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Managing_COPD_How_to_Avoid_Common_Mistakes_and_Optimize_Treatment
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    Por: Luis C. Torrellas Ruiz, Pulmonologist
    Collaborator and Clinical Consultant for MCS


    There are currently 150,000 Puerto Ricans on the island suffering from chronic obstructive pulmonary disease (COPD). In the case of seniors who have this disease along with other chronic conditions, managing it can be a challenge. That’s why it’s important to have an early and accurate diagnosis to begin the corresponding treatment.


    Asthma or COPD?

    • One of the most common problems in managing COPD is diagnosing it incorrectly, given that its symptoms can be confused with asthma. For seniors who have wheezing in the chest, it’s even more difficult to differentiate between them. And for obese patients, there have been cases of misdiagnosis of COPD instead of asthma – a condition that can improve with weight loss.

    • It’s essential that all patients with COPD symptoms get a spirometry to confirm the diagnosis, with an FEV1% < 70% after treatment with a bronchodilator. Although in some cases it’s very difficult to distinguish between the two conditions, making an effort to diagnose them correctly is key to choosing the right treatment.

    Overuse of Inhaled Steroids and the use of Montelukast

    • The first treatment for COPD is not steroids or the drug montelukast – both of which are often misprescribed. The first lines of treatment for managing COPD are long-acting beta agonists (LABAs) and long-acting muscarinic agents (LAMAs). If there is no improvement, a triple therapy of LABAs, LAMAs and steroids is used, especially in patients with eosinophilia. Due to the risk of pneumonia in patients with COPD on steroids, it’s recommended to reevaluate these drugs in the absence of allergy symptoms and persistent exacerbations, despite being on a long-acting bronchodilator.

    Technique Optimization and the Proper Use of Inhalers

    • Studies reveal that most patients don’t use their inhalers correctly. Effective treatment requires a high level of adherence, which depends on the correct use of the inhaler. Therefore, at each visit, patients must demonstrate how they are using the inhaler, and if necessary, correct the technique. When prescribing an inhaler, it’s important to consider the challenges in patients with severe cognitive impairment, poor grip and/or arthritis, and to evaluate their inspiratory strength in order to determine whether another method should be used to administer the drug.

    • Another important point is to reinforce the correct use of maintenance and rescue drugs, along with the continuity of treatment, even if the patient feels better. If symptoms worsen, adherence should be assessed, and education should be provided on the importance of taking the drugs as recommended.

    Other Considerations for Proper Management

    • For a COPD patient to have quality of life, physical activity and vaccination against influenza, pneumonia and COVID-19 should be promoted. If the patient smokes, it’s imperative to promote cessation. For patients who suffer an exacerbation, visit an emergency room or are hospitalized, it is of vital importance for them to follow up with their doctor for a period of no more than one week to receive the appropriate therapy in the coming days and avoid hospitalization or readmission.

    • Shared decision-making between the COPD patient and his or her healthcare team is key to success in managing this condition. However, for it to be effective, an environment must be created that invites patients to express and clarify their doubts at each visit, while educating them using simple language and open-ended questions. That way, they can understand the information and take action. These practices are essential for facilitating self-management and achieving good clinical outcomes.


    References:

    1. Azkan Ture, Deniz, et al. “Health Literacy and Health Outcomes in Chronic Obstructive Pulmonary Disease Patients: An Explorative Study.” Frontiers in Public Health, U.S. National Library of Medicine, 17 Mar. 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8970619/#:~:text=Patients%20with%20COPD%20were%20found,of%20patients%20with%20inadequate%20HL
    2. Dekhuijzen, Pieter Nicolaas Richard, et al. “Patients’ Perspectives and Preferences in the Choice of Inhalers: The Case for Respimat(®) or HandiHaler(®).” Patient Preference and Adherence, U.S. National Library of Medicine, 18 Aug. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4993394/.
    3. Jeannette Y Wick, RPh. “Selecting an Inhaler: Matching the Device with the Patient’s Abilities.” Contemporary Clinic, Contemporary Clinic, 11 June 2020,https://www.contemporaryclinic.com/view/selecting-an-inhaler-matching-the-device-with-the-patients-abilities.
    4. Kaplan, Alan, and David Price. “Matching Inhaler Devices with Patients: The Role of the Primary Care Physician.” Canadian Respiratory Journal, U.S. National Library of Medicine, 23 May 2018,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989279/.
    5. Leung, Janice, et al. “Empowering Family Physicians to Impart Proper Inhaler Teaching to Patients with Chronic Obstructive Pulmonary Disease and Asthma.” Canadian Respiratory Journal, U.S. National Library of Medicine, 2015,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596648/.
    6. LMegan Huang, Pharm.D. “How to Use Your Inhaler.” The Checkup, 27 Feb. 2023,https://www.singlecare.com/blog/how-to-use-inhaler/.
    7. Personal de Mayo Clinic. “Inhaladores para el asma: ¿cuál es el adecuado para ti?” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 Mar. 2022,https://www.mayoclinic.org/es/diseases-conditions/asthma/in-depth/asthma-inhalers/art-2004.
    8. Usmani, Omar S. “Choosing the Right Inhaler for Your Asthma or COPD Patient.” Therapeutics and Clinical Risk Management, U.S. National Library of Medicine, 14 Mar. 2019,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422419/. ​