How to Choose the Best Inhaler for COPD

At a session at the AGS Annual Meeting, Christine Eisenhower, PharmD, BCPS, (The University of Rhode Island, Kingston, RI) provided recommendations for selecting optimal COPD therapy for older adult patients.

The approach involves a combination of considering patient comorbidities and functional limitations, using the GOLD guidelines to assess COPD severity, and factoring in cost considerations.

The updated GOLD guidelines for severe COPD recommend using triple therapy—that is, a combination of LABA, ICS, and LAMA. Comparison studies have shown that triple therapy is superior to different doublet combinations of the three medications.

Dr Eisenhower recommended conducting a multidisciplinary assessment to determine whether treatment devices are being used correctly by the patient and the appropriate doses are being taken at the right time. She noted that a universal inhaler requires that 10 steps be followed to use the device correctly, and additional steps may be required for certain devices. A recent study found that 2.5 steps were missed on average per patient, and that only about 67% of older adult patients followed the correct technique when using inhalers for COPD.

Dr Eisenhower suggested that care providers check for predictors of poor inhaler technique, such as the presence of cognitive impairments or physical disabilities such as osteoporosis. A multitude of inhaler device options are currently available, providing an opportunity to cater inhaler selection to the patient’s specific needs and abilities. For example, Dr. Eisenhower said, Resperimat requires fewer steps but must be twisted, posing a potential problem for patients with osteoporosis. Ellipta is easier to hold and easier to read the dial on the device; however, patients have to open the cover before using, a step that patients with memory impairment may be likely to forget.

Next, Dr Eisenhower urged providers to take the patient’s cost burden into consideration. She suggested looking up the patient’s coverage, either on the Medicare website or on Medscape for private insurance coverage. While some manufacturers offer discounts and copay assistance programs, some do not apply to patients older than 65 years of age, Dr Eisenhower cautioned.

Finally, Dr. Eisenhower recommended letting the patient try out different inhaler devices for themselves so that they can be involved in selecting the optimal device. She also stressed the importance of regularly checking in with patients to review their inhaler technique and ensure appropriate use.

—Kara Rosania

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