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      The Use of Inhalation Therapy in the Management of Chronic Obstructive Pulmonary Disease (COPD) in the Community: A Review of Studies

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          Abstract

          Inhalation therapies are central to the management of chronic obstructive pulmonary disease (COPD). Although, findings from previous studies reveal suboptimal use and a wide range of problems with inhaler handling among COPD patients, very little is known about how and why problems arise. A systematic search of studies related to the topic area was conducted using Scopus and PubMed, from 2000 to 2013. As a result, twenty-two studies were included. Most studies had similar baseline characteristics. This review indicated that adherence to inhalation therapy was of concern. Rates of non-adherence to medication ranged from 29.5% to 80%. This review confirms non-adherence as a problem among patients and identifies factors which were potential contributors to medication non-adherence. The review reveals issues in operating the inhalation devices especially with the pressurised metered dose inhalers (pMDIs), which may lead to sub-optimal therapeutic outcomes and treatment failures.

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          Most cited references 27

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          Medication adherence issues in patients treated for COPD

          Although medical treatment of COPD has advanced, nonadherence to medication regimens poses a significant barrier to optimal management. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to therapy. An average of 40%–60% of patients with COPD adheres to the prescribed regimen and only 1 out of 10 patients with a metered dose inhaler performs all essential steps correctly. Adherence to therapy is multifactorial and involves both the patient and the primary care provider. The effect of patient instruction on inhaler adherence and rescue medication utilization in patients with COPD does not seem to parallel the good results reported in patients with asthma. While use of a combined inhaler may facilitate adherence to medications and improve efficacy, pharmacoeconomic factors may influence patient’s selection of both the device and the regimen. Patient’s health beliefs, experiences, and behaviors play a significant role in adherence to pharmacological therapy. This manuscript reviews important aspects associated with medication adherence in patients with COPD and identifies some predictors of poor adherence.
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            Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care.

            The correct use of inhalation devices is an inclusion criterion for all studies comparing inhaled treatments. In real life, however, patients may make many errors with their usual inhalation device, which may negate the benefits observed in clinical trials. Our study was undertaken to compare inhalation device handling in real life. A total of 3811 patients treated for at least 1 month with an inhalation device (Aerolizer, Autohaler, Diskus, pressurized metered dose inhaler (pMDI), or Turbuhaler) were included in this observational study performed in primary care in France between February 1st and July 14th, 2002. General practitioners had to assess patient handling of their usual inhaler device with the help of a checklist established for each inhaler model, from the package leaflet. Seventy-six percent of patients made at least one error with pMDI compared to 49-55% with breath-actuated inhalers. Errors compromising treatment efficacy were made by 11-12% of patients treated with Aerolizer, Autohaler, or Diskus compared to 28% and 32% of patients treated with pMDI and Turbuhaler, respectively. Overestimation of good inhalation by general practitioners was maximal for Turbuhaler (24%), and lowest for Autohaler and pMDI (6%). Ninety percent of general practitioners felt that participation in the study would improve error detection. These results suggest that there are differences in the handling of inhaler devices in real life in primary care that are not taken into account in controlled studies. There is a need for continued education of prescribers and users in the proper use of these devices to improve treatment efficacy.
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              Problems with inhaler use: a call for improved clinician and patient education.

              Patient education is a critical factor in the use and misuse of medication inhalers. Inhalers represent advanced technology that is considered so easy to use that many patients and clinicians do not receive adequate training in their use. Between 28% and 68% of patients do not use metered-dose inhalers or powder inhalers well enough to benefit from the prescribed medication, and 39-67% of nurses, doctors, and respiratory therapists are unable to adequately describe or perform critical steps for using inhalers. Of an estimated 25 billion dollars spent for inhalers annually, 5-7 billion dollars is wasted because of inhaler misuse. Reimbursement and teaching strategies to improve patient education could substantially reduce these wasted resources. Problems with inhaler use, the cost of inhalers, and myths associated with inhalers are reviewed, with recommendations for strategies and techniques to better educate patients in inhaler use.
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                Author and article information

                Journal
                BJPharm
                British Journal of Pharmacy
                University of Huddersfield Press
                2058-8356
                14 November 2016
                : 1
                : 1
                : 30-45
                Affiliations
                Department of Clinical and Pharmacy Practice, School of Pharmacy, Umm Al-Qura University, Al-Taif Road, Mecca 24382, Saudi Arabia
                Author notes
                *Corresponding author. Tel.: +966547003275 E-mail: f_alhomoud83@ 123456yahoo.com
                Article
                10.5920/bjpharm.2016.14
                © 2016, Farah K. Alhomoud

                This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/.

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