Optimising Inhaled Pharmacotherapy for Elderly Patients with Chronic Obstructive Pulmonary Disease: The Importance of Delivery Devices

Abstract

Chronic obstructive pulmonary disease (COPD) is common in older people. Inhaled medications are the mainstay of pharmacological treatment of COPD, and are typically administered by handheld inhalers, such as pressurised metered-dose inhalers and dry powder inhalers, or by nebulisers. For each of the three major categories of aerosol delivery devices, several new inhalers have recently been launched, each with their own particularities, advantages and disadvantages. Consequently, broader availability of new drug-device combinations will increase prescription opportunities. Despite this, however, there is limited guidance available in published guidelines on the choice of inhalers, and still less consideration is given to elderly patients with COPD. The aim of this article is to provide a guide for healthcare professionals on device selection and factors to be considered for effective inhaled drug delivery in elderly COPD patients, including device factors (device type and complexity of use), patient factors (inspiratory capabilities, manual dexterity and hand strength, cognitive ability, co-morbidities) and considerations for healthcare professionals (proper education of patients in device use).

Addressing the Impact and Unmet Needs of Nonadherence in Asthma and Chronic Obstructive Pulmonary Disease: Where Do We Go From Here?

“…17 Additional considerations for patients with COPD that may affect adherence include the fact that patients in this group are generally older than those with asthma (asthma can be diagnosed as early as 1 year of age vs a median age at diagnosis of 68 years for COPD). [18][19][20] Older age is accompanied by the potential for lower cognitive function (up to 50% in some studies) and an associated possibility of misunderstanding treatment details, plus a greater probability of comorbidity/polypharmacy and the link to unintentional nonadherence. 14 Poorer prognosis in such patients and greater risk of disease-associated depression may both contribute to adherence issues due to fatalism or apathy, while mobility and dexterity problems also play a part.…”

“…In addition, patients with COPD often have limited ability to inhale with enough force to achieve adequate drug delivery from a drypowder inhaler (DPI). 20 Several studies have explored the impact of suboptimal treatment on patient outcomes and health care resources including drug costs, hospitalizations, and loss of productivity.…”

Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD

“…Failure to follow the instructions may lead to inhalation errors, some of which reduce, or prevent entirely, deposition of the medication in the lungs [61,147]. In clinical studies, 50-90% of patients with asthma or COPD show incorrect inhaler technique [161][162][163][164][165][166]. In addition, even when patients are able to demonstrate correct inhaler technique, they may not maintain this standard at other times [161,162].…”

“…Some patients appear to be at a greater risk of poor inhalation technique [166,168]. Some risk-factors relate to the patient: these include extreme ages (i.e., young children and the elderly), very severe airflow obstruction, cognitive dysfunction, motor handicap of the upper extremities; Other risk factors relate to the prescription and delivery of the treatment: patients who are simultaneously prescribed different types of devices (e.g., a pMDI and a DPI) tend to use their devices less In the Cochrane Collaboration review of homeopathic medicine, involving a meta-analysis [140] its preventive effect was found, based on the cumulative result of the meta-analysis, to be protective, but without reaching the statistically significant limit (overall risk ratio (RR) = 0.48; 95% CI = 0.17-1.34).…”

Incorporating the Environmental Impact into a Budget Impact Analysis: The Example of Adopting RESPIMAT® Re-usable Inhaler

“…Innovation in the management of respiratory diseases has traditionally focused on the development of new molecules, but the choice of inhaler is as important as the selection of drug for inhaling in achieving an optimal treatment outcome [7]. Poor adherence to therapy is common among patients with asthma and COPD and is partly associated with difficulties in managing the inhaler device [7][8][9][10]. Patients have expressed preference for inhalers which are easy to use in episodes of breathing difficulties and provide reassurance about the inhaled dose being taken, e.g.…”