In COPD, Medication Delivery Matters

By: Nicola Hanania, MD, MS, FCCP

December 14, 2017

Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is a progressive respiratory disease that causes worsening obstruction to airflow in the lungs over time. Approximately 15.7 million adults in the United States report that they have been diagnosed with COPD. It is estimated that several million more are undiagnosed. COPD is responsible for over 120,000 deaths per year, making it the third-leading cause of death in the United States.

There are many treatments that help patients with COPD feel and function better. Most of these treatments for COPD are delivered by inhalation, and several delivery devices are currently available. However, recent data show that health-care providers (HCPs) often prescribe COPD medications, failing to consider the way these devices may significantly impact their patients.

In August 2016, CHEST and Sunovion Pharmaceuticals Inc. announced a strategic initiative focused on increasing recognition of the importance of medication delivery in evaluating therapy for patients with COPD. As a part of this collaboration, the organizations launched the Delivery Makes a Difference survey, which aimed to understand patient and HCP practices and to provide tools for matching patients with appropriate medications and delivery devices.

Some of the key findings gathered from research conducted in the Delivery Makes a Difference survey include:

• Patients, like HCPs, are much more likely to consider medication solutions over device barriers when dealing with symptomatic patients. In addition, only a minority of patients express concern that poor device technique may be inhibiting the performance of their COPD medications.
• While medication considerations predominate in all circumstances, patients with mild COPD appear to have greater attention paid to device fit. This is consistent with HCP survey findings that suggest the greatest attention to assessing device fit occurs in the early years of treatment planning and management.
• Device considerations are not being completely neglected. Half of the patients who responded stated that a treatment plan change was made, in part, to provide them with a device that would be easier for them to use. However, the overwhelming patient perception is that the desire to change medication drives treatment plan changes. Further, poorly controlled symptoms are judged to require a medication change much more so than a device change.
• Pulmonologists are more likely to take a holistic treatment approach to their patients with COPD. They are somewhat more likely to be managing severe COPD patients and generate better scores when it comes to: patient satisfaction with their COPD treatment, medication adherence, referral and completion of pulmonary rehabilitation programs, and providing patients with education about the proper use of their inhalation device. Patients also say that pulmonologists are substantially more likely to make a medication change to accommodate a device that will be easier for them to use. These findings are consistent with those reported by pulmonologists and primary care providers in the HCP survey.

One should remember that the delivery of medication is a crucial component impacting adherence, control of patient symptoms, and quality of life. A comprehensive approach to the patient’s needs is essential to optimize treatment of COPD. This approach extends beyond the molecule and has to consider patient’s inhaler technique and any underlying comorbidities that may influence this as well as an ongoing clinician-patient communication.

Have you witnessed the impact of delivery device on patient’s care and disease outcomes?