By Debbie Bunch
September 9, 2024
Inhalers Frequently Misused by Hospitalized COPD Patients
COPD patients rely on inhalers to control the condition. But those inhalers only help if they are used correctly. According to a recent study in Chronic Obstructive Pulmonary Diseases, too many people with COPD fall short when it comes to meeting that goal.
The research was carried out by Swiss investigators who evaluated 96 COPD patients in their hospital to determine how often they were using inhalers correctly and how often they were using them incorrectly. Physiotherapist assessments and the In-Check G16 were used to determine inhaler efficacy.
Overall, 160 inhalers were used over the nine-month study, and among that group, 111, or nearly 70%, were misused. At least one misused inhaler was found in 82.3% of the total study population.
Inhaler misuse was cited when the patient made a critical error in inhalation technique and/or when insufficient peak inspiratory flow (PIF) resulted, but critical error in technique was responsible for significantly more cases of misuse, 65.6% vs. 13.8%.
To combat this misuse, the team had physiotherapists carry out three training sessions with the patients and then reassessed their inhaler use after each session. The number of inhalers with critical errors dropped with each session, going from 33 after one session, to 15 after two sessions, to nine after three sessions.
Other results showed –
- Cognitive disorders kept five patients from reaching an adequate inhalation technique, a lack of coordination between inhaler activation and inspiration thwarted four patients, and fine motor disorders and the inability to hold one’s breath sufficiently affected two each.
- 27 inhalers, or 16.9%, were deemed incapable of being used optimally because of insufficient PIF or because of the patient’s inability to use the inhaler optimally even after training.
- Overall, use of at least one unsuitable inhaler was noted in 25% of the study population.
- 62.2% of inhalers used by patients hospitalized with a COPD exacerbation were misused vs. 85.7% of inhalers used by COPD patients who were hospitalized without an exacerbation.
The authors believe these findings point to the need for more education on inhaler use for people with COPD who end up in the hospital. “Misused inhalers in hospitalized patients with COPD is a major problem, irrespective of the reason for hospitalization,” they write. “The assessment of the inhalation technique and the PIF should be part of the standard clinical assessment of patients with COPD during hospitalization, regardless of the reason for hospitalization.” Read Article Read Full Paper
Immune Cells May be Behind Cases of PASC
People who end up with long-COVID may also suffer from a condition known as post-acute sequelae of SARS-CoV-2 (PASC). A multicenter research study co-led by investigators from Cedars-Sinai in Los Angeles has now uncovered a possible mechanism leading to the condition.
“This study sought to understand the pathways that led to abnormal repair in the lungs that produced a scar-forming environment,” explained study author Peter Chen, MD. “Our findings may lead to therapeutic strategies to prevent fibrotic lung disease after viral illnesses.”
He and his colleagues established models of post-viral lung disease in mice and used molecular profiling and imaging to identify immune cells called CD8+ T cells as a driving factor in preventing lung healing and repair post-infection. PASC patient cohorts were used to validate the abnormal immunologic pathways, corroborating the animal model work.
The study went on to find that IFNγ and TNF derived from CD8+ T cells stimulated local macrophages to chronically release IL-1β. This led to the long-term maintenance of dysplastic epithelial progenitors and lung fibrosis. Alveolar regeneration and pulmonary function were markedly improved by the therapeutic neutralization of IFNγ + TNF or IL-1β.
These finding are important, write the investigators because they suggest there are “therapeutic strategies to rescue fibrotic disease after the resolution of acute disease, addressing a current unmet need in the clinical management of PASC and post-viral disease.” The study was published by Nature. Read Press Release Read Abstract
Palliative Care Lacking for COPD, IPF Patients
Patients with COPD and idiopathic pulmonary fibrosis (IPF) may be shortchanged when it comes to palliative care, report researchers from the University of California, San Francisco who published their findings in CHEST.
The team looked at 1,819 COPD, IPF, and lung cancer patients who had died and compared their use of outpatient palliative care in the last six months of their lives. Results showed the COPD and IPF patients were more likely to be male and older, and significantly less likely to be offered outpatient palliative care or to receive outpatient opioids. IPF patients were, however, more likely to receive inpatient palliative care.
COPD and IPF patients had a higher probability of end-of-life ICU admissions than the lung cancer patients in the study.
The authors note that proactive integration of palliative care in lung cancer can improve outcomes but say that it is not clear whether similar tactics are being employed for patients with end-stage COPD and IPF.
“Patients with COPD and IPF are less likely to receive outpatient palliative care and opioid prescriptions and more likely to use end-of-life intensive care than patients with lung cancer,” write the authors. “Further research should explore health system barriers contributing to differences in care patterns to optimize quality of life and align with patient goals of care.” Read Article Read Abstract
