First Quarter Edition 2017
Feature article
Technology advances build case for prescribing nebulizers
Following the advent of meter dosed inhalers (MDIs), nebulizers were mostly used by patients who were unable to receive the appropriate medication dose through the quick-delivery method, especially elderly and pediatric patients. Patients who preferred inhalers associated nebulizers with restricted mobility and considered traditional equipment to be bulky and noisy. But recent technology advances in nebulizer equipment have shone new light on the advantages of prescribing nebulizers over inhalers, especially smaller, more mobile options offering increased patient adherence and decreased hospital readmissions.
Recognizing one’s health can be impacted by reduced adherence, the World Health Organization conducted a comprehensive review on non-adherence.3 It was recognized that non-adherence behaviors as spilt almost equally between conscious and unconscious behaviors, or those where a patient struggles to comply with the regimen due to competing demands on their lifestyle that may lead to forgetfulness or disorientation, and those where a patient makes a deliberate decision to discontinue treatment based on cost or beliefs about effectiveness.3 While unconscious behaviors can be addressed through reminders or training aids, solutions for conscious non-adherence must be tailored to the patient.3 Some ways to motivate non-adherent COPD patients include monitoring, education, goal-setting and management plans, but in order to intervene effectively, nebulizer devices must automatically record adherence patterns and provide feedback.1 New devices now offer the opportunity to monitor both adherence and technique, providing information on the pattern of non-adherence and allowing clinicians to create a customized approach for improved adherence.1 Current mobile and web apps for patient medication management may offer reminders, but these only address unconscious non-adherence behaviors. Most apps rely on the patient to enter information on their adherence, but there are a few products that permit automated and, in most cases, remote tracking of adherence. Looking forward, nebulizers will offer more opportunities to combine remote management of medication with monitoring of other symptoms of disease to prevent or intercept exacerbations. Data will not only be recorded and monitored, but also transmitted from the nebulizer to a pharmacy to fill repeat electronic prescription requests and deliver the prescription directly to a patient’s home. Among the most technologically advanced and sophisticated nebulizer systems is the I-neb Adaptive Aerosol Delivery System (Philips Respironics). The I-neb allows for remote monitoring of adherence for nebulized therapies and contains a data-logging system that can be interfaced to a computer.4 First, this allows patients to train themselves to inhale slowly and deeply, thereby maximizing the time spent nebulizing and minimizing treatment time. In a randomized controlled trial by McCormick and McNamara, this feature proved popular with patients, as it resulted in an approximate 40% reduction in treatment time.2 The shorter treatment times also correlate with higher levels of adherence, confirming that the patient appears more likely to take their treatment if it is less of an intrusion into their daily life.1 The healthcare provider can also download the information to observe patterns of behavior, for example missed doses at lunchtimes or weekends, and then hold an informed conversation with the patient as to how they might modify their behaviors in order to improve adherence5. This is currently being used to manage pulmonary arterial hypertension (PAH) patients on nebulized iloprost.1
For a patient’s perspective on using I-neb, click below.
Reference: 1. Von Hollen, Dirk, BSc, and John N. Pritchard, PhD. "Nebulized Therapy." Advance Healthcare Network. Advance for Respiratory Care and Sleep Medicine, 2014. Web. 10 Feb. 2017. (Note: this published paper references a study conducted by Philips Respironics) 2. McCormack P, McNamara PS, Southern K. A randomised controlled trial of breathing modes for adaptive aerosol delivery in children with cystic fibrosis. J Cyst Fibros. 2011;10(5):343-349. 3. Adherence to Long-Term Therapies: Evidence for Action. Geneva: WHO; 2003. 4. Dhand, Rajiv. "Intelligent Nebulizers in the Age of the Internet: The I-neb Adaptive Aerosol Delivery (AAD) System." Journal of Aerosol Medicine and Pulmonary Drug Delivery. Mary Ann Liebert, Inc., Apr. 2010. Web. 23 Feb. 2017. 5. Dyche T et al., The association of true adherence, inhalation time and treatment time for patients using the I-neb AAD System. Respiratory Drug Delivery 2012;3:679-684
New Sleep and Respiratory Care (SRC) Medical Education Updates
Four new online continuing medical education activities are now available on the CHESTTM Journal website in the CME Resource Center: *Presentations available in German and English COPD Advanced Patient Management: Post-acute care
Servo Ventilation Therapy for Sleep Disordered Breathing
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released its latest report with recommendations for the assessment and treatment of chronic obstructive pulmonary disease (COPD). A refined ABCD assessment tool is just one of the changes. The ABCD assessment tool has been updated to separate airflow limitations from clinical parameters. With this change, the process of categorizing patients no longer relies solely on spirometry. While spirometry is required to make the diagnosis of COPD, the condition should be considered in any patient who has dyspnea, chronic cough, sputum production, or a history of exposure to risk factors. ABCD categories should now be assigned based on respiratory symptoms and each patient’s individual history of exacerbations. The refined ABCD assessment tool:
Consider this patient
Old Guideline: This patient would have been classified as: GOLD grade 3, Group C
New Guideline: This patient is now classified as: Group A
The refined ABCD assessment tool now clearly shows what is being evaluated and assessed. It allows for quick initiation of treatment in the ER and/or for hospitalization, including: Reference: "GOLD 2017 Global Strategy for the Diagnosis, Management and Prevention of COPD." Global Initiative for Chronic Obstructive Lung Disease - GOLD. Global Initiative for Chronic Obstructive Lung Disease, 2017. Web. 10 Feb. 2017. For additional GOLD guideline changes, please see the COPD Insider.
Connect with Philips
Mark your calendars for the following conferences where Philips Respironics will share information about its latest technology and discuss the most important issues facing sleep medicine and respiratory care. Sleep & Breathing 2017 Sleep and Breathing 2017 conference will take place in Marseille, France, April 6-8. This year marks the fourth international conference organized by the European Respiratory Society (ERS) and the European Sleep Research Society (ESRS). Sleep and Breathing offers an integrated approach to the investigation and treatment of sleep disorders. American Thoracic Society (ATS) 2017 ATS will take place in Washington, D.C., May 19-24. It features groundbreaking research in pulmonary, critical care, and sleep medicine. This year will mark the 113th year of the conference. SLEEP (APSS) 2017 The 31st Annual Meeting of the Associated Professional Sleep Societies (APSS) will take place in Boston, MA, June 3-7. The SLEEP meeting provides evidence-based education to advance the science and clinical practice of sleep medicine, disseminates cutting-edge sleep and circadian research, promotes the translation of basic science into clinical practice and fosters the future of the field by providing career development opportunities at all levels. European Respiratory Society (ERS) International Congress ERS 2017 will take place in Milan, Italy, Sept 9-13. The event is catered to needs of all respiratory care professionals, from scientists to clinicians and allied health professionals.
