Relationship between cognitive function and proper inhaler device use in elderly patients

Iwata, Yusuke; Kakuta, Saki; Osawa, Satoshi; Fujimoto, Yuki; Oki, Yutarou; Yamada, Youji; Yamada, Kanji; Yamaguti, Takumi; Umehara, Ken; Miura, Kazumo; Murakami, Shigefumi; Yamamoto, Akio; Sawada, Kyoko; Natori, Hiroshi; Ishikawa, Akira

doi:10.1183/13993003.congress-2019.pa687

Cited by 2 publications

(1 citation statement)

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“…Examples of this include hand arthritis, both osteo-and rheumatoid, and loading and dispensing drug from the Respimat, Turbuhaler and even pMDIs [36], or dealing with loading capsules such as with the HandiHaler or Breezhaler. Additionally, cognitive issues may necessitate the medication being delivered to the patient, not by the patient [37]. In these patients, the use of a pMDI with a valved holding chamber (VHC) or spacer or the use of a nebulizer is required to facilitate proper inhalation.…”

Section: Physical Limitationsmentioning

confidence: 99%

Switching Inhalers: A Practical Approach to Keep on UR RADAR

Kaplan

Boven

2020

Pulm Ther

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The choice of an inhaler device is often as important as the medication put in it to achieve optimal outcomes for our patients with asthma and/or COPD. With a multitude of drug-device combinations available, optimization of respiratory treatment could well be established by switching devices rather than changing or even augmenting pharmacological or non-pharmacological therapies. Importantly, while notable between-device differences in release mechanism, particle size, drug deposition and required inspiratory flow exist, a patient uncomfortable with their device is unlikely to use it regularly and certainly will not use it properly. Switching requires a careful process and should not be done without patient consent. Switching devices entails several steps that need to be considered, which can be guided using the UR-RADAR mnemonic. It starts with (i) UncontRolled asthma/COPD (or UnaffoRdable device), followed by RADAR: (ii) review the patient's condition (e.g. diagnosis, phenotype, co-morbidities) and address reasons for suboptimal control (e.g. triggers, smoking, non-adherence, poor inhaler technique) to be ruled out before switching; (iii) assess patient's skills related to inhalation (e.g. inspiratory force); (iv) discuss inhaler switch options, patient preferences (e.g. size, daily regimen) and treatment goals; (v) allow patients input and use shared decision-making to decide final treatment choice, acknowledging individual patient skills, preferences and goals; and (vi) re-educate to the new device (at minimum, physical demonstration, verbal explanation and patient repetition, both verbally and physically) and prime the patient for the follow-up (i.e. explain the future patient journey, including multidisciplinary work flows with physicians, nurses and pharmacists).

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Section: Physical Limitationsmentioning

confidence: 99%