Inhaled Maintenance Regimen Changes from pMDI and/or DPI to SMI and/or Nebulizer Therapy and Education to Improve Medication Effectiveness With Measurement by CAT Score

Abstract

Background: Misunderstanding and incorrect inhaler technique is prevalent in COPD. Incorrect device usage of DPI’s and MDI’s include failure to exhale fully before inhaling, incorrect preparation, and lack of breath hold after inhalation. Several DPI’s require a minimum PIFR of 30 L/min causing inability of patients to meet requirements. Limited studies have compared SMI’s with alternative like medication in DPI form warranting further research. Additionally, recommendations for regular inhaler technique checks have been published, however not all outpatient centers have resources to complete assessments. UC Davis Comprehensive COPD Clinic integrates RCP assessment and education of inhaled medication and delivery devices to see if patients need further education, meet PIFR requirements, and/or require an alternative device. We hypothesize that changing MDI/ DPI regimens to SMI and/or nebulized regimens made an improvement in CAT scores.

Methods: Retrospective analysis of 241 patients enrolled in the COPD Clinic QI registry with IRB approval. Sixty-four patients had a follow up appointment with pre and post CAT scores, 131 patients had either no follow up CAT score, did not have or follow up with an appointment, or have a future appointment scheduled. The 64 patients were all assessed and had education on their current inhaled regimens and/or education to their changes that were made to their inhaled medication regimen during their clinic visit. A limited number of five patients had MDI and/or DPI regimens to SMI and/or nebulized regimens made with no changes in their baseline inhaled medication classification. Descriptive statistical analysis was performed with Chi square, Student t-test, and 95% confidence intervals when appropriate.

Results: All 64 patients had a mean CAT score of 20.9 (±2.1, 95% CI) with a follow up CAT of 18.9 (±2.1, 95% CI), an improvement of 2.04. The five patients that had MDI and/or DPI regimens to SMI and/or nebulized regimens had a baseline CAT of mean 29 (±6.7, 95% CI) with a CAT mean at follow up change of 23.4 (±5, 95% CI).

Conclusions: This under-powered limited exploratory study demonstrates that further research is necessary to demonstrate overall symptom improvement when changing maintenance medication regimens from MDI and/or DPI to SMI and/or nebulized regimens. Continued outpatient assessments, education, regimen changes when warranted, and individualized patient care attributes to improvements in CAT scores with appropriate outpatient management of COPD patients.