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  1. A quick survey about COPD patients and devices There is no one-size-fits-all treatment for chronic obstructive pulmonary disease (COPD). To help healthcare providers consider each patient’s individual needs when formulating their treatment regimen, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends continual evaluation and management of therapy based on assessment of device technique, reviews of the patient’s symptoms and exacerbations, and any adjustments necessary to meet other outstanding patient needs.1 Matching the right device to the right patient can help adherence to a treatment plan.2 Take this quick survey to see how your peers assess a patient’s satisfaction and ability to use their devices. Matching the right device to the right patient could make all the difference in managing their COPD symptoms.1,2 Managing COPD requires consistent revaluation and reassessment of patient ability and preference.1 For patients who may need another option, consider twice-daily LONHALA® MAGNAIR® (glycopyrrolate). LONHALA MAGNAIR is an anticholinergic indicated for the long-term maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema. LONHALA MAGNAIR is not a rescue medication. References: 1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2020:1-125. 2. Amin AN, Ganapathy V, Roughley A, Small M. Confidence in correct inhaler technique and its association with treatment adherence and health status among US patients with chronic obstructive pulmonary disease. Patient Prefer Adherence. 2017;11:1205-1212. To learn more about LONHALA MAGNAIR, visit www.sunovionprofile.com/lonhala-magnair. This survey is sponsored by Sunovion Pharmaceuticals. IMPORTANT SAFETY INFORMATION AND INDICATION IMPORTANT SAFETY INFORMATION LONHALA MAGNAIR is contraindicated in patients with a hypersensitivity to glycopyrrolate or to any of the ingredients. LONHALA MAGNAIR should not be initiated in patients with acutely deteriorating or potentially life-threatening episodes of COPD or used as rescue therapy for acute episodes of bronchospasm. Acute symptoms should be treated with an inhaled short-acting beta2-agonist. As with other inhaled medicines, LONHALA MAGNAIR can produce paradoxical bronchospasm that may be life-threatening. If paradoxical bronchospasm occurs following dosing with LONHALA MAGNAIR, it should be treated immediately with an inhaled, short-acting bronchodilator; LONHALA MAGNAIR should be discontinued immediately and alternative therapy instituted. Immediate hypersensitivity reactions have been reported with LONHALA MAGNAIR. If signs occur, discontinue LONHALA MAGNAIR immediately and institute alternative therapy. LONHALA MAGNAIR should be used with caution in patients with narrow-angle glaucoma and in patients with urinary retention. Prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (e.g., eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) and of urinary retention (e.g., difficulty passing urine, painful urination), especially in patients with prostatic hyperplasia or bladder-neck obstruction. Patients should be instructed to consult a physician immediately should any of these signs or symptoms develop. The most common adverse events reported in ≥2% of patients taking LONHALA MAGNAIR, and occurring more frequently than in patients taking placebo, were dyspnea (4.9% vs 3.0%) and urinary tract infection (2.1% vs 1.4%). LONHALA solution is for oral inhalation only and should not be injected or swallowed. LONHALA vials should only be administered with MAGNAIR. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. For additional information, please see full Prescribing Information and Patient Information for LONHALA MAGNAIR at www.sunovionprofile.com/lonhala-magnair. INDICATION LONHALA® MAGNAIR® (glycopyrrolate) is an anticholinergic indicated for the long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema. LONHALA and are registered trademarks of Sunovion Pharmaceuticals Inc. MAGNAIR is a registered trademark of PARI Pharma GmbH, used under license. SUNOVION and are registered trademarks of Sumitomo Dainippon Pharma Co., Ltd. Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd. ©2020 Sunovion Pharmaceuticals Inc. All rights reserved. Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA 01752. 5/20 LON-US-00043-20
  2. Approximately 15.7 million Americans have been diagnosed with chronic obstructive pulmonary disease (COPD), and each one of them requires an individualized approach.1,2 It’s important to understand the different options when selecting an inhalation device for this complex patient population. On top of their breathing troubles, many patients may have other issues, such as cognitive and physical limitations.3,4 Remembering and following multiple steps, and coordinating a sequence of exhalations and inhalations, are some of the challenges these patients may face when operating their devices. In addition, maintaining an active lifestyle can be important for many patients struggling with COPD, so equipment and/or treatments with prolonged administration duration can be a challenge.5 A review of the different delivery options for COPD could help healthcare professionals choose the appropriate device for their patients.6 For many patients with COPD, adherence can be a major problem. Healthcare professionals can strive to mitigate adherence issues by considering their patients’ abilities and preferences and matching them to the appropriate inhalation device.6,7 Surveys suggest that there are opportunities for healthcare professionals to better connect with patients in terms of device training and technique. Approximately 25% of patients do not receive instructions for using their inhalation device, and 69% of patients report that their healthcare professionals have never watched them take their medication.8 COPD delivery options Metered-dose inhalers (MDIs)4,7,9-11 Compressed chemical propellant delivers medication in aerosol form Require coordination of breathing and actuation of device No drug preparation necessary, though shaking the device is required Administered in 1 or 2 breaths Slow-mist inhalers (SMIs)4,12,13 Use a Spring mechanism to create a mist Breath coordination is required Multiple steps for setup Administered in 1 or 2 breaths Dry-powder inhalers (DPIs)9,10,14-17 Breath actuated Proper breathing technique is required Minimal setup; patient may need to load capsule Administered in 1 or 2 breaths Jet nebulizers4,9,18 High-velocity air stream creates breathable mist Natural breathing administration Multiple steps for setup and maintenance Administration can take up to 20 minutes Vibrating membrane or mesh nebulizers4,13 Vibrating perforated material creates breathable mist Natural breathing administration Multiple steps for setup and maintenance Administration can take less than 5 minutes It is important to train patients on how to use their devices upon initiation and to regularly reassess and refresh them on proper technique. Knowing the pros and cons of different delivery options can help optimize treatments and deliver the best results for patients. When necessary, healthcare professionals should consider and advocate for alternative device options for appropriate patients.6 References: 1. Wheaton AG, Cunningham, TJ, Ford ES, Croft JB; Centers for Disease Control and Prevention. Employment and activity limitations among adults with chronic obstructive pulmonary disease—United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;64(11):289-295. 2. Patel M, Steinberg K, Suarez-Barcelo M, et al. Chronic obstructive pulmonary disease in post-acute/long-term care settings: seizing opportunities to individualize treatment and device selection. J Am Med Dir Assoc. 2017:18(6):S53. e17-S53.e22. 3. Zarowitz BJ O’Shea T. Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment. J Manag Care Pharm. 2012;18(8):598-606. 4. Dhand R, Dolovich M, Chipps B, Myers TR, Restrepo R, Farrar JR. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9(1):58-72. 5. Amultiari HJ, Mussa CC, Lambert CT, Vines DL, Strickland SL. Perspectives from COPD subjects on portable longterm oxygen therapy devices. Respiratory Care. 2018;63(11):1321-1330. 6. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2020:1-125. 7. Restrepo RD, Alvarez MT, Wittnebel LD, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-384. 8. Cho-Reyes S, Celli BR, Dembek C, Yeh K, Navaie M. Inhalation technique errors with metered-dose inhalers among patients with obstructive lung diseases: a systematic review and meta-analysis of U.S. studies. Chronic Obstr Pulm Dis. 2019;6(3):267-280. 9. Dolovich MB, Ahrens RC, Hess Dr, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. CHEST. 2005;127(1):335-371. 10. Pelegrin GM. Asthma inhalers? What you should know. Pharm Times. https://www.pharmacytimes.com/publications/ issue/2003/2003-05/2003-05-7182. Published May 1, 2018. Accessed March 30, 2020. 11. AZMACORT [prescribing information]. Kos Pharmaceuticals, Inc. 2007. 12. Anderson P. Use of Respimat® Soft MistTM Inhaler in COPD patients. Int J Chron Obstruct Pulmon Dis. 2006;1(3):251- 259. 13. Tashkin DP. A review of nebulized drug delivery in COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:2585-2596. 14. Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593-604. 15. Al-Showair RA, Tarsin WY, Assi KH, Pearson SB, Chrystyn H. Can all patients with COPD use the correct inhalation flow with all inhalers and does training help? Respir Med. 2007;101(11):2395-2401. 16. ADVAIR DISKUS [prescribing information]. GlaxoSmithKline: 2019. 17. SPRIVIA RESPIMAT [prescribing information]. Boehringer Ingelheim International GmbH: 2019. 18. Knoch M, Keller M. The customised electronic nebuliser: a new category of liquid aerosol drug delivery systems. Expert Opin Drug Deliv. 2005;2(2):377-390. SUNOVION is a registered trademark of Sumitomo Dainippon Pharma Co., Ltd. Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd. ©2020 Sunovion Pharmaceuticals Inc. All rights reserved. 4/20 RESP-US-00039-20
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