatric populations and patients with physical and mental disabilities.…”

Section: Challenge Of Matching Patient Drug and Devicementioning

confidence: 99%

Assessing New Technologies in Aerosol Medicine: Strengths and Limitations

Berlinski

2015

Respir Care

View full text Add to dashboard Cite

Aerosols are the mainstay of treatment for pulmonary diseases such as asthma, cystic fibrosis, and COPD. In addition, aerosols are also being used for systemic drug delivery. Patients need devices that are safe, reliable, portable, and easy to use; have few steps in their operation; help them keep track of the remaining doses; are not expensive; and provide age-appropriate positive reinforcement and feedback. Computational fluid dynamics, human factor sciences, and quality by design are now applied to device development. Matching patient, drug, and device remains a challenge. Formulary restrictions, the current status of the industry-academia relationship, and the need to use multiple platforms hinder the process. Patients and families need to participate in the selection of a device that is appropriate for them. Practitioners need comparative data to help them choose the right device. New devices and drugs can be compared with the existing technology using in vitro and in vivo methods (lung imaging, pharmacokinetic and pharmacodynamics studies). Drug manufacturers need to be able to justify coverage of new products by third-party payers by showing a positive cost/benefit relationship. Finally, post-market surveillance is necessary for old drugs with new devices or for new drugs and devices to ensure patient safety.

show abstract

“…A study [74] specifically aimed at assessing the inhalation technique by objectively measuring the ability to generate adequate peak inspiratory flow (PIF) for a variety of inhalers demonstrated that elderly patients with COPD, even when in stable clinical conditions, were generally unable to generate sufficient inspiratory flows for the activation of the dry powder inhaler. Moreover, as the effect of age on PIF reduction was independent of the disease severity [74], it is possible to hypothesize that elderly patients with asthma may also experience similar problems.…”

Section: Practical Considerations For Elderly Patients On Long-term Dmentioning

confidence: 99%

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

et al. 2015

View full text Add to dashboard Cite

Inhaled corticosteroids (ICSs) are widely used in the treatment of patients with chronic obstructive pulmonary diseases. However, high-dose regimens and longterm use of ICSs have the potential to cause a variety of local and systemic side effects such as candidiasis, cataracts, glaucoma, and osteoporosis. The use of ICSs can also be associated with the risk of bone fractures, diabetes mellitus and pneumonia. These ICS-related side effects are of particular importance in elderly patients due to the presence of comorbidities and age-related behavioral, cognitive, and psychological problems, which can all interact with inhaled treatment. We reviewed the available literature on the clinically relevant side effects of ICSs in the elderly to provide practical measures to properly monitor and manage the risk of ICSs in the geriatric population. Inspection of the mouth, monitoring of ocular pressure, and use of bone-protective drugs may be necessary in patients on prolonged ICS therapy. Above all, the use of the lowest possible ICS dose and a careful re-assessment of the inhalation procedure should be recommended. Taken together, these observations suggest that physicians should use ICSs appropriately for those patients in whom the benefit will outweigh the risk, especially chronic obstructive pulmonary disease (COPD) patients with previous frequent exacerbations. Given the paucity of information on the topic and the need to extrapolate the results from studies with broader age ranges, we strongly encourage the design of specifically tailored clinical studies in the elderly. Key PointsAsthma and chronic obstructive pulmonary disease (COPD) are inflammatory disorders of the airways. The pharmacological management of these chronic diseases is based on persistent and long-term use of inhaled corticosteroids (ICSs).Asthma and COPD are among the most common chronic diseases in clinical settings, and physicians are expected to diagnose and manage those diseases in the geriatric population on a daily basis. The management of chronic obstructive respiratory diseases in the geriatric population is complicated by the increased occurrence of comorbidities and associated treatment, and by age-associated physiological and structural changes of the lung.The chronic use of ICSs in the elderly is associated with the increased risk of local and systemic side effects such as candidiasis, cataract, glaucoma, diabetes mellitus, bone fractures, and pneumonia. Physicians should be aware of this in order to select those patients in whom the benefits will outweigh the risks.The online version of the original article can be found under

show abstract

Inhaled therapy in elderly COPD patients; time for re-evaluation?

Abstract: elderly patients with COPD, even when in a stable clinical condition, may be unable to gain optimum benefit from their inhaler.

Cited by 130 publications

References 24 publications

Inhaler technique: does age matter? A systematic review

Inhaler technique: does age matter? A systematic review

Assessing New Technologies in Aerosol Medicine: Strengths and Limitations

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

Contact Info

Product

Resources

About