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.
The 2016 survey of 205 US 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 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% considered themselves knowledgeable or very knowledgeable about treatment devices overall
- 34% considered themselves knowledgeable or very knowledgeable about small-volume nebulizers
- 70% typically discussed the use of a device on a patient’s first visit
- 43% said they felt very knowledgeable in teaching patients how to use their device
- 22% felt very knowledgeable in teaching patients how to clean and maintain their device
- 83% said they would like to learn more about treatment devices
In addition, the survey also found among respondents:
- 56% believed that SVNs are essential for some COPD patients
- 63% 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% 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.
“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,” said Braman. “This may be beneficial to certain patients.”