Participants who took part in the meeting were Chris Baron, Assistant Director, Business Development, Aptar Pharma Prescription Division, France; Beverley Bostock, Nurse Practitioner, Clinical Lead, Warwickshire, UK; Guillaume Brouet, President GMD, Aptar Pharma Prescription Division, France; Dr Nayna Govind, NG Pharma Consulting Ltd, UK; Dr Kevin Gruffydd-Jones, GP, RCGP Respiratory Clinical Lead, Wiltshire, UK; Christine Loveridge, Respiratory Clinical Lead, Education for Health, UK; Professor Nicolas Roche, Head of Pulmonary Service, Central Paris University Hospital, France; Dr Gerallt Williams, Director, Scientific Affairs, Aptar Pharma Prescription Division, France.
During the one-day meeting, which focused on inhaler adherence, the key opinion leaders shared their knowledge and debated a number of topics, including: Current guidance with regard to therapy/inhaler prescribing; Specific healthcare professional and patient issues with inhaler devices and unmet needs; Potential avenues for making more adherence-friendly inhalers; Healthcare costs, reimbursement and emerging therapies.
Recent figures show that over 90 per cent of the devices used worldwide by sales volume (and over 70 per cent by sales value) for the treatment of asthma and COPD are pressurised metered dose inhalers (pMDIs) or dry powder inhalers (DPIs). It has been estimated that non-compliance with the prescription can reach 50 per cent in patients suffering from asthma. Studies specifically on pMDIs show that misuse of these devices is seen in 50 per cent of cases. The result of this non-compliance is poor disease control and elevated healthcare costs.
Participants looked at the process of prescribing inhalers for the treatment of asthma and COPD, which was seen to be a complex issue. Although detailed industry guidance exists to help select the correct therapeutic class of drug, there are a number of factors related to the patient’s capabilities that must also be considered. These include age, coordination skills, inhalation capacity and patient preferences. Selecting the actual device type depends on the therapeutic class of drug, the cost, and whether to use innovator or generic products. The participants noted that the selection of the inhaler device type is at least as important as the type of therapy chosen.
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Key thoughts from key opinion leaders
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The participants then discussed what happens once the inhaler is selected. When a patient consults a physician about a new inhaler, it is unlikely that much time can be spent on instructions for use. Consulting a respiratory nurse practitioner for instructions for use is seen as best practice, with follow-up sessions to check on correct use.
The diversity of inhaler devices on the market is also seen as a challenge. This is perceived as a specific issue for DPIs, which may have very different modes of operation, with some patients having separate inhalers for asthma relief and asthma control, each providing a different patient experience.
Looking to the future, the participants saw promise for better adherence in active monitoring and feedback, using smart devices. A new generation of e-devices will be potentially able to communicate with future tele-health systems. In a study in the UK, reminders and incentives to use the inhaler proved capable of reducing costs by over 20 per cent and emergency admissions to hospital by 50 per cent.
Participants noted that healthcare providers and pharmaceutical companies may need to collaborate on the issue of reconciling the ‘increased costs’ associated with developing more patient adherent devices and products with the target of reducing overall health care costs.
“It was agreed by all the participants in this round table that inhaler non-adherence is a real issue in asthma and COPD therapy. Discussions identified a number of issues that impact non-adherence and looked at ways of addressing these issues, in both the short and long term,” said Chris Baron, Associate Director, Business Development, Aptar Pharma Prescription Division. He concluded by saying, “Aptar Pharma is pleased to have once again provided the platform for such a productive and industry- relevant roundtable.”
Several issues were identified as having an impact on patient inhaler adherence, ranging from lack of time to train or instruct the patients all the way to there being too many different types of inhalers already available in the market place. Training and follow-up are obvious avenues for improving inhaler adherence and several add-on features would be welcome on inhaler devices. Looking into the future the role of monitoring and feedback could also play a role in improving adherence. Finally, cost is becoming a major influence on how inhalers are prescribed and ultimately on inhaler adherence, very much tied in with the ever-increasing healthcare cost burden worldwide.
EP News Bureau – Mumbai