Showing papers by "Federico Lavorini published in 2015"

Switching treatments in COPD: implications for costs and treatment adherence

Abstract: Inhaled therapy is key to the management of chronic obstructive pulmonary disease (COPD). New drugs and inhalers have recently been launched or will soon become available, and the expiry of patent protection covering several currently used inhaled bronchodilators and corticosteroids will be accompanied by the development of bioequivalent, generic inhaled drugs. Consequently, a broader availability of branded and generic compounds will increase prescription opportunities. Given the time course of COPD, patients are likely to switch drugs and inhalers in daily practice. Switching from one device to another, if not accompanied by appropriate training for the patient, can be associated with poor clinical outcomes and increased use of health care resources. In fact, while it seems reasonable to prescribe generic inhaled drugs to reduce costs, inadequate use of inhaler devices, which is often associated with a poor patient-physician or patient-pharmacist relationship, is one of the most common reasons for failure to achieve COPD treatment outcomes. Further research is needed to quantify, as in asthma, the impact of inappropriate switching of inhalers in patients with COPD and show the outcomes related to the effect of using the same device for delivering inhaled medications.

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly.

Abstract: Inhaled corticosteroids (ICSs) are widely used in the treatment of patients with chronic obstructive pulmonary diseases. However, high-dose regimens and long-term use of ICSs have the potential to cause a variety of local and systemic side effects such as candidiasis, cataracts, glaucoma, and osteoporosis. The use of ICSs can also be associated with the risk of bone fractures, diabetes mellitus and pneumonia. These ICS-related side effects are of particular importance in elderly patients due to the presence of comorbidities and age-related behavioral, cognitive, and psychological problems, which can all interact with inhaled treatment. We reviewed the available literature on the clinically relevant side effects of ICSs in the elderly to provide practical measures to properly monitor and manage the risk of ICSs in the geriatric population. Inspection of the mouth, monitoring of ocular pressure, and use of bone-protective drugs may be necessary in patients on prolonged ICS therapy. Above all, the use of the lowest possible ICS dose and a careful re-assessment of the inhalation procedure should be recommended. Taken together, these observations suggest that physicians should use ICSs appropriately for those patients in whom the benefit will outweigh the risk, especially chronic obstructive pulmonary disease (COPD) patients with previous frequent exacerbations. Given the paucity of information on the topic and the need to extrapolate the results from studies with broader age ranges, we strongly encourage the design of specifically tailored clinical studies in the elderly.

P154 Evaluation of Inhaler Technique Mastery for Budesonide Formoterol Spiromax® Compared with Symbicort Turbohaler® in Adult Patients with Asthma: Primary Results From the Easy Low Instruction Over Time [ELIOT] Study

Abstract: Introduction and objectives Technical errors in the use of inhalers are associated with poor asthma control. This study evaluated achievement of mastery in a training environment using a randomised cross-over design (stage 1), followed by randomization into a prospective 12-week trial to assess maintenance of mastery in patients receiving inhaled corticosteroids (ICS)/long-acting β2-agonists (LABA) via SPIROMAX versus ICS/LABA received via TURBOHALER (stage 2). Methods Patients with asthma were randomised to a 6-step training protocol using empty Spiromax and empty Turbohaler devices. The proportion of patients achieving and maintaining inhaler mastery, respectively defined as the absence of health care professional (HCP)-observed errors by training step 3 (instructional video) in stage 1, and the absence of HCP-observed errors after 12 weeks of inhaler use in stage 2, were analysed using logistic regression. The maintenance of independent expert video-observed inhaler mastery was analysed using logistic regression. Total observed errors (HCP and technology) were analysed using a negative binomial regression model. Vitalograph Pneumatic Spirometry results were compared using a Mann Whitney U test. Results A total of 493 (89.1%) patients (stage 1) and 305 (61.9%) (stage 2) were eligible for the full analysis set. The odds of maintaining inhaler mastery were not significantly different for patients using either inhaler, although achieving inhaler mastery was significantly greater in patients using Spiromax compared with Turbohaler at baseline. A higher, non-significant percentage of patients using Spiromax maintained inhaler mastery (assessed by HCPs). This result was supported by significantly higher odds of maintaining mastery when HCP errors were calibrated using independent video assessment in patients using Spiromax (consented videos available for 243/305 patients [79%]). Maintaining inhaler mastery improved asthma control in both treatment groups and was not significantly different (Table 1). Conclusions The proportion of patients achieving inhaler mastery at baseline was significantly greater for Spiromax compared with Turbohaler; no significant difference was found in inhaler mastery at 12 weeks. Patients using Spiromax made significantly fewer errors overall (HCP-observed and HCP- and technology-observed) than patients using Turbohaler. Maintaining inhaler mastery improved asthma control in both treatment groups. Independent video assessment can assist HCPs in evaluating device mastery, and is proposed as the gold standard in such studies.

Prevalence of serious post-training inhaler technique errors made by device-naïve patients using three different dry powder inhalers (DPIs)

Abstract: Introduction: Many patients with asthma and COPD make serious inhaler technique errors, which can impair dose delivery and have an adverse impact on clinical outcomes. Aim: To compare the prevalence of serious inhaler technique errors made by patients with asthma and/or COPD after training on DPIs in real life. Methods: Single visit, prospective, randomised, crossover study. Patients ≥18 years and naive to study devices were randomised to training on PulmoJet® and comparator DPIs (Diskus® or Turbohaler®). Patients inhaled through empty devices after reading the patient information leaflet (PIL); if errors (those potentially affecting dose delivery) were observed they repeated the inhalations after video demonstration (PIL+video). Errors were recorded using nurse observed (check list) and technological (spirometry) methods. Conditional logistic regression was used to compare errors for PulmoJet vs comparator DPIs ( p Results: Of 431 patients, 421 eligible and 416 completed technological assessment. Patients were less likely to make errors using PulmoJet vs comparator devices (table). Conclusion: Device-naive patients with asthma and/or COPD were significantly less likely to make serious inhaler technique errors with PulmoJet compared with Diskus or Turbohaler after reading the patient information leaflet, both with and without additional video demonstration training.

Endobronchialer Ultraschall mit Führungsschleuse für reine oder gemischte Milchglastrübungen

Abstract: Hintergrund: Milchglastrubungen (MGT) sind mittels transbronchialer Biopsie (TBB) schwierig zu diagnostizieren. Ziele: Wir ve

Neue Inhalationshilfen - Die guten und die schlechten Nachrichten

Abstract: Aerosole sind eine wirkungsvolle Art, Arzneimittel gezielt in die Lunge einzubringen, um obstruktive Atemwegserkrankungen wie Asthma und chronisch-obstruktive Lungenerkrankung (COPD) zu behandeln. In

Wirksamkeit endobronchialer Coils zur Lungenvolumen-Reduktion bei Patienten mit schwerem heterogenem Lungenemphysem und bilateral inkompletten Fissuren: Eine Nachbeobachtung über 6 Monate

Abstract: Hintergrund: Die Lungenvolumen-Reduktion mittels Coils (LVRC) kann bei Patienten mit schwerem heterogenem Lungenemphysem und inkompletten Fissuren eine wirksame B