Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death by disease in the United States.1 COPD is one of the most prevalent chronic diseases associated with lifelong economic burden without a cure. As the disease progresses, patients can experience exacerbations leading to a decreased quality of life, and increased costs.

Individualizing COPD therapy is key in every patient’s progression, and pharmacists play a vital role. Individualized care can lead to better adherence, decreased exacerbations, and ultimately decreased costs for patients.

A study published in Journal of the COPD Foundation evaluated an unclear benefit of nebulized arformoterol (ARF) over handheld inhaled corticosteroid and long-acting beta agonist (ICS-LABA). The team of researchers discovered that beneficiaries who switched to nebulized ARF following a respiratory event (COPD-related hospitalization or emergency department (ED) visit) experienced 1.5 fewer exacerbations at the 180-day follow-up.2

An earlier study published in the journal Chest attempted to study uncontrolled COPD symptoms with ARF with budesonide. These researchers also found significant reductions in ED visits, and hospitalizations, due to a decrease in exacerbations.3

Nebulized ARF may cause concern due to the cost of durable medical equipment (DME). Research proves despite the initial cost for the ARF DME, the total health costs compared to control are similar due to decreased use of pharmacies, inpatient, and outpatient care.

Decreased adherence to inhaled therapy increases unplanned admissions. Researchers explored causes behind this as it is multifactorial.

One reason is that some patients have difficulty using the inhalation devices properly.2 Pharmacists need to emphasize and reiterate the importance of individualized therapy; that is, patients need to be matched to the best device for them.

In the study completed by the COPD Foundation, the researchers indicated that many factors that could have contributed to patients’ exacerbations and hospitalizations—things like cognitive impairment, dexterity, and patient preference—escaped their observation. This was a potential limitation.

Ensuring patients receive individualized therapy with devices that they are able to use promotes adequate medication dose delivery—ultimately decreasing exacerbations, hospitalizations, ED visits, and costs.
 
Samuel Breiner is a 2021 Pharmacy Candidate at the University of Connecticut in Storrs.


REFERENCES
  1. American Lung Association. How Serious is COPD. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/learn-about-copd/how-serious-is-copd.html. Accessed on January 8, 2020.
  2. Maryam Navaie, Bartolome R. Celli, Zhun Xu, PhD, et.al. Exacerbations, Health Resource Utilization, and Costs Among Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease Treated with Nebulized Arformoterol Following a Respiratory Event. J COPD Found. https://journal.copdfoundation.org/jcopdf/id/1244/Exacerbations-Health-Resource-Utilization-and-Costs-Among-Medicare-Beneficiaries-with-Chronic-Obstructive-Pulmonary-Disease-Treated-with-Nebulized-Arformoterol-Following-a-Respiratory-Event. Accessed on January 10, 2020.
  3. Lydia Winnicka, MD, Jamie Molina, MD, Crystal Duran, MD, Charumathi Raghu Subramanian, MD. Improved COPD Control With Combination LABA/CS Using Small Volume Nebulized Delivery. Chest Journal.  https://journal.chestnet.org/article/S0012-3692(16)57223-7/fulltext. Accessed on January 10, 2020.