Frequency Of Inhaler Use Research Articles

Effect of Hospital-to-Home Transitional Care for COPD on Patient-Centered Outcomes.

Appropriate hospital-to-home transitional care has been recognized for its positive impact on health care usage and health outcomes in patients with COPD. However, there is limited research assessing its effects on patient-centered outcomes, focusing on patient symptoms and experiences. This single-blind randomized controlled trial included subjects diagnosed with COPD at one of 2 university hospitals in South Korea. The study included 179 subjects (transitional care group [transitional care], 87; usual care group [usual care], 92). The transitional care received transitional care comprising post-discharge care planning, personalized education, breathing exercises, telephone counseling, home visits, and referral to social services. We analyzed the effects of these interventions by comparing breathing symptoms and various patient-centered outcomes between the 2 groups. The Modified Medical Research Council scores (mean [SD], transitional care 1.3 [1.06], usual care 1.82 [1.1], P = .002) and COPD Assessment Test scores (transitional care 6.32 [5.5], usual care 9.43 [7.16], P = .001) in the intervention group demonstrated more significant improvement than did those in the usual care. Following intervention, the subjects exhibited enhanced awareness of their disease, an increased frequency of inhaler use (transitional care 49.69 [1.67], usual care 46.86 [7.92], P = .002), and lower depression and anxiety scores. Additionally, the transitional care outperformed the usual care in the domain of subject experience during hospitalization (transitional care 39.34 [6.14], usual care 37.5 [5.61], P = .036), preparedness before discharge (transitional care 34.54 [4.96], usual care 32.3 [5.09], P = .003), and post-discharge management (transitional care 34.72 [4.36], usual care 30.29 [4.26], P = .003). Evidence-based transitional care services can exert positive effects on patient-centered indices. Our findings can be used as evidence of the need to establish patient-centered transitional care as a form of universal care for patients with COPD.

Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany.

IntroductionWith increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE).MethodsQualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs).ResultsOverall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p<0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p<0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p<0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers.ConclusionWhen selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients’ preferences are considered may encourage treatment compliance.

PRS91 - EVALUATING PATIENT PREFERENCES OF MAINTENANCE THERAPY FOR THE TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN GERMANY: A DISCRETE CHOICE EXPERIMENT

With new single-inhaler triple therapies available for treatment of COPD, patient preferences can be used to inform treatment decisions. This study elicited patient preferences for different attributes of COPD treatments using a discrete choice experiment (DCE) in the UK, Germany and USA. This abstract presents results from Germany only. Following qualitative research in patients with COPD, attributes describing features of COPD maintenance treatments were identified: ease of inhaler use, number of exacerbations in the next year, daily frequency of inhaler use, number of different inhalers used, out-of-pocket costs, and side-effects. The online DCE survey comprised 18 choice sets with logical (dominant) choice and consistency checks, along with demographic and disease history questions. Cognitive debriefing interviews and a pilot study confirmed survey feasibility. The final DCE survey was completed by 150 patients with moderate/severe COPD in Germany. DCE data were analysed using mixed-effect logit models. The logical choice check was answered correctly by 146 (97%) participants, who were included in the final models; 112 (75%) selected the same choice within the consistency check. Patients placed most value on a treatment with fewer side effects (OR 5.14 [95% CI: 4.40-6.01] “no side effects” vs. “a lot of side effects”), fewer exacerbations (1.82 [1.69-1.97] per exacerbation per year), and which are easier to use (1.33 [1.16-1.51] “no mistakes” vs. “a lot of mistakes”). Patients also preferred treatments with fewer inhalers (1.17 [1.09-1.25] per inhaler reduction), taken less frequently (1.10 [1.02-1.17] per reduction in daily-dose), and were likely to choose a cheaper option (1.16 [1.07-1.25] per 5% decrease in cost). In principle, patients in Germany with COPD place most importance on the avoidance of side effects and reduction of symptoms when choosing a treatment. However, ease and frequency of use, inhaler number, and cost were also important drivers of choice.

EVALUATING PATIENT PREFERENCES OF MAINTENANCE THERAPY FOR THE TREATMENT OF COPD: A DISCRETE CHOICE EXPERIMENT

SESSION TITLE: Obstructive Lung Diseases 3 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: With new single-inhaler triple therapies available for maintenance treatment of advanced COPD and a wide variety of existing treatments, which can vary in terms of regimen and number of inhalers, improved understanding of patient preferences can be used to inform physicians’ prescribing decisions. As part of a wider effort to understand patient preference in both the USA and Europe, a study was conducted in the USA, UK and Germany using discrete choice experiment (DCE) methodology to assess patient treatment preferences in COPD. This abstract presents results from the USA only. METHODS: Following qualitative research in patients with COPD, attributes describing features of COPD maintenance treatments were identified: ease of inhaler use, number of exacerbations, frequency of inhaler use, number of different inhalers used, side-effects, and out of pocket costs. The DCE experimental design comprised 18 choice sets with logical (dominant) choice and consistency checks also included. Demographic and disease history data were collected and the survey was administered online. Cognitive debriefing interviews and a pilot study concluded that the survey was feasible to conduct and easily understood by respondents. The final DCE survey was completed by 150 patients in the USA recruited from patient panels. Responses to the DCE were analysed using mixed-effect logit models with the results expressed as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Of the 150 US respondents, 147 (98%) answered the logical choice check correctly and were included in the final models; 114 (76%) selected the same choice within the consistency check. Patients placed most value on an inhaler reducing exacerbation rates (OR 0.59 [95% CI: 0.54-0.65] per exacerbation per year) and avoiding a lot of side effects (0.12 [0.10-0.16] versus “no side effects”). Patients preferred treatments with fewer inhalers (0.67 [0.61-0.73] per inhaler), taken less frequently (0.78 [0.71-0.85] per daily dose), and were also likely to opt for a cheaper option if the efficacy of their treatment is not compromised (1.22 [1.12-1.33] per 5% decrease in cost). CONCLUSIONS: This study suggests that patients in the USA with COPD may place highest value on the improvement in efficacy and avoidance of side effects when choosing a treatment. They also recognised the benefit of an inhaler that is used less frequently, is less costly, and is easier to use. CLINICAL IMPLICATIONS: Patient inhaler preference is important when selecting COPD treatment as preference for an inhaler may improve treatment compliance. Patients in the USA preferred efficacious and safe, easy to use maintenance therapy for the treatment of their COPD. DISCLOSURES: No relevant relationships by Helen Doll, source=Web Response Employee relationship with GSK Please note: >$100000 Added 03/01/2018 by Necdet Gunsoy, source=Web Response, value=Salary Employee relationship with GSK Please note: $20001 - $100000 Added 03/01/2018 by Necdet Gunsoy, source=Web Response, value=Shares Employee relationship with GlaxoSmithKline Please note: >$100000 Added 03/01/2018 by Afisi Ismaila, source=Web Response, value=Salary Employee relationship with GSK Please note: >$100000 Added 03/01/2018 by Paul Jones, source=Web Response, value=Salary No relevant relationships by Hannah Lewis, source=Web Response No relevant relationships by Samuel Llewellyn, source=Web Response Employee relationship with GSK Please note: $20001 - $100000 Added 03/01/2018 by Melanie Schroeder, source=Web Response, value=Salary

Attentional bias to respiratory- and anxiety-related threat in children with asthma

This study investigated attentional biases in children with asthma. The study aimed at testing whether children with asthma are vigilant to asthma and/or anxiety cues. Thirty-six children (18 with asthma and 18 healthy controls) aged 9–12 completed a computerised dot probe task designed to measure attentional bias to three different categories of words: asthma, anxiety symptom and general negative emotion. Main caregiver anxiety was also assessed, as was frequency of inhaler use for those with asthma. Children with asthma showed an attentional bias towards asthma words but not anxiety or general negative emotion words. Children without asthma showed no significant attentional biases to any word categories. Caregiver anxiety was correlated with asthma word attentional bias in the asthma group. The findings indicate that attentional bias is present in children with asthma. Further research is required to ascertain if this exacerbates or maintains health-related problems.

Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil

OBJECTIVE: To evaluate the characteristics of users of inhalers and the prevalence of inhaler use among adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema. METHODS: A population-based study conducted in the city of Pelotas, Brazil, involving 3,670 subjects ≥ 10 years of age, evaluated with a questionnaire. RESULTS: Approximately 10% of the sample reported at least one of the respiratory diseases studied. Among those individuals, 59% reported respiratory symptoms in the last year, and, of those, only half reported using inhalers. The use of inhalers differed significantly by socioeconomic status (39% and 61% for the lowest and the highest, respectively, p = 0.01). The frequency of inhaler use did not differ by gender or age. Among the individuals reporting emphysema and inhaler use, the use of the bronchodilator-corticosteroid combination was more common than was that of a bronchodilator alone. Only among the individuals reporting physician-diagnosed asthma and current symptoms was the proportion of inhaler users higher than 50%. CONCLUSIONS: In our sample, inhalers were underutilized, and the type of medication used by the individuals who reported emphysema does not seem to be in accordance with the consensus recommendations.

Incorrect Inhaler Technique Compromising Quality of Life of Asthmatic Patients

Introduction: The inhalation route is widely used for the treatment of asthma. It is considered that inadequate inhaler technique is the leading cause of therapy failure. Objective: To determine the proportion of incorrect inhaler use and associated factors in asthmatic patients compromising quality of life. Methodology: It is a cross sectional study conducted at Specialist Chest Clinic Fatima Bhai Hospital Karachi from September 2010 to March 2011. A sample size of 215 was selected by Non-probability purposive sampling technique. Trained health care workers in presence Chest specialist requested patients to demonstrate their inhaler technique and assessed it according to the checklist. If any of the steps was missing or done incorrectly, it was marked as incorrect technique. Information was also collected through a structured questionnaire on socio-demographic variables such as age, gender, education, duration of asthma, duration of inhaler use, and patient education of inhaler technique. Data was entered and analyzed on SPSS-14. Results: There was an inverse relationship between education level and incorrect inhaler technique (p&lt;0.05). Education of inhaler usage provided by doctors was more effective as compared to education provided by nurses (p&lt;0.038). There was no significant relationship between age, sex, duration of asthma, duration of inhaler use, frequency of inhaler use and incorrect inhaler technique. Conclusion: Quality of life of a large percentage of patients is compromised by incorrect inhaler use and education level of patients had significant relationship with incorrect inhaler technique.DOI: http://dx.doi.org/10.3329/jom.v13i1.7980 JOM 2012; 13(1): 16-21