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Topics About 'Chronic Obstructive Pulmonary Disease'.

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  1. 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
  2. Chronic Obstructive Pulmonary Disease (COPD) Many patients with chronic obstructive pulmonary disease (COPD) struggle to use their inhalers properly.1 Though COPD is the fourth-leading cause of death in the United States, proper treatment can help many patients manage their condition.1,2 Unfortunately, the challenges presented by inhalation devices can place an additional burden on an already vulnerable patient population.1 It is critical that healthcare professionals work with patients to train them on inhalation techniques upon initiating treatment. In follow-up appointments, physicians and nurses should reassess and refresh patients on proper technique; and, when necessary, it may be important for healthcare professionals to consider and advocate for alternative device options for appropriate patients.1 A meta-analysis published in Chronic Obstructive Pulmonary Diseases in 2019 was a strong reminder of that basic tenet of treating patients with COPD: a large fraction of patients may not be getting adequate treatment because they are making errors with their inhalers. Metered-dose inhalers (MDIs) are the most commonly prescribed handheld device for treating COPD patients, but MDIs require hand–breath coordination that can be a barrier to proper administration. Some delivery devices, such as nebulizers, may be preferred by some patients. COPD treatments and devices vary and should be individualized to a patient's needs and abilities. Matching the proper delivery device to the correct patient can make a significant difference for patients struggling with their MDIs.1 How many patients are making errors with their MDIs? Eight in 10 patients who used an MDI made at least 1 error in taking their medication, according to the meta-analysis, which aggregated data for 1360 individuals across 10 published studies. Furthermore, the study showed that 7 in 10 patients performed ≥20% of their devices’ steps incorrectly.1 Though these numbers might seem high, the authors point out that they are in line with previous studies of MDI usage.1 The problem has been well documented by others looking at adherence and device usage in COPD. In other select reports, researchers have shown that ~25% of patients never receive instructions on how to use their device, and 69% report that their healthcare providers have never watched them try to take their medication.1 What kinds of errors are patients making? Coordinating breath, generating an adequate inspiratory force, and engaging the device by hand can be challenging, especially for a patient population plagued by comorbidities that include dementia and arthritis in addition to their breathing difficulties.1 The authors of the meta-analysis highlighted the following mistakes: 2 in 3 patients had trouble exhaling fully away from the MDI before inhalation (ie, failure to empty their lungs)1 2 in 5 patients failed to hold their breath after inhaling. This type of error can negatively impact treatment because of poor medication deposition1 1 in 3 patients failed to inhale slowly and deeply1 1 in 3 patients failed to shake the MDI1 What can be done? Clearly, nurses treating patients with COPD have significant challenges to overcome. More patient education and assessing and reassessing their patients’ technique with MDIs are crucial steps.1 Nurses should advocate for treatment options that suit their patients’ abilities and preferences, which may include nebulized therapies.1 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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