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  1. Meet Ken, a LONHALA MAGNAIR user. Ken, like many people living with COPD, struggled to manage his symptoms with previous treatments. He was motivated to find an option that worked as his disease progressed. For patients like Ken, there’s LONHALA MAGNAIR LONHALA MAGNAIR 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 MAGNAIR should not be used as a rescue therapy. Patients should always have a rescue inhaler with them to treat sudden symptoms of COPD. LONHALA MAGNAIR features include: Patients use their natural breathing to take treatment1 Fine, flowing mist administered in 2-3 minutes (with proper assembly and cleaning)1,2* Virtually silent administration3 All within a small, portable, and battery-operated device1† LONHALA vials should only be administered with MAGNAIR. *Improper cleaning and maintenance may increase administration time.1 †Handset is 2.4 x 4.7 inches. Controller is 1.6 x 4.6 inches. MAGNAIR weighs 10.2 ounces (including batteries).1 How individualizing Ken’s COPD treatment helped him If Ken’s story reminds you of any of your patients, then your go-to devices may not be working for them. According to GOLD (Global Initiative for Chronic Obstructive Lung Disease), the choice of device should be individualized based on patient ability and preferences.4‡ It’s important to note that GOLD does not endorse any specific treatments. While a patient’s preference may be subjective, their ability to use their device can be assessed objectively. Look out for issues, such as, if the patient has5§: Comorbidities that impair their ability to use their device properly Limited inspiratory flow that makes it difficult to inhale the medication Difficulties using the inhaler regardless of how much instruction they are provided The factors listed above could introduce patient errors when administering their treatment.4 It’s important to adjust treatments if you assess that the treatment and/or device doesn’t align with your patient's abilities and preferences.4 Individual results may vary. ‡No randomized trials have identified superiority of one device or formulation.4 §Depending on patient abilities, caregiver assistance may be required for a COPD inhalation device. References: 1. LONHALA MAGNAIR [manufacturer’s instructions for use]. Marlborough, MA: Sunovion Pharmaceuticals Inc.; 2019. 2. Pham S, Ferguson GT, Kerwin E, Goodin T, Wheeler A, Bauer A. In vitro characterization of the eFlow closed system nebulizer with glycopyrrolate inhalation solution. J Aerosol Med Pulm Drug Deliv. 2018;31(3):162-169. 3. Data on file. PARI. Test report: loudness measurement eLete. November 30, 2017. 4. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2020:1-125. 5. 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. IMPORTANT SAFETY INFORMATION & 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 http://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-00041-20
  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
  3. PedsRN91

    Nebulizer/MDI for toddlers advice

    Hi all, I'm looking for advice from those with experience administering MDI/nebulizer treatments to toddlers. I've scoured the internet looking for resources but thought my best bet would be from those with actual experience! Mostly looking for any recommendations to make life easier for those terrified 2 year olds who are fighting the nebulizer/MDI and for the parents/nurses attempting to administer the medication. My patient today fought so hard that the provider eventually prescribed albuterol syrup (which I never knew existed honestly). Any tips/info would be greatly appreciated.
  4. ariessanne

    Nebulizer

    Hi. If you received an order to administer different nebulizer: albuterol, brovana, pulmicort to a patient, in what order you will administer it? Would you mix albuterol and ipratropium together or administer it separately?
  5. Dani95rn

    Oxygen too high for COPD patient?

    Hi everyone it's my first post here. I started my first nursing job a couple of months ago after graduating in May. I'm on orientation and made a mistake regarding oxygen delivery to a patient. I had a COPD patient using her BiPap at night. I gave a nebulizer treatment and attached it to her BiPap mask and connected it to the wall oxygen. Now I know BiPap delivers a certain amount of oxygen in itself. I turned the nebulizer treatment up to about 5 lpm so she was getting the oxygen from nebulizer plus BiPap. I became busy and returned hours later to find that I kept the nebulizer with the oxygen connected to the mask still going. I'm worried I gave her too much oxygen. Patient was alert and fine. Another nurse told me the BiPap would help prevent any side effects of too much oxygen? I don't know if this is true or not. I feel so dumb!!
  6. Hi, I'm a new RN at a SNF and I was checking on some medication charting for patients during the NOC shift and I see that a tracheostomy patient has an order for albuterol sulfate but that charting states that is is not being given at nighttime because patient is asleep. My question is that is albuterol sulfate via trach or nebulizer usually done during NOC shift or is this nurse in the wrong?
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