In an era of personalized medicine, physicians treating patients with chronic obstructive pulmonary disease (COPD) should consider individualized therapy depending on disease severity and the cost and availability of medications. However, some physicians may not be as informed as they would like to be about which inhalation devices for COPD are best for which patients, according to a survey designed by American Thoracic Society clinicians and scientists and conducted by Harris Poll, which was published in the July issue of Respiratory Care.
The 2016 survey of 205 U.S. pulmonologists and pulmonary fellows focused particularly on small-volume nebulizers (SVNs). According to the authors, these devices offer several advantages, including delivering high concentrations of drugs to the airways due to the large volume of liquid that can be delivered via such devices. These devices are an important option for COPD patients seeking treatment that is administered through natural breathing.
“The 2018 International Global Initiative for Chronic Obstructive Lung Disease Report stresses the importance of patient education and training in inhalation device technique, especially with elderly patients and patients using multiple devices,” said lead study author Sidney S. Braman, MD, a professor of medicine and COPD expert at the Icahn School of Medicine at Mount Sinai in New York City.
According to Dr. Braman, observational studies have identified an important relationship between poor inhalation device technique and symptom control in patients with COPD, and yet, more than two-thirds of patients make at least one error in using an inhalation device.
“The choice of inhalation device must account for the skills and ability of the patient,” he said. “It is essential for the clinician to ensure that inhalation device technique is correct and to re-check this at each visit.”
The survey found that among respondents:
54 percent considered themselves knowledgeable or very knowledgeable about treatment devices overall, but only 34 percent considered themselves knowledgeable or very knowledgeable about small-volume nebulizers.
70 percent typically discussed the use of a device, on a patient’s first visit, but only 43 percent said they felt very knowledgeable in teaching patients how to use their device and even fewer, 22 percent, in how to clean and maintain their device.
83 percent said they would like to learn more about treatment devices.
In addition, the survey also found among respondents:
56 percent believed that SVNs are essential for some COPD patients.
63 percent of pulmonologists and fellows believed hand-held SVNs are more effective than pressurized metered-dose inhalers (pMDIs) or dry powder inhalers (DPIs) as maintenance therapy in COPD patients with the most severe levels of dyspnea.
70 percent believed that hand-held SVNs are more effective than pMDIs or DPIs in managing COPD exacerbations.
Study limitations include the fact that pulmonologists surveyed stated that they had a special interest in COPD, so results may not be generalizable to all pulmonologists. The study did not attempt to measure the impact of the clinicians’ knowledge or perceptions of inhalation devices on actual patient care.
Dr. Braman added, “SVNs appear to offer important options. Unlike pMDIs and DPIs, SVNs administer treatment through natural breathing, so no special breathing technique is needed to get the full therapeutic benefit,” he said. “This may be beneficial to certain patients.”