Ruth

Why consider dexterity and other limitations?

  • Dexterity, or the skill and ease of using the hand, can be measured by the ability to grasp, hold, and manipulate objects1,2
  • Decreased hand strength leads to loss of dexterity3,4
  • Hand strength peaks at age 20 and starts a steep decline around age 505

81% of patients could not use their MDI correctly6

81% of patients could not use their MDI correctly
Prospective study of 156 pulmonary clinic patients with a mean age 61 years (58% with COPD), designed to evaluate inhalation technique. Study used a validated videotaped scoring method. 81% of patients using an MDI (n=32) and 47% of patients using an MDI with spacer (n=36) made at least one essential error that could compromise the delivery of medication.

With an MDI, why can dexterity loss be a problem?

  • MDIs require both dexterity and hand strength for actuation7-9
  • Many COPD patients may lack the hand strength or dexterity to use an MDI effectively6

What may be other limitations when using an MDI?

  • MDIs require hand/breath coordination11,12
  • Deep breaths required11,12
  • Breath holding required11,12

BROVANA, a nebulized therapy, may be the right fit

When COPD patients have

  • Dexterity limitations or trouble using an MDI11,12
  • Difficulty with hand/breath coordination11,12
  • Difficulty performing deep breaths or breath holding11,12

References:

1. Mosby’s Medical Dictionary. 8th ed. St Louis, MO: Elsevier; 2009:541. 2. Seidel D, Crilly N, Matthews FE, Jagger C, Clarkson PJ. Patterns of functional loss among older people: a prospective analysis. Human Factors. 2009;51(5):669-680. 3. Hughes S, Gibbs J, Dunlop D, Edelman P, Singer R, Chang RW. Predictors of decline in manual performance in older adults. J Am Geriatr Soc. 1997;45(8):905-910. 4. Latash ML, Lestienne F. Motor Control and Learning. New York, NY: Springer; 2006:145. 5. Beenakker KGM, Ling CA, Meskers CGM, et al. Patterns of muscle strength loss with age in the general population and patients with a chronic inflammatory state. Ageing Res Rev. 2010;9(4):431-436.  6. Rootmensen GN, van Keimpema ARJ, Jansen HM, de Haan, RJ. Predictors of incorrect inhalation technique in patients with asthma or COPD: a study using a validated videotaped scoring method. J Aerosol Med Pulm Drug Deliv. 2010;23(5):323-328. 7. Rau JL. Practical problems with aerosol therapy in COPD. Respir Care. 2006;51(2):158-172. 8. Sorenson HM. Aerosol delivery devices for the geriatric population. AARC Times. 2000;36-41. 9. Fromer L, Goodwin E, Walsh J. Customizing inhaled therapy to meet the needs of COPD patients. Postgrad Med. 2010;122(2):83-93. 10. Gray SL, Williams DM, Pulliam CC, et al. Characteristics predicting incorrect metered-dose inhaler technique in older subjects. Arch Intern Med. 1996;156(9):984-988. 11. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2010). htp://www.goldcopd.org. Accessed March 15, 2011. 12. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines. Chest. 2005;127(1):335-371.