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Optimizing Drug Therapies in Patients with COPD in the US Nursing Home Setting.
Drugs Aging 2019; 36(8):733-745DA

Abstract

Chronic obstructive pulmonary disease (COPD) can be a disabling disease, and the impact on older adults is particularly evident in the nursing home setting. Chronic obstructive pulmonary disease is present in about 20% of nursing home residents, most often in women, and accounts for significant healthcare utilization including acute care visits for exacerbations and pneumonia, as well as worsening heart disease and diabetes mellitus. The emphasis on hospital readmissions is particularly important in nursing homes where institutions have quality measures that have financial implications. Optimizing drug therapies in individuals with COPD involves choosing medications that not only improve symptoms, but also decrease the risk of exacerbations. Optimizing the treatment of comorbidities such as heart disease, infections, and diabetes that may affect COPD outcomes is also an important consideration. Depending on the nursing home setting and the patient, the options for optimizing COPD drug therapies may be limited owing to patient-related factors such as cognition and physical impairment or available resources, primarily reimbursement-related issues. Choosing the best drug therapy for COPD in older adults is limited by the difficulty in assessing respiratory symptoms using standardized assessment tools and potentially decreased inspiratory ability of frail individuals. Because of cognitive and physical impediments, ensuring optimal delivery of inhaled medications into the lungs has significant challenges. Long-acting bronchodilators, inhaled corticosteroids, and roflumilast decrease the risk of exacerbations, although inhaled corticosteroids should be used judiciously in this population because of the risk of pneumonia and oropharyngeal side effects. Treatment of COPD exacerbations should occur early and consideration should be made to the benefits and risks of systemic corticosteroids and antibiotics. Clinical research in the COPD population in nursing homes is clearly lacking, and ripe for discovery of effective management strategies.

Authors+Show Affiliations

UNC Chapel Hill Division of Pulmonary and Critical Care Medicine, Chapel Hill, NC, USA. Durham Veterans Administration Medical Center, Durham, NC, USA.Insight Therapeutics, LLC, 150 Boush Street, Suite 1005, Norfolk, VA, 23510, USA.Insight Therapeutics, LLC, 150 Boush Street, Suite 1005, Norfolk, VA, 23510, USA. edavidson@inther.com. Clinical Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA. edavidson@inther.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31172422

Citation

Pleasants, Roy A., et al. "Optimizing Drug Therapies in Patients With COPD in the US Nursing Home Setting." Drugs & Aging, vol. 36, no. 8, 2019, pp. 733-745.
Pleasants RA, Radlowski PA, Davidson HE. Optimizing Drug Therapies in Patients with COPD in the US Nursing Home Setting. Drugs Aging. 2019;36(8):733-745.
Pleasants, R. A., Radlowski, P. A., & Davidson, H. E. (2019). Optimizing Drug Therapies in Patients with COPD in the US Nursing Home Setting. Drugs & Aging, 36(8), pp. 733-745. doi:10.1007/s40266-019-00680-x.
Pleasants RA, Radlowski PA, Davidson HE. Optimizing Drug Therapies in Patients With COPD in the US Nursing Home Setting. Drugs Aging. 2019;36(8):733-745. PubMed PMID: 31172422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimizing Drug Therapies in Patients with COPD in the US Nursing Home Setting. AU - Pleasants,Roy A, AU - Radlowski,Peter A, AU - Davidson,H Edward, PY - 2019/6/7/pubmed PY - 2019/6/7/medline PY - 2019/6/8/entrez SP - 733 EP - 745 JF - Drugs & aging JO - Drugs Aging VL - 36 IS - 8 N2 - Chronic obstructive pulmonary disease (COPD) can be a disabling disease, and the impact on older adults is particularly evident in the nursing home setting. Chronic obstructive pulmonary disease is present in about 20% of nursing home residents, most often in women, and accounts for significant healthcare utilization including acute care visits for exacerbations and pneumonia, as well as worsening heart disease and diabetes mellitus. The emphasis on hospital readmissions is particularly important in nursing homes where institutions have quality measures that have financial implications. Optimizing drug therapies in individuals with COPD involves choosing medications that not only improve symptoms, but also decrease the risk of exacerbations. Optimizing the treatment of comorbidities such as heart disease, infections, and diabetes that may affect COPD outcomes is also an important consideration. Depending on the nursing home setting and the patient, the options for optimizing COPD drug therapies may be limited owing to patient-related factors such as cognition and physical impairment or available resources, primarily reimbursement-related issues. Choosing the best drug therapy for COPD in older adults is limited by the difficulty in assessing respiratory symptoms using standardized assessment tools and potentially decreased inspiratory ability of frail individuals. Because of cognitive and physical impediments, ensuring optimal delivery of inhaled medications into the lungs has significant challenges. Long-acting bronchodilators, inhaled corticosteroids, and roflumilast decrease the risk of exacerbations, although inhaled corticosteroids should be used judiciously in this population because of the risk of pneumonia and oropharyngeal side effects. Treatment of COPD exacerbations should occur early and consideration should be made to the benefits and risks of systemic corticosteroids and antibiotics. Clinical research in the COPD population in nursing homes is clearly lacking, and ripe for discovery of effective management strategies. SN - 1179-1969 UR - https://www.unboundmedicine.com/medline/citation/31172422/Optimizing_Drug_Therapies_in_Patients_with_COPD_in_the_US_Nursing_Home_Setting L2 - https://dx.doi.org/10.1007/s40266-019-00680-x DB - PRIME DP - Unbound Medicine ER -