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1 Device inalatori nella BPCO: d uso, counseling, aderenza alla terapia Fulvio Braido

2 COPD OUTCOMES Cazzola M et al. ERJ 2008

3 15.1%

4 Total medicare spending Simoni-Wastila, Am J Geriatr Pharmacother, 2012

5 Efficacia: outcomes effettivamente raggiunti / outcomes attesi Efficienza : rapporto output input

6 Drug Disease Cognition Patient Satisfaction Effectiveness = Efficacy X Adherence Treatment Schedule Inhaler Clinical effects Side effects Patient Behaviour Patient-Physician Relationship Drug delivering

7 The tough math of evidence based health care ROI = E x KT2 ROI = return on investment. E = efficacy of treatment. KT2*: Physician Patient *knowledge translation type 2 Haynes, ACP Journal Club 2009

8 The tough math of evidence based health care: asthma and ICS 25% therapeutic efficacy. 37% for patient adherence. 78% Physician adherence..25 x.37 x.78 = % the overall effectiveness Haynes ACP, Journal Club 2009

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10 PAP Respiratory diseases management Perception and experience of the disease, adherence and attitudes towards the device PUBLIC PERCEPTION EXTENSIVE SURVEY

11 The methodology used Type of investigation: ad hoc quantitative Detection mode: Reference population: Sample: personal interv iews (C.A.P.I. system) 30 minutes structured questionnaire men and women aged 15 years and ov er resident in the whole national territory interviews representative of the sample according to the main socio-demographic parameters Survey: from May 22 nd to June 7 th, 2012

12 PAP Sample demographic characteristics N of patients: 2008 AGE < >64 TOWN SIZE LITTLE < inhab. 59 MEDIUM inhab. 16 BIG > inhab. 25

13 Socio-economic condition EDUCATION JOB DIPLOMA WORKING EMPLOYEE 18 DEGREE 9 50 ELEMENTARY- SECONDARY TRADER, CRAFSTMAN 8 TECHNICIAN 6 WORKER 5 ENTREPRENEUR, FREELANCE PROFESSIONAL 5 TEACHER 2 SOCIO-ECONOMIC CATEGORY MIDDLE MANAGER 2 EXECUTIVE MANAGER 1 Medium-high High Low Medium FARMER 1 NOT WORKING 53 RETIRED HOUSEWIFE 12 Medium-low STUDENT 10 UNEMPLOYED 6 N of patients: 2008

14 AWARENESS OF RESPIRATORY DISEASES diabetes Have you recently heard of any of the following diseases? 61 migraine artrosis hypertension ASTHMA osteoporosis 48 colitis hepatitis ASMA celiac disease BPCO 38 glaucoma BPCO PAP

15 La conoscenza delle malattie respiratorie Di recente Le è capitato di sentir parlare di qualcuna delle seguenti malattie? LIVELLO DI AWARENESS diabete emicrania artrosi ipertensione asma osteoporosi colite epatite celiachia glaucoma BPCO Rispondenti (totale campione): % Presso il general public la conoscenza delle malattie respiratorie croniche presenta consistenti discontinuità. Da un lato si è sentito parlare molto di asma, mentre la BPCO rimane un patologia ancora misconosciuta. Awareness per classi di età ASMA BPCO

16 USE OF THE INHALER DEVICE Respondents: suffer from asthma/copd USE OF THE INHALER DEVICE (%) 65 Patients currently using it % The use of device is less extended than we might expect. The percentage of abandoners is significant Patients who never used it Patients who used it in the past It should be noticed an intermittent use of the device: in most cases it is used as needed. PAP

17 Attitudes towards the device OVERALL OPINION If you had to give your overall opinion on the treatment with drugs taken by means of an inhaler device, which would be your judgment? % They use the inhaler device A relative uses the inhaler device A person they know uses the inhaler device They have heard about the inhaler device They don t know the inhaler device Positivo Positive judgement 83 Quite positive Quite negative + negative Respondents: total sample The resistance to the device is limited to people who can not rely on knowledge of the device. Where there is direct or indirect experience, there is an attitude of frank openness.

18 I believe that all device are more or less the same, that one is as good as another INDIFFERENCE 70 65,5 59, ,8 18,4 18,7 Under 64 Over I agree I disagree I don't know 2 = p<0.0130

19 The device is just a device, it does not contribute to the effectiveness of treatment INDIFFERENCE 60 51, , ,4 35,6 30 Under 64 Over ,1 17, I agree I disagree I don't know 2 = p<0.0293

20 I would be willing to use the device only for a short period of time, for therapies of a few days AVAILABILITY 60 58,2 53, ,2 27,1 30 Under 64 Over ,8 11, I agree I disagree I don't know 2 = p<0.0021

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24 The Genuair inhaler: first multidose dry powder inhaler containing a LAMA Novel, multidose breath-actuated DPI with 1 month s supply Ready-to-use device from the package Handihaler Breezehaler Respimat Chrystyn and Niederlaender, Int J Clin Pract 2012 DPI, dry powder inhaler

25 The Genuair inhaler: inhalation is a simple two-step process Turbohaler 5 Diskus 4 Nexthaler 3

26 The Genuair inhaler: inbuilt safety measures Dose indicator Indicates when patient is close to last dose Empty inhaler prevention system Button is locked and cannot be depressed after last dose has been taken Over-dosing prevention system Only one dose released prior to inhalation, irrespective of how many times button is pressed

27 Genuair Tecnologia

28 Drug deposition (% metered dose) Lung deposition Whole-lung deposition: 30.1% of metered dose 34.0% of delivered dose Whole lungs Oropharynx Inhaler Exhaled air Newman et al, Respiration 2009 Reproduced w ith permission of S Karger AG, Basel

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30 % dose predeterminata Genuair Pattern di distribuzione intrapolmonare 16 Interno Esterno Regioni polmonari CV = 24% CV, coefficiente di variazione; dati ottenuti da 12 adulti maschi sani dopo l inalazione di una singola dose di aclidinium 200 μg radiomarcato con 99mTc New man SP, Sutton DJ, Segarra R et al. Respiration 2009;78(3):

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32 Highest PIF (L/min) Patients achieved highest peak inspiratory flow (PIF) with Genuair ** ** Genuair inhaler HandiHaler (slow, deep inhale) HandiHaler (fast, forceful inhale) ** All patients Moderate COPD Severe COPD Magnussen et al, Respir Med 2009 **p<0.001 vs HandiHaler Reproduced w ith permission of Elsevier

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35 Correct inhalations with Genuair and HandiHaler 97.2% of inhalations through Genuair were successful (activation of trigger mechanism) and optimal (PIF 45 L/min) 73.6% of inhalations through HandiHaler (slow, deep inhalation) resulted in capsule vibration heard and no powder remaining in the centre chamber Magnussen et al, Respir Med 2009

36 % participants who succeeded Overall inhaler success is higher with Genuair compared with other inhalers Genuair HandiHaler * Respimat * Diskus % 67% 40 35% 20 23% 0 Overall inhaler success *HandiHaler blister pack manipulation and Respimat cartridge loading were not tested Hass et al, CHEST 2010

37 Average rating* Patients are more satisfied with Genuair compared with other inhalers 5 Genuair HandiHaler Respimat Diskus Overall satisfaction measures Hass et al, CHEST 2010 *Rating 1 5 (worst best)

38 Patients prefer Genuair compared with other inhalers Most preferred Least preferred Genuair Diskus HandiHaler Respimat Average cm from 0; max is 100 Hass et al, CHEST 2010

39 COSTS ADHERENCE Implementation Strategies Media Campaigns MD students Education Interactions HCS CME-Meetings Opinion Leaders Scientific Societies HC Blogs Blogs Internet Social Networks Patient Organizations EFFECTIVENESS patient/physician partnership Patient Education

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42 The tough math of evidence based health care ROI = E x KT2 ROI = return on investment. E = efficacy of treatment. KT2*: Physician Patient *knowledge translation type 2 Haynes, ACP Journal Club 2009

43 Assist and motivate patients to enact optimal guided self-management Patient s expertise, experience, knowledge and attitude Tools and resources supporting patient s selfmanagement Phy sician s behavioural and/or practice change supporting patient s guided selfmanagement Guidelines, knowledge production and dissemination and expert opinion Optimal practice Workplace culture and peer influence and support Phy sician s education, expertise and knowledge Phy sician s attitude and efforts with regards to optimal practice Support physicians to achieve optimal practice Offer effective and efficient services Interprofessional patient management Reorganisation of care and organizational change management Resources and tools supporting phy sician s decision making and optimal practice

44 Device inalatori nella BPCO: d uso, counseling, aderenza alla terapia Fulvio Braido

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