Correlates of adherence to respiratory drugs in COPD patients

In this issue of theCanadian Respiratory Journal, Blais et al (pages 27 to 32) publish an interesting study of the use of inhaled steroids in chronic obstructive pulmonary disease (COPD). Using the Quebec provincial database from the years 1990 to 1996, they found that these medications were given to more and more patients during the period of the study, and that the patients tended to be sicker than those who were not given inhaled steroids: they saw more physicians, including specialists; took more bronchodilators; and had more exacerbations. This is the result that I would have predicted if asked and is therefore not surprising. What surprised me is the fact that patients did not continue to use inhaled steroids once they had been started on them; of those given these drugs for the first time, one-half stopped them after approximately 18 months, and after five years, approximately only 20% were still taking them. Further, as the number of patients given inhaled steroids increased, persistence decreased. What are we to make of this? One could argue that the dates covered by the study of Blais et al preceded the clinical trials (1) showing that inhaled steroids reduced exacerbations in COPD and that they were not prescribed with the conviction that present-day physicians would employ. On the other hand, it seems unlikely that COPD patients were given these medications as a temporary expedient; presumably, most prescriptions for inhaled steroids were for chronic maintenance therapy. It is therefore unlikely that the prescribing physicians told COPD patients to take the drugs until they felt better and then discontinue them. It is also possible that inhaled steroids were unique respiratory drugs in that they were expensive and that this impacted persistence negatively. Although these patients had provincial drug insurance coverage, it was probably on a reimbursement basis, as in Manitoba, and inhaled steroids presented a cash flow problem.

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Oral and Oropharyngeal Sensory Function in Adults With Chronic Obstructive Pulmonary Disease

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-19-00095 ◽

2020 ◽

Vol 29 (2) ◽

pp. 864-872

Author(s):

Fernanda Borowsky da Rosa ◽

Adriane Schmidt Pasqualoto ◽

Catriona M. Steele ◽

Renata Mancopes

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Oral Cavity ◽

Pulmonary Disease ◽

Thermal Sensation ◽

Sensory Function ◽

Control Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Age Related ◽

Copd Patients

Introduction The oral cavity and pharynx have a rich sensory system composed of specialized receptors. The integrity of oropharyngeal sensation is thought to be fundamental for safe and efficient swallowing. Chronic obstructive pulmonary disease (COPD) patients are at risk for oropharyngeal sensory impairment due to frequent use of inhaled medications and comorbidities including gastroesophageal reflux disease. Objective This study aimed to describe and compare oral and oropharyngeal sensory function measured using noninstrumental clinical methods in adults with COPD and healthy controls. Method Participants included 27 adults (18 men, nine women) with a diagnosis of COPD and a mean age of 66.56 years ( SD = 8.68). The control group comprised 11 healthy adults (five men, six women) with a mean age of 60.09 years ( SD = 11.57). Spirometry measures confirmed reduced functional expiratory volumes (% predicted) in the COPD patients compared to the control participants. All participants completed a case history interview and underwent clinical evaluation of oral and oropharyngeal sensation by a speech-language pathologist. The sensory evaluation explored the detection of tactile and temperature stimuli delivered by cotton swab to six locations in the oral cavity and two in the oropharynx as well as identification of the taste of stimuli administered in 5-ml boluses to the mouth. Analyses explored the frequencies of accurate responses regarding stimulus location, temperature and taste between groups, and between age groups (“≤ 65 years” and “> 65 years”) within the COPD cohort. Results We found significantly higher frequencies of reported use of inhaled medications ( p < .001) and xerostomia ( p = .003) in the COPD cohort. Oral cavity thermal sensation ( p = .009) was reduced in the COPD participants, and a significant age-related decline in gustatory sensation was found in the COPD group ( p = .018). Conclusion This study found that most of the measures of oral and oropharyngeal sensation remained intact in the COPD group. Oral thermal sensation was impaired in individuals with COPD, and reduced gustatory sensation was observed in the older COPD participants. Possible links between these results and the use of inhaled medication by individuals with COPD are discussed.

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