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Clinical Considerations for Long-Term Care

Cognitive Impairments Icon

Cognitive impairments in COPD patients are a common obstacle to correct inhaler administration1*

Common cognitive impairments among COPD patients in the LTC setting2†

62% Icon

Short-term
memory problems

43% Icon

Moderately or severely
impaired cognitive skills for
daily decision making

37% Icon

Alzheimer's disease
or dementia

*Cognitive impairments may also hinder nebulizer setup and maintenance, with which LTC staff may provide assistance. Inhaled therapies require understanding and execution of breath synchronization, while nebulized therapy is delivered through regular tidal breathing.

Based on a 2012 retrospective analysis of claims from skilled nursing facilities. The majority of LTC residents diagnosed with COPD in this cohort were female (58%) and aged ≥75 years (64.7%).2


Nebulizer Device Icon

Physical and cognitive limitations common in the elderly may interfere with proper administration of inhaled therapies3

  • Elderly patients, particularly those aged ≥75 years, may have cognitive difficulties that hinder inhaler use3
  • In a study of cognitively impaired patients who were instructed on five-stage metered-dose inhaler use, 50% of patients with borderline cognitive impairment could not operate a metered-dose inhaler correctly 1 day after training1

Residents with cognitive impairment may be candidates for nebulized therapy3*

COPD therapy can be delivered using modern nebulized technology, which may offer:

Lung Icon

Medication delivery with regular tidal breathing3

 

Breath Icon

No deep breaths or breath holding required4

 

Clock Icon

Treatment time of up to 20 minutes5

Treatment time for BROVANA typically takes 5 to 10 minutes6

 

Feather Icon

Lightweight (compressors generally less than 1.5 lb)7

 

Battery Icon

Capability to run while plugged in or through use of a rechargeable battery7

 

*Cognitive impairments may also hinder nebulizer setup and maintenance, with which LTC staff may provide assistance. Inhaled therapies require understanding and execution of breath synchronization, while nebulized therapy is delivered through regular tidal breathing. 

COPD Brochure

To learn more, download the brochure.

COPD in the Long-Term Care Setting
 

COPD=chronic obstructive pulmonary disease; LTC=long-term care.

NEXT: SEE CLINICAL GUIDELINES HIGHLIGHTS 

Cognitive impairments in COPD patients are a common obstacle to correct inhaler administration1*

Common cognitive impairments among COPD patients in the LTC setting2†

62% Icon

Short-term memory problems

43% Icon

Moderately or severely impaired cognitive skills for daily decision making

37% Icon

Alzheimer's disease or dementia

*Cognitive impairments may also hinder nebulizer setup and maintenance, with which LTC staff may provide assistance. Inhaled therapies require understanding and execution of breath synchronization, while nebulized therapy is delivered through regular tidal breathing.

Based on a 2012 retrospective analysis of claims from skilled nursing facilities. The majority of LTC residents diagnosed with COPD in this cohort were female (58%) and aged ≥75 years (64.7%).2


Physical and cognitive limitations common in the elderly may interfere with proper administration of inhaled therapies3

  • Elderly patients, particularly those aged ≥75 years, may have cognitive difficulties that hinder inhaler use3
  • In a study of cognitively impaired patients who were instructed on five-stage metered-dose inhaler use, 50% of patients with borderline cognitive impairment could not operate a metered-dose inhaler correctly 1 day after training1

Residents with cognitive impairment may be candidates for nebulized therapy3*

COPD therapy can be delivered using modern nebulized technology, which may offer:

Lung Icon

Medication delivery with regular tidal breathing3

Breath Icon

No deep breaths or breath holding required4

Clock Icon

Treatment time of up to 20 minutes5

Treatment time for BROVANA typically takes 5 to 10 minutes6

Feather Icon

Lightweight (compressors generally less than 1.5 lb)7

Battery Icon

Capability to run while plugged in or through use of a rechargeable battery7

*Cognitive impairments may also hinder nebulizer setup and maintenance, with which LTC staff may provide assistance. Inhaled therapies require understanding and execution of breath synchronization, while nebulized therapy is delivered through regular tidal breathing.
Based on a 2012 retrospective analysis of claims from skilled nursing facilities. The majority of LTC residents diagnosed with COPD in this cohort were female (58%) and aged ≥75 years (64.7%).2

COPD Brochure

To learn more, download the brochure.

COPD in the Long-Term Setting
 

COPD=chronic obstructive pulmonary disease; LTC=long-term care.

NEXT: SEE CLINICAL GUIDELINES HIGHLIGHTS 


References:
1. Allen SC. Competence thresholds for the use of inhalers in people with dementia. Age Ageing. 1997;26(2):83-86. 
2. Zarowitz BJ, O’Shea T. Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment. J Manag Care Pharm. 2012;18(8):598-606. 
3. Taffet GE, Donohue JF, Altman PR. Considerations for managing chronic obstructive pulmonary disease in the elderly. Clin Interv Aging. 2014;9:23-30. 
4. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. CHEST. 2005;127(1):335-371.
5. Dhand R, Dolovich M, Chipps B, Myers TR, Restrepo R, Farrar JR. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9:58-72. 
6. BROVANA [prescribing information]. Marlborough, MA: Sunovion Pharmaceuticals Inc.; 2014. 
7. PARI Respiratory Equipment, Inc. Trek® S Portable Aerosol System: Instructions for use. https://www.pari.com/fileadmin/user_upload/PARI.com_Amerika/Instructions/047D0205-Rev-A-11-15-Trek-S-Combo-IFU-EN-FR-v2.pdf. Accessed August 22, 2017.

Important Safety Information & Indication

Important Safety Information

WARNING: ASTHMA-RELATED DEATH

Long-acting beta2-adrenergic agonists (LABAs) increase the risk of asthma-related death. Data from a large placebo-controlled US study that compared the safety of another LABA (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol is considered a class effect of LABAs, including arformoterol, the active ingredient in BROVANA.

The safety and efficacy of BROVANA in patients with asthma have not been established. BROVANA is not indicated for the treatment of asthma.


All LABAs, including BROVANA, are contraindicated in patients with asthma without use of a long-term asthma control medication; BROVANA is also contraindicated in patients with a history of hypersensitivity to arformoterol, racemic formoterol or to any of the ingredients. 

BROVANA should not be initiated in patients with acutely deteriorating COPD or potentially life-threatening episodes of COPD, or used as rescue therapy for acute episodes of bronchospasm. Acute symptoms should be treated with an inhaled short-acting beta2-agonist.

BROVANA should not be used more often, at higher doses than recommended, or in conjunction with other medications containing LABAs as an overdose may result. Patients who have been taking inhaled short-acting beta2-agonists on a regular basis should be instructed to discontinue their regular use and to use them only for symptomatic relief for acute respiratory symptoms. Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs. Patients using BROVANA should not use another medicine containing a LABA for any reason.

Immediate hypersensitivity reactions may occur with BROVANA. If signs occur, discontinue immediately and institute alternative therapy.

As with other inhaled beta2-agonists, BROVANA can produce paradoxical bronchospasm that may be life-threatening. If paradoxical bronchospasm occurs, BROVANA should be discontinued immediately and alternative therapy instituted.

BROVANA, like other beta2-agonists, can produce a clinically significant cardiovascular effect in some patients as measured by increases in pulse rate, systolic or diastolic blood pressure, and/or symptoms. BROVANA should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension. Beta2-adrenergic agonists may produce significant hypokalemia in some patients.

As with other beta2-agonists, BROVANA, should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors, tricyclic antidepressants, or drugs known to prolong the QTc interval because these agents may potentiate the action of adrenergic agonists on the cardiovascular system.

As with other beta2-agonists, BROVANA should be used with caution in patients treated with additional adrenergic drugs, non-potassium-sparing diuretics, and beta-blockers.

BROVANA, like all medicines containing sympathomimetic amines, should be used with caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, ketoacidosis, and in patients who are unusually responsive to sympathomimetic amines.

Overall efficacy of BROVANA was maintained throughout the 12-week trial duration. Some tolerance to the bronchodilator effect of BROVANA was observed after 6 weeks of dosing (at the end of the dosing interval), although the FEV1 improvement remained statistically significant. This was not accompanied by other clinical manifestations of tolerance.

The five most common adverse events reported with frequency ≥2% in patients taking BROVANA, and occurring more frequently than in patients taking placebo, were pain (8% vs 5%), chest pain (7% vs 6%), back pain (6% vs 2%), diarrhea (6% vs 4%), and sinusitis (5% vs 4%).

BROVANA should not be swallowed as the intended effects on the lungs will not be obtained.  BROVANA is only for oral inhalation via a standard jet nebulizer connected to an air compressor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

For additional information, please see the full Prescribing Information including BOXED WARNING, and Medication Guide for BROVANA (arformoterol tartrate) Inhalation Solution, at www.sunovionprofile.com/brovana.

Indication

BROVANA® (arformoterol tartrate) Inhalation Solution is a long-acting beta2 -adrenergic agonist (LABA) indicated for the long-term, twice-daily (morning and evening) maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema. BROVANA is for use by nebulization only.

Important limitations: BROVANA is not indicated to treat acute deteriorations of COPD and is not indicated to treat asthma.