Gaps Remain in HCP, Patient Knowledge of Inhalation Device's Role in COPD

Nicola A. Hanania, MD, MS

New study data from the American College of Chest Physicians (CHEST) has revealed that there are several gaps remaining in both health care professional (HCP) and patient understanding of the role of inhalation devices in the management of chronic obstructive pulmonary disease (COPD).

Led by Nicola A. Hanania, MD, MS, the study utilized a duo of quantitative, web-based, descriptive, cross-sectional surveys: 1 targeting HCPs and 1 targeting patients with COPD in the United States. In total, there were 1016 responses, though 6 patient responses were discounted due to time of completion (HCP, n = 513; patient, n = 499). Of the HCP respondents, 40.8% were pulmonologists (PUDs), 29.2% primary care physicians (PCPs), and 30% non-physician providers (NPPs) such as physician assistants, respiratory care practitioners, and nurse practitioners.

HCPs reported that the severity of COPD in their patients was relatively evenly distributed between mild (24%), moderate (32%), severe (27%). When questioned about whether they prioritized medication class or device type in a newly diagnosed patient, the 89% of the HCPs polled answered medication class (94% PUDs; 89% PCPs; 82% NPPs).

“Clinicians should recognize the importance of having conversations about medication delivery devices with the patients they treat,” Hanania told MD Magazine. “Their time meeting with patients is often brief, but it is crucial not to discount the need to evaluate and reinforce proper delivery technique. We’re living in an era of personalized medicine. I think we need to broaden our treatment discussions to make sure patients’ devices meet their everyday needs and preferences according to their unique challenges.”

Additionally, 35% of all HCPs polled (33% PUDs; 28% PCPs; 43% NPPs) responded that the inhalation device is “highly important” when determining medication for a newly diagnosed, stable patient with COPD, and in total, 52% of HCPs (56% PUDs; 56% PCPs; 44% NPPs) declared the device “somewhat important.” Results were similar with regard to a newly diagnosed patient that is post-exacerbation, with 37% of HCPs considering the device “highly important” (35% PUDs; 33% PCPs; 44% NPPs) and 49% of HCPs declaring it “somewhat important” in the medication prescription process (52% PUDs; 54% PCPs; 40% NPPs).

The majority of HCPs (87%) testified that they were more likely to change or add medications than to switch inhalation devices with the same medication in patients with established COPD experiencing frequent exacerbations. In regard to proper device use, 45% of HCPs said they assessed every newly diagnosed patients’ use, 30% said they checked use frequently, and 18% reported doing so some of the time.

“It is important to find a balance [in prioritization],” Hanania said. “What works best for 1 patient might not work for another, and this is true for both medications and delivery devices. COPD treatment strategies state that the importance of inhalation device education and training cannot be over-emphasized. Certainly, if a patient makes errors in device use, either because they are unable or are insufficiently trained with the device, dose administration can be impacted. That can have an effect on symptom management.”

On the patient side, when asked about their concerns about medication effectiveness and device technique, 24% and 64% of patients said they “never worried,” respectively. On the other hand, 8% and 3%, respectively, said they “worried all of the time.”

When patients were surveyed about devices used, the majority noted that their inhalation device was very simple to use, assemble, and operate—regardless of type. Although, a markedly greater percentage of patients who used small volume nebulizers (82%) were “very confident about medication delivery” compared to patients who used dry-powder inhalers (51%), metered-dose inhalers (57%), or soft mist inhalers (62%). All told 61% to 69% of patients believed that they used their device correctly all the time, with patients who used small volume nebulizers being most confident.

“When I first saw the data, I was surprised that both physicians and patients deprioritized delivery device in favor of medication,” Hanania said. “I was also surprised how few health care providers, including pulmonologists, checked their new patients’ inhaler technique. What it tells me is that we need to continue to reinforce discussion and training around device selection with our patients.”

The study, “The Role of Inhalation Delivery Devices in COPD: Perspectives of Patients and Health Care Providers,” was published in Chronic Obstructive Pulmonary Diseases.