COPD: ORGANIZED VS DISORGANIZED RESCUE INHALER USE

Our DIGMA program was established to allow patients time to interact with an allergist, a behaviorist and an asthma educator in a group setting. Weekly meetings targeted patients with chronic asthma. DIGMAs typically last for 90 minute s and include 10 patients per session. Outcome parameters were established to assess the effectiveness of the program over a 4 year time period. Sixty four adult asthmatic patients were enrolled and followed for 4 years. Patients were seen in a group setting in groups of ten. The AQLQ test was administered each year. Spirometry, an analog self assessment scale and the ACT were administered at each visit. Forty two of the 64 patients were followed for a minimum of 3 visits to DIGMA during four years. The average baseline FVC was 85% predicted and remained unchanged. FEV1 was 78% baseline and was 77% at the last determination. Baseline rescue inhaler use was 4 per week compared to 1.5 per week at last visit. ACT scores are 18 at baseline and 19 at last visit. ER claims are 5 at one year prior to enrollment and 2 at the last year of DIGMA. Patient satisfaction improved from 30 to 34 at the last visit. This was an effective, multidisciplinary asthma intervention that focused on behavior. It fulfilled the goals of asthma care as described by the 2007 NAEPP guidelines.

Download Full-text

Real-world use of rescue inhaler sensors, electronic symptom questionnaires and physical activity monitors in COPD

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2018-000350 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000350 ◽

Cited By ~ 3

Author(s):

Russell Bowler ◽

Matthew Allinder ◽

Sean Jacobson ◽

Andrew Miller ◽

Bruce Miller ◽

...

Keyword(s):

Physical Activity ◽

Pulmonary Disease ◽

Respiratory Symptoms ◽

Airflow Obstruction ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Digital Monitoring ◽

Metered Dose ◽

Reduced Physical Activity ◽

Rescue Inhaler

BackgroundChronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterised by airflow obstruction and other morbidities such as respiratory symptoms, reduced physical activity and frequent bronchodilator use. Recent advances in personal digital monitoring devices can permit continuous collection of these data in COPD patients, but the relationships among them are not well understood.Methods184 individuals from a single centre of the COPDGene cohort agreed to participate in this 3-week observational study. Each participant used a smartphone to complete a daily symptom diary (EXAcerbations of Chronic pulmonary disease Tool, EXACT), wore a wrist-worn accelerometer to record continuously physical activity and completed the Clinical Visit PROactive Physical Activity in COPD questionnaire. 58 users of metered dose inhalers for rescue (albuterol) were provided with an inhaler sensor, which time stamped each inhaler actuation.ResultsRescue inhaler use was strongly correlated with E-RS:COPD score, while step counts were correlated with neither rescue use nor E-RS:COPD score. Frequent, unpatterned inhaler use pattern was associated with worse respiratory symptoms and less physical activity compared with frequent inhaler use with a regular daily pattern. There was a strong week-by-week correlation among measurements, suggesting that 1 week of monitoring is sufficient to characterise stable patients with COPD.DiscussionThe study highlights the interaction and relevance of personal real-time monitoring of respiratory symptoms, physical activity and rescue medication in patients with COPD. Additionally, visual displays of longitudinal data may be helpful for disease management to help drive conversations between patients and caregivers and for risk-based monitoring in clinical trials.

Download Full-text