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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 34

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          Inhaler mishandling remains common in real life and is associated with reduced disease control.

          Proper inhaler technique is crucial for effective management of asthma and COPD. This multicentre, cross-sectional, observational study investigates the prevalence of inhaler mishandling in a large population of experienced patients referring to chest clinics; to analyze the variables associated with misuse and the relationship between inhaler handling and health-care resources use and disease control. We enrolled 1664 adult subjects (mean age 62 years) affected mostly by COPD (52%) and asthma (42%). Respectively, 843 and 1113 patients were using MDIs and DPIs at home; of the latter, the users of Aerolizer®, Diskus®, HandiHaler® and Turbuhaler® were 82, 467, 505 and 361. We have a total of 2288 records of inhaler technique. Critical mistakes were widely distributed among users of all the inhalers, ranging from 12% for MDIs, 35% for Diskus® and HandiHaler® and 44% for Turbuhaler®. Independently of the inhaler, we found the strongest association between inhaler misuse and older age (p = 0.008), lower schooling (p = 0.001) and lack of instruction received for inhaler technique by health caregivers (p < 0.001). Inhaler misuse was associated with increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), courses of oral steroids (p < 0.001) and antimicrobials (p < 0.001) and poor disease control evaluated as an ACT score for the asthmatics (p < 0.0001) and the whole population (p < 0.0001). We conclude that inhaler mishandling continues to be common in experienced outpatients referring to chest clinics and associated with increased unscheduled health-care resource use and poor clinical control. Instruction by health caregivers is the only modifiable factor useful for reducing inhaler mishandling. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Patient adherence to treatment: three decades of research. A comprehensive review

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              The clinical and economic burden of chronic obstructive pulmonary disease in the USA

              Chronic obstructive pulmonary disease (COPD) is the third most common cause of death in the USA. In 2010, the cost of COPD in the USA was projected to be approximately US$50 billion, which includes $20 billion in indirect costs and $30 billion in direct health care expenditures. These costs can be expected to continue to rise with this progressive disease. Costs increase with increasing severity of disease, and hospital stays account for the majority of these costs. Patients are diagnosed with COPD following a multifactorial assessment that includes spirometry, clinical presentation, symptomatology, and risk factors. Smoking cessation interventions are the most influential factor in COPD management. The primary goal of chronic COPD management is stabilization of chronic disease and prevention of acute exacerbations. Bronchodilators are the mainstay of COPD therapy. Patients with few symptoms and low exacerbation risk should be treated with a short-acting bronchodilator as needed for breathlessness. Progression of symptoms, as well as possible decline in forced expiratory volume in the first second of expiration (FEV1), warrant the use of long-acting bronchodilators. For patients with frequent exacerbations with or without consistent symptoms, inhaled corticosteroids should be considered in addition to a long-acting beta2-agonist (LABA) or long-acting muscarinic antagonist (LAMA) and may even consist of “triple therapy” with all three agents with more severe disease. Phosphodiesterase-4 inhibitors may be an option in patients with frequent exacerbations and symptoms of chronic bronchitis. In addition to a variety of novel ultra-LABAs, LAMAs and combination bronchodilator and inhaled corticosteroid (ICS) therapies, other bronchodilators with a variety of mechanisms are also being considered, to expand therapeutic options for the treatment of COPD. With more than 50 new medications in the pipeline for the treatment of COPD, optimal management will continue to evolve and grow more complex as benefits of therapy are balanced with the limitations and needs of each patient.
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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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