Clinical and economic outcomes of multiple versus single long-acting inhalers in COPD

Yu, Andrew P.; Guérin, Annie; Leon, Diego Ponce de; Ramakrishnan, Karthik; Wu, Eric Q.; Mocarski, Michelle; Blum, Steven I.; Setyawan, Juliana

doi:10.1016/j.rmed.2011.07.001

Cited by 46 publications

(36 citation statements)

References 12 publications

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“…The current results are also consistent with studies showing that simpler treatment regimens are more effective in COPD. Large observational studies by Yu et al14 and Chrischilles et al15 found that patients using multiple inhaler devices, rather than a single device, had increased hospital resource utilization and number of exacerbations. Although the cohorts in the current study were comparable in terms of number of devices, the trend toward simplicity is common in both scenarios.…”

Section: Discussionmentioning

confidence: 99%

“…Incorrect inhalation technique is well-recognized as a problem with patients using only one inhaler, and it could be compounded when introducing additional inhalers into a treatment regimen. Use of multiple inhalers compared to single inhalers has been shown to have an adverse effect on outcomes, even without consideration of inhalation technique 14,15…”

Section: Introductionmentioning

confidence: 99%

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The use of multiple respiratory inhalers requiring different inhalation techniques has an adverse effect on COPD outcomes

Bosnic‐Anticevich

Chrystyn

Costello

et al. 2016

COPD

100

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BackgroundPatients with COPD may be prescribed multiple inhalers as part of their treatment regimen, which require different inhalation techniques. Previous literature has shown that the effectiveness of inhaled treatment can be adversely affected by incorrect inhaler technique. Prescribing a range of device types could worsen this problem, leading to poorer outcomes in COPD patients, but the impact is not yet known.AimsTo compare clinical outcomes of COPD patients who use devices requiring similar inhalation technique with those who use devices with mixed techniques.MethodsA matched cohort design was used, with 2 years of data from the Optimum Patient Care Research Database. Matching variables were established from a baseline year of follow-up data, and two cohorts were formed: a “similar-devices cohort” and a “mixed-devices cohort”. COPD-related events were recorded during an outcome year of follow-up. The primary outcome measure was an incidence rate ratio (IRR) comparing the rate of exacerbations between study cohorts. A secondary outcome compared average daily use of short-acting beta agonist (SABA).ResultsThe final study sample contained 8,225 patients in each cohort (mean age 67 [SD, 10], 57% males, 37% current smokers). Patients in the similar-devices cohort had a lower rate of exacerbations compared with those in the mixed-devices cohort (adjusted IRR 0.82, 95% confidence interval [CI] 0.80–0.84) and were less likely to be in a higher-dose SABA group (adjusted proportional odds ratio 0.54, 95% CI 0.51–0.57).ConclusionCOPD patients who were prescribed one or more additional inhaler devices requiring similar inhalation techniques to their previous device(s) showed better outcomes than those who were prescribed devices requiring different techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The use of multiple respiratory inhalers requiring different inhalation techniques has an adverse effect on COPD outcomes

Bosnic‐Anticevich

Chrystyn

Costello

et al. 2016

COPD

100

View full text Add to dashboard Cite

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“…Previously, Yu and colleagues have shown that COPD patients using multiple long-acting inhalers experience significantly more exacerbations than those using a single long-acting inhaler (23). In this study, we found that the number of respiratory medications was significantly associated with the frequency of exacerbations or severe exacerbations.…”

Section: Discussionmentioning

confidence: 99%

Significance of Medication History at the Time of Entry into the COPDGene Study: Relationship with Exacerbation and CT Metrics

Park

Make

Hersh

et al. 2014

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Background Despite the importance of respiratory medication use in COPD, relatively little is known about which clinical phenotypes were associated with respiratory medications. Methods To determine the association between respiratory medication use and exacerbations or quantitative CT metrics, we analyzed medication history from 4,484 COPD subjects enrolled in the COPDGene Study. Results 2,941 (65.6%) subjects were receiving one or more respiratory medications; this group experienced more frequent exacerbations in the year before study entry and had increased gas trapping, emphysema, and subsegmental airway wall area, compared to the patients who were on no respiratory medication. In subgroup analysis, subjects who were on triple therapy (long-acting beta2-agonist [LABA], long-acting muscarinic antagonist [LAMA], and inhaled corticosteroids [ICS]) had the highest frequencies of exacerbations and severe exacerbations and tended to have increased quantitative measures of emphysema and gas trapping on CT compared to other five groups. After adjustment for confounding variables, the triple therapy group experienced more exacerbations and severe exacerbations compared with other five groups. In addition, the LABA+LAMA+ICS group was more likely to have emphysema and gas trapping on CT than other groups in multivariable logistic analysis. Interestingly, the total number of respiratory medications was significantly associated with not only the frequency of exacerbations but also gas trapping and airway wall thickness as assessed by CT scan in multivariable analysis. Conclusions These results suggest that the use of respiratory medications, especially the number of medications, may identify a more severe phenotype of COPD that is highly susceptible to COPD exacerbations.

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“…In addition to providing improvements in airflow limitation and symptom control, dual bronchodilator therapy reduces the risk of adverse effects that may be associated with increased dosages of a single bronchodilator [1]. The use of a fixed-dose combination (FDC), in which the two agents are combined in a single device, may improve adherence, leading to improved outcomes and reduced costs [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

A randomized, seven-day study to assess the efficacy and safety of a glycopyrrolate/formoterol fumarate fixed-dose combination metered dose inhaler using novel Co-Suspension™ Delivery Technology in patients with moderate-to-very severe chronic obstructive pulmonary disease

et al. 2017

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BackgroundLong-acting muscarinic antagonist/long-acting β2-agonist combinations are recommended for patients whose chronic obstructive pulmonary disease (COPD) is not managed with monotherapy. We assessed the efficacy and safety of glycopyrrolate (GP)/formoterol fumarate (FF) fixed-dose combination delivered via a Co-Suspension™ Delivery Technology-based metered dose inhaler (MDI) (GFF MDI).MethodsThis was a Phase IIb randomized, multicenter, placebo-controlled, double-blind, chronic-dosing (7 days), crossover study in patients with moderate-to-very severe COPD (NCT01085045). Treatments included GFF MDI twice daily (BID) (GP/FF 72/9.6 μg or 36/9.6 μg), GP MDI 36 μg BID, FF MDI 7.2 and 9.6 μg BID, placebo MDI, and open-label formoterol dry powder inhaler (FF DPI) 12 μg BID or tiotropium DPI 18 μg once daily. The primary endpoint was forced expiratory volume in 1 s area under the curve from 0 to 12 h (FEV1 AUC0–12) on Day 7 relative to baseline FEV1. Secondary endpoints included pharmacokinetics and safety.ResultsGFF MDI 72/9.6 μg or 36/9.6 μg led to statistically significant improvements in FEV1 AUC0–12 after 7 days’ treatment versus monocomponent MDIs, placebo MDI, tiotropium, or FF DPI (p ≤ 0.0002). GFF MDI 36/9.6 μg was non-inferior to GFF MDI 72/9.6 μg and monocomponent MDIs were non-inferior to open-label comparators. Pharmacokinetic results showed glycopyrrolate and formoterol exposure were decreased following administration via fixed-dose combination versus monocomponent MDIs; however, this was not clinically meaningful. GFF MDI was well tolerated.ConclusionsGFF MDI 72/9.6 μg and 36/9.6 μg BID improve lung function and are well tolerated in patients with moderate-to-very severe COPD.Trial registrationClinicalTrials.gov NCT01085045. Registered 9 March 2010.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-016-0491-8) contains supplementary material, which is available to authorized users.

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Clinical and economic outcomes of multiple versus single long-acting inhalers in COPD

Abstract: After controlling for a number of potentially confounding factors, multiple-inhaler users had more exacerbations, a higher risk of exacerbation, and higher healthcare resource utilization and costs compared to single-inhaler users.

Cited by 46 publications

References 12 publications

The use of multiple respiratory inhalers requiring different inhalation techniques has an adverse effect on COPD outcomes

The use of multiple respiratory inhalers requiring different inhalation techniques has an adverse effect on COPD outcomes

Significance of Medication History at the Time of Entry into the COPDGene Study: Relationship with Exacerbation and CT Metrics

A randomized, seven-day study to assess the efficacy and safety of a glycopyrrolate/formoterol fumarate fixed-dose combination metered dose inhaler using novel Co-Suspension™ Delivery Technology in patients with moderate-to-very severe chronic obstructive pulmonary disease

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