12,446 results match your criteria inhaler therapy


Flow Structure and Particle Deposition Analyses for Optimization of a Pressurized Metered Dose Inhaler (pMDI) in a Model of Tracheobronchial Airway.

Eur J Pharm Sci 2021 Jun 12:105911. Epub 2021 Jun 12.

Institute of Lung Biology and Disease, Helmholtz Zentrum Muenchen, Neuherberg 85764, Germany; Comprehensive Pneumology Center, Member of the German Center for Lung Research, Max-Lebsche-Platz 31, Munich 81377, Germany. Electronic address:

Inhalation therapy plays an important role in management or treatment of respiratory diseases such asthma and chronic obstructive pulmonary diseases (COPDs). For decades, pressurized metered dose inhalers (pMDIs) have been the most popular and prescribed drug delivery devices for inhalation therapy. The main objectives of the present computational work are to study flow structure inside a pMDI, as well as transport and deposition of micron-sized particles in a model of human tracheobronchial airways and their dependence on inhalation air flow rate and characteristic pMDI parameters. Read More

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Acute and durable effect of inhaled hypertonic saline on mucociliary clearance in adult asthma.

ERJ Open Res 2021 Apr 7;7(2). Epub 2021 Jun 7.

Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Background: Impaired mucus clearance and airway mucus plugging have been shown to occur in moderate-severe asthma, especially during acute exacerbations. In cystic fibrosis, where airway mucus is dehydrated, it has been shown that inhaled hypertonic saline (HS) produces both acute and sustained enhancement of mucociliary clearance (MCC). The current study was designed to assess the acute and sustained effect of inhaled 7% HS on MCC in adult asthma. Read More

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INTREPID: single- multiple-inhaler triple therapy for COPD in usual clinical practice.

ERJ Open Res 2021 Apr 7;7(2). Epub 2021 Jun 7.

Global Respiratory Franchise, GSK, Brentford, UK.

Introduction: Real-world trial data comparing single- with multiple-inhaler triple therapy (MITT) in COPD patients are currently lacking. The effectiveness of once-daily single-inhaler fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) and MITT were compared in usual clinical care.

Methods: INTREPID was a multicentre, randomised, open-label, phase IV effectiveness study comparing FF/UMEC/VI 100/62. Read More

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Inhaled corticosteroids do not adversely impact outcomes in COVID-19 positive patients with COPD: An analysis of Cleveland Clinic's COVID-19 registry.

PLoS One 2021 3;16(6):e0252576. Epub 2021 Jun 3.

Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.

Inhaled Corticosteroids (ICS) are commonly prescribed to patients with severe COPD and recurrent exacerbations. It is not known what impact ICS cause in terms of COVID-19 positivity or disease severity in COPD. This study examined 27,810 patients with COPD from the Cleveland Clinic COVID-19 registry between March 8th and September 16th, 2020. Read More

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Maximizing Adherence and Gaining New Information For Your Chronic Obstructive Pulmonary Disease (MAGNIFY COPD): Study Protocol for the Pragmatic, Cluster Randomized Trial Evaluating the Impact of Dual Bronchodilator with Add-On Sensor and Electronic Monitoring on Clinical Outcomes.

Pragmat Obs Res 2021 24;12:25-35. Epub 2021 May 24.

Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.

Background: Poor treatment adherence in COPD patients is associated with poor clinical outcomes and increased healthcare burden. Personalized approaches for adherence management, supported with technology-based interventions, may offer benefits to patients and providers but are currently unproven in terms of clinical outcomes as opposed to adherence outcomes.

Methods: Maximizing Adherence and Gaining New Information For Your COPD (MAGNIFY COPD study), a pragmatic cluster randomized trial, aims to evaluate the impact of an adherence technology package (interventional package), comprising an adherence review, ongoing provision of a dual bronchodilator but with an add-on inhaler sensor device and a connected mobile application. Read More

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Incorrect Holding Angle of Dry Powder Inhaler during the Drug-Loading Step Significantly Decreases Output Efficiency.

Biol Pharm Bull 2021 ;44(6):822-829

College of Pharmaceutical Sciences, Ritsumeikan University.

It is well known that correct use of inhalers plays a critical role in optimal inhalation therapy, but the impact of incorrect inhaler use on pulmonary drug delivery has not been quantitatively evaluated. The aim of this study was to investigate the frequency of holding inhalers at incorrect angles during the drug-loading step while using Turbuhaler and to quantify the influence of the inhaler angle on in vitro pulmonary delivery. Thirty patients prescribed Turbuhaler at Shiga University of Medical Science Hospital were enrolled. Read More

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January 2021

A Safety and Tolerability Study of Thin Film Freeze-Dried Tacrolimus for Local Pulmonary Drug Delivery in Human Subjects.

Pharmaceutics 2021 May 13;13(5). Epub 2021 May 13.

Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA.

Due to the low and erratic bioavailability of oral tacrolimus (TAC), the long-term survival rate following lung transplantation remained low compared to other solid organs. TAC was reformulated and developed as inhaled formulations by thin film freezing (TFF). Previous studies reported that inhaled TAC combined with 50% lactose (LAC) was safe and effective for the treatment of lung transplant rejection in rodent models. Read More

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Parental administration of inhaled short-acting beta agonists in the pediatric emergency department: a survey of family perspectives.

CJEM 2021 Jun 1. Epub 2021 Jun 1.

Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de La Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.

Background: The management of children with an asthma exacerbation includes timely systemic corticosteroids and frequent short-acting beta-agonist therapy. In selected patients, inhaled short-acting beta-agonist administration by parents may promote comfort, constitute an educational opportunity for the family, and safely reduce provider workload. Our objective was to evaluate parental satisfaction and perceived safety of this new approach. Read More

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Comparison of 3% saline and 0.9% normal saline nebulization as diluent in children with bronchiolitis.

J Pak Med Assoc 2021 Mar;71(3):822-825

Ghurki Trust Teaching Hospital, Lahore, Pakistan.

Objective: To compare the outcome in terms of mean time to disappearance of cough, wheezing, crackles and length of hospital stay in patients treated with sodium chloride 3% with sodium chloride 0.9% as nebulisation diluent in children for suffering from bronchiolitis.

Methods: The prospective study was conducted at the Department of Paediatric Medicine Sheikh Zayed Hospital, Lahore, Pakistan, from November 2014 to April 2015, and comprised children aged between 6 weeks and 24 months having bronchiolitis. Read More

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Are we overcoming our inability to have pediatric patients properly use inhaled corticosteroids by inappropriately escalating their therapy?

J Asthma 2021 Jun 9:1-12. Epub 2021 Jun 9.

Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.

Objective: To perform a narrative review to describe and discuss potential methods and strategies for effectively assessing and dealing with poor adherence and/or misuse of inhalers in difficult-to-treat pediatric asthmatic patients.

Data Sources: Articles available in electronic databases, published from inception to April 2021.

Study Selections: Relevant articles in the literature that discuss and analyze potential methods and strategies for effectively assessing and dealing with poor adherence and/or misuse of inhalers in difficult-to-treat pediatric asthmatic patients. Read More

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A triple combination 'nano' dry powder inhaler for tuberculosis: in vitro and in vivo pulmonary characterization.

Drug Deliv Transl Res 2021 May 26. Epub 2021 May 26.

Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga-400 019, Mumbai, Maharashtra, India.

Inhalation route of drug delivery is the most favorable for pulmonary infections wherein direct drug delivery is desired to the lungs. Tuberculosis is one such infection suffering from poor therapeutic efficacy because of low patient compliance due to high drug dosing and lengthy treatment protocols. The current research work was undertaken to develop a dry powder inhaler (DPI) for administration of three first-line antitubercular antibiotics directly to the lungs to improve the treatment rates. Read More

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Single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy versus tiotropium monotherapy in patients with COPD.

NPJ Prim Care Respir Med 2021 May 25;31(1):29. Epub 2021 May 25.

Respiratory Unit, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, FE, Italy.

Chronic obstructive pulmonary disease (COPD) treatment guidelines do not currently include recommendations for escalation directly from monotherapy to triple therapy. This 12-week, double-blind, double-dummy study randomized 800 symptomatic moderate-to-very-severe COPD patients receiving tiotropium (TIO) for ≥3 months to once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 mcg via ELLIPTA (n = 400) or TIO 18 mcg via HandiHaler (n = 400) plus matched placebo. Read More

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Long-term macrolide therapy for chronic obstructive pulmonary disease: a population-based time series analysis.

CMAJ Open 2021 Apr-Jun;9(2):E576-E584. Epub 2021 May 21.

Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont.

Background: Macrolides are recommended as an adjunctive treatment for patients with moderate to severe chronic obstructive pulmonary disease (COPD) who experience recurrent exacerbations. The objective of this study was to examine temporal trends in the provision of long-term macrolide therapy, specifically before and after publication of the landmark MACRO trial in August 2011 showing efficacy of macrolides for this indication.

Methods: We performed an interrupted time series analysis using population-level health administrative data. Read More

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Triple vs Dual Inhaler Therapy and Asthma Outcomes in Moderate to Severe Asthma: A Systematic Review and Meta-analysis.

JAMA 2021 May 19. Epub 2021 May 19.

Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Importance: The benefits and harms of adding long-acting muscarinic antagonists (LAMAs) to inhaled corticosteroids (ICS) and long-acting β2-agonists (LABAs) for moderate to severe asthma remain unclear.

Objective: To systematically synthesize the outcomes and adverse events associated with triple therapy (ICS, LABA, and LAMA) vs dual therapy (ICS plus LABA) in children and adults with persistent uncontrolled asthma.

Data Sources: MEDLINE, Embase, CENTRAL, ICTRP, FDA, and EMA databases from November 2017, to December 8, 2020, without language restriction. Read More

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Variability of COPD inhaler coverage in Medicare Part D.

Am J Manag Care 2021 05;27(5):187-193

Johns Hopkins University School of Medicine, 200 N Wolfe St, Ste 2088, Baltimore, MD 21287. Email:

Objectives: Stand-alone prescription drug plans (S-PDPs) and Medicare Advantage prescription drug (MA-PD) plans are incentivized to cover outpatient medications differently. This could affect the coverage of inhalers that prevent costly exacerbations of chronic obstructive pulmonary disease (COPD), with impacts for the Medicare program and its beneficiaries. This study compared the coverage of guideline-recommended COPD inhalers between S-PDPs and MA-PD plans. Read More

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Aerosol delivery via noninvasive ventilation: role of models and bioanalysis.

Ann Transl Med 2021 Apr;9(7):589

Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.

Non-invasive ventilation (NIV) is external support for respiration to assist breathing in case of respiratory failure (either hypercapnic or hypoxemic) without patient intubation. Nowadays, medicated aerosols are normally delivered to mechanically ventilated patients by nebulizers and pressurized metered-dose inhaler (pMDI) attached to adapter or spacer that fit into the ventilated circuit. Studies with obstructive lung disease patients have shown that aerosol delivery during mechanical ventilation is possible and of benefit. Read More

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Aerosol delivery via invasive ventilation: a narrative review.

Ann Transl Med 2021 Apr;9(7):588

Department of Respiratory Care, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

In comparison with spontaneously breathing non-intubated subjects, intubated, mechanically ventilated patients encounter various challenges, barriers, and opportunities in receiving medical aerosols. Since the introduction of mechanical ventilation as a part of modern critical care medicine during the middle of the last century, aerosolized drug delivery by jet nebulizers has become a common practice. However, early evidence suggested that aerosol generators differed in their efficacies, and the introduction of newer aerosol technology (metered dose inhalers, ultrasonic nebulizer, vibrating mesh nebulizers, and soft moist inhaler) into the ventilator circuit opened up the possibility of optimizing inhaled aerosol delivery during mechanical ventilation that could meet or exceed the delivery of the same aerosols in spontaneously breathing patients. Read More

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Real-World Treatment Patterns of Multiple-Inhaler Triple Therapy Among Patients with Chronic Obstructive Pulmonary Disease in UK General Practice.

Int J Chron Obstruct Pulmon Dis 2021 6;16:1255-1264. Epub 2021 May 6.

Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA.

Introduction: Until recently, triple therapy for chronic obstructive pulmonary disease (COPD) has only been available through treatment with multiple inhalers. Evidence on real-world use of multiple-inhaler triple therapy (MITT), including duration of use and treatment patterns, is limited.

Methods: A retrospective, observational study of electronic health records and hospital episodes in patients with COPD initiating MITT between 2013 and 2015 in the UK was performed. Read More

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Inhaler technique in asthma and COPD: challenges and unmet knowledge that can contribute to suboptimal use in real life.

Authors:
Andrea S Melani

Expert Rev Clin Pharmacol 2021 May 13. Epub 2021 May 13.

Dipartimento Scienze Mediche, Policlinico Le Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy.

: Inhalers are the most commonly used devices for lung drug delivery in asthma and COPD. Inhaler use offers several advantages but requires the user's proper mastery. The issue of inhaler technique is very important as inhaler misuse remains common in real life regardless of the inhaler used and is associated with poor disease control. Read More

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Combination fixed-dose beta agonist and steroid inhaler as required for adults or children with mild asthma.

Cochrane Database Syst Rev 2021 05 4;5:CD013518. Epub 2021 May 4.

Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Background: Asthma affects 350 million people worldwide including 45% to 70% with mild disease. Treatment is mainly with inhalers containing beta₂-agonists, typically taken as required to relieve bronchospasm, and inhaled corticosteroids (ICS) as regular preventive therapy. Poor adherence to regular therapy is common and increases the risk of exacerbations, morbidity and mortality. Read More

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Single inhaler triple therapy in COPD - all that glitters is not gold.

Monaldi Arch Chest Dis 2021 Apr 28;91(2). Epub 2021 Apr 28.

Department of Pulmonary Medicine, Yashoda Hospital, Delhi.

Dear Editor, The recent studies on combination triple therapy of inhaled corticosteroid, long acting beta2 agonist and long-acting muscarinic antagonist (ICS-LABA-LAMA) in COPD have consistently demonstrated an improvement in exacerbation frequency and/or improvement of lung function... Read More

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Long-Acting Bronchodilator Use in Chronic Obstructive Pulmonary Disease in Primary Care in New Zealand: A Retrospective Study of Treatment Patterns and Evolution Using the HealthStat Database.

Int J Chron Obstruct Pulmon Dis 2021 20;16:1075-1091. Epub 2021 Apr 20.

Public Sector Surveying, CBG Health Research Limited, Auckland, New Zealand.

Purpose: Long-acting bronchodilator (LABD) use is the mainstay of pharmacologic treatment for chronic obstructive pulmonary disease (COPD). Few studies describe evolving patterns of LABD use in the setting of changing inhaler availability and updated clinical guidelines.

Methods: A retrospective cohort study in New Zealand using the HealthStat general practice database (01/2014 to 04/2018). Read More

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Comparative Study of Inhaler Device Handling Technique and Risk Factors for Critical Inhaler Errors in Korean COPD Patients.

Int J Chron Obstruct Pulmon Dis 2021 19;16:1051-1059. Epub 2021 Apr 19.

Department of Internal Medicine, Division of Pulmonology and Allergy, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Republic of Korea.

Objective: Critical inhaler handling errors are associated with an increased risk of adverse outcomes in patients with chronic obstructive pulmonary disease (COPD). However, real-world data on inhaler device handling techniques and the risk factors for critical inhaler errors in the Asian population have been examined in only a few studies. We evaluated the rates and risk factors for critical inhaler errors in the COPD population in Korea. Read More

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Formulation and clinical perspectives of inhalation-based nanocarrier delivery: a new archetype in lung cancer treatment.

Ther Deliv 2021 05 27;12(5):397-418. Epub 2021 Apr 27.

Faculty of Pharmacy, Kalabhavan Campus, The Maharaja Sayajirao University of Baroda, Vadodara 390001, Gujarat, India.

Despite tremendous research in targeted delivery and specific molecular inhibitors (gene delivery), cytotoxic drug delivery through inhalation has been seen as a core part in the treatment of the lung cancer. Inhalation delivery provides a high dose of the drug directly to the lungs without affecting other body organs, increasing the therapeutic ratio. This article reviews the research performed over the last several decades regarding inhalation delivery of various cancer therapeutics for the treatment of lung cancer. Read More

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TRICOP - A Real-world effectiveness study with a single-inhaler extrafine triple therapy over 52 weeks in Austrian patients with COPD.

Respir Med 2021 Jun 14;182:106398. Epub 2021 Apr 14.

Karl Landsteiner Institute for Experimental and Clinical Pneumology, Department of Pulmonary Diseases, Hietzing Hospital, Vienna, Austria.

Objective: Evidence of the efficacy of single-inhaler triple therapy in COPD patients inferred from RCTs has not been assessed in a real-world setting in Austria. In this non-interventional study (NIS) tolerability and effectiveness of extrafine beclometasone-dipropionate, formoterol-fumarate and glycopyrronium (Trimbow® 87/5/9 μg) was evaluated in COPD patients.

Methods: A prospective NIS was conducted over 52 weeks in 24 sites in Austria. Read More

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The Impact of Inhaler Device Regimen in Patients with Asthma or COPD.

J Allergy Clin Immunol Pract 2021 Apr 24. Epub 2021 Apr 24.

Graduate School of Medicine, University of Tennessee, Knoxville, TN.

Many inhaler devices with varying handling requirements for optimal use are available for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Patients may be prescribed different device types for reliever and maintenance medications, which may lead to confusion and suboptimal device use. We aimed to understand whether simplifying inhaler regimens by employing a single device type in patients who use multiple devices or prescribing a device with which a patient was already experienced could improve clinical and economic outcomes in asthma and COPD management. Read More

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Hidden Costs of Multiple-Dose Products: Quantifying Ipratropium Inhaler Wastage in the Hospital Setting.

Can J Hosp Pharm 2021 1;74(2):117-121. Epub 2021 Apr 1.

, BSc(Pharm), PharmD, ACPR, is with the Therapeutics Initiative, The University of British Columbia, and the Pharmacy Department, Lower Mainland Pharmacy Services, Vancouver, British Columbia.

Background: Previous studies have quantified wastage involving drugs that are available in multiple-dose formats. Ipratropium bromide by metered dose inhaler (MDI) is commonly used in hospitals, and may be contributing to waste of pharmaceutical and financial resources.

Objectives: The primary objective was to quantify the number of patients in the authors' health authority with waste of at least 1 ipratropium MDI. Read More

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Evaluation of In-Hospital Management of Inhaler Therapy for Chronic Obstructive Pulmonary Disease.

Can J Hosp Pharm 2021 1;74(2):110-116. Epub 2021 Apr 1.

, BSc, BScPharm, PharmD, ACPR, FCSHP, is a Pharmacotherapeutic and Research Specialist (Internal Medicine) with Vancouver General Hospital and an Assistant Professor (Partner) with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.

Background: In the past decade, the number of inhaled devices approved for management of chronic obstructive pulmonary disease (COPD) has tripled. Management of at-home inhaled COPD therapy can present a problem when patients are admitted to hospital, because only a limited number of these therapies are currently included in hospital formularies and there is a lack of established interchanges.

Objectives: To characterize and evaluate the appropriateness of management of patients' before-admission inhaled therapy upon hospital admission. Read More

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Retraction: Determinants of self-reported adherence to inhaler therapy in patients with chronic obstructive pulmonary disease.

Multidiscip Respir Med 2020 Jan 23;15(1):721. Epub 2020 Sep 23.

S.C. Pneumologia U, Respiratory Clinic Città della Salute e della Scienza, Turin, Italy.

[This retracts the article DOI: 10.4081/mrm.2020. Read More

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January 2020

Clinical Characterization of Nursing Facility Residents With Chronic Obstructive Pulmonary Disease.

Sr Care Pharm 2021 May;36(5):248-257

Objective And Design: To describe clinical characteristics, medication use, and low peak inspiratory flow rate (PIFR) (< 60 L/min) prevalence in nursing facility residents with chronic obstructive pulmonary disease (COPD).

Patients And Setting: Residents 60 years of age and older with a COPD diagnosis and≥ 6 months' nursing facility residence, were enrolled between December 2017 and February 2019 from 26 geographically varied United States nursing facilities.

Outcome Measures: Data, extracted from residents' charts, included demographic/clinical characteristics, COPD-related medications, exacerbations and hospitalizations within the past 6 months, and functional status from the most recent Minimum Data Set. Read More

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