Opportunities for inhaler device selection in elderly patients with asthma or COPD

Abstract

An anticipated surge in the elderly population will be accompanied by a rise in aging patients with asthma or COPD. Clinician selection of inhalers needs to address the unique challenges to elderly patients. These challenges to the use of inhalers include diminished physical and cognitive abilities, as well as cost reimbursement issues associated with polypharmacy and the Medicare gap. Clinicians should consider patient preferences for an inhaler device that provides ease of administration, and addresses conveniences such as portability, visual, and auditory indicators of dosing completion. The addition of spacer devices resolves hand-breath coordination difficulty with pressurized metered dose inhalers, but reduces overall inhaler convenience. Soft mist inhalers (Respimat ®) improve ease of administration, but use may be limited by cost and formulary availability. Multiple dose dry powder inhalers provide convenience and simplified use by requiring only one to two steps prior to administration, but concerns of peak inspiratory flow requirements remain among patients with advanced age and severity of COPD. If unaddressed, these challenges to inhaler selection contribute to inappropriate use of inhalers in 41% to 69% of patients, accompanied by at least 51% non-adherence to treatment. Clinicians must first avail themselves of reputable educational resources regarding new inhaler developments and administration, for competent patient instruction. Patient education should include a checklist of inhaler technique, with physical demonstration of each device by the patient and provider. Device demonstration significantly improves inhaler technique and identifies the need for nebulization therapy. Clinician and patient knowledge of available inhalers and their administration should initiate shared decision-making involving patient and provider medication preferences and choices. Patient education and shared decision-making should be longstanding and opportunistic, addressing failed inhaler adherence in the outpatient setting, and the contribution of inhaler non-adherence to hospital admissions and emergency department visits.

<p>Inhaler Devices in a Geriatric Patient Population: A Prospective Cross-Sectional Study on Patient Preferences</p>

“…Above all, ease-of-use of an inhaler seems to markedly influence geriatric patients' preference for a device. 22 Our results are consistent with the literature on this point. A study conducted in France assessed asthma and COPD patients' preferences for different attributes of DPIs.…”

“…When choosing suitable inhalers for geriatric patients, the patient's specific needs, physical and cognitive abilities and preferences should be taken into account, 22 for matching the patients to the device that is the most appropriate for them. [35][36][37] In respiratory disorders, patient-perceived satisfaction with the inhaler device is an important factor driving treatment adherence and outcomes.…”

“…20 If these challenges were not addressed, 41% to 60% of patients used their inhaler inappropriately, which was accompanied by a non-adherence rate of at least 51%. 22 Therapeutic success of inhalation therapy depends not only on the correct inhalation technique but also on the patient's perception, preference and satisfaction with the inhaler device. 9,11 Multiple factors determine the patient's preference for an inhaler, and understanding these factors is critical to improve adherence and, hence, the treatment results.…”

How to Choose the Right Inhaler Using a Patient-Centric Approach?

“…Several patient-related factors codetermine the choice of an inhaler, such as disease severity, comorbidities, level of coordination, manual dexterity, rheumatismal problems, physical properties (sex, height), and cognitive function [2,4,57]. To construct a practical tool, the expert panel defined three core questions to which the answers can provide guidance to decide which device types can be used for a specific patient, with a focus on adults.…”

<p>Choosing the right inhaler for your asthma or COPD patient</p>

“… Challenges with the use of inhalation therapy in elderly patients, and an algorithm for appropriate inhaler device selection. 26 , 92 , 93 …”