Impact of COPD in Long-Term Care

Hospital Admission Icon

COPD is a top-5 cause of avoidable hospital admissions1*

People Icon

 

People Icon

Approximately 1 in 5 long-term care residents has COPD2

Hospital Admission Icon

COPD is a top-5 cause of avoidable hospital admissions1*

People Icon

Approximately 1 in 5 long-term care residents has COPD2

UTIBRON NEOHALER has not been shown or indicated to reduce hospitalizations in prospective, randomized, placebo-controlled studies.

UTIBRON NEOHALER has not been shown or indicated to reduce hospitalizations in prospective, randomized, placebo-controlled studies.

Treatment of COPD in the LTC setting often does not align with the Clinical Practice Guidelines of AMDA–The Society for Post-Acute and Long-Term Care Medicine (AMDA) or recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD).2,3†

View Clinical Guidelines Highlights


Treatment of COPD in the LTC setting often does not align with the Clinical Practice Guidelines of AMDA–The Society for Post-Acute and Long-Term Care Medicine (AMDA) or recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD).2,3†

View Clinical Guidelines Highlights


Long-term care icon

COPD is a major cause of hospitalizations in LTC residents

COPD is a major cause of hospitalizations in LTC residents

1 in 5 patients icon

Approximately 1 in 5 hospitalized patients age 75 years and older discharged to a skilled nursing facility (SNF) is readmitted within 30 days4

In a study of 3,037 LTC residents with COPD5

43%

were admitted to the hospital
at least once

90%

experienced at least 1 emergency
department visit

COPD costs are substantial and on the rise

70%

National US surveys estimate 70% of COPD expenditures are related to hospitalizations and ED visits5

49B

COPD costs are projected to increase from $32 billion in 2010 to $49 billion in 20206


UTIBRON NEOHALER has not been shown or indicated to impact hospitalizations in prospective, randomized, placebo-controlled trials.

*Among dual-eligible beneficiaries of Medicare and Medicaid.
AMDA and GOLD are nationally recognized organizations that provide evidence-based clinical practice guidelines.7,8

COPD in the Long-Term Care Setting Article

Read more about COPD in the long-term care setting in Annals of Long-Term Care.

Download the PDF
 
 

COPD is undertreated in the LTC setting

SABA monotherapy is overused as maintenance therapy for COPD2

  • The GOLD Report recommends using long-acting bronchodilators, including long-acting beta2-agonists, as a standard of care for COPD maintenance

More than two thirds of patients use their inhalation devices incorrectly8

  • This can result in decreased delivery of medication and, over time, may reduce COPD symptom control7

AMDA and GOLD do not endorse any specific treatments.

1 in 5 patients icon

Approximately 1 in 5 hospitalized patients age 75 years and older discharged to a skilled nursing facility (SNF) is readmitted within 30 days4

In a study of 3,037 LTC residents with COPD5

43%

were admitted to the hospital at least once

90%

experienced at least 1 emergency department visit

COPD costs are substantial and on the rise

70%

National US surveys estimate 70% of COPD expenditures are related to hospitalizations and ED visits5

49B

COPD costs are projected to increase from $32 billion in 2010 to $49 billion in 20206


UTIBRON NEOHALER has not been shown or indicated to impact hospitalizations in prospective, randomized, placebo-controlled trials.

*Among dual-eligible beneficiaries of Medicare and Medicaid.
AMDA and GOLD are nationally recognized organizations that provide evidence-based clinical practice guidelines.7,8

COPD in the Long-Term Care Setting Article

Read more about COPD in the long-term care setting in Annals of Long-Term Care.

Download the PDF
 
 

COPD is undertreated in the LTC setting

SABA monotherapy is overused as maintenance therapy for COPD2

  • The GOLD Report recommends using long-acting bronchodilators, including long-acting beta2-agonists, as a standard of care for COPD maintenance

More than two thirds of patients use their inhalation devices incorrectly8

  • This can result in decreased delivery of medication and, over time, may reduce COPD symptom control7

AMDA and GOLD do not endorse any specific treatments.

Long-Term Care Icon

Long-acting bronchodilators are underutilized in LTC settings

Long-acting bronchodilators are underutilized in LTC settings

In a study of 27,106 LTC residents with COPD

17%

did not receive respiratory treatments
for COPD
2

In a study of Medicare patients with COPD

69%

of those with more severe COPD and multiple comorbidities did not receive a long-acting COPD maintenance medication9

In another study of LTC residents with COPD

60%

of patients did not receive long-acting COPD maintenance therapy2

UTIBRON NEOHALER has not been shown or indicated to reduce exacerbations and/or hospitalizations in prospective, randomized, placebo-controlled trials.


LTC residents with COPD often have more advanced disease. For these patients, AMDA recommends maintenance therapy with long-acting bronchodilators, such as a LABA or LAMA alone or in combination.7


AMDA guidelines summary

AMDA recommends maintenance therapy in LTC.

Read a summary about the guidelines
 
 

AMDA does not endorse any specific treatments.

COPD=chronic obstructive pulmonary disease.
LABA=long-acting beta2 adrenergic  agonist.
LAMA=long-acting muscarinic antagonist.
LTC=long-term care.
SABA=short-acting beta2-agonist.

SEE CLINICAL GUIDELINES HIGHLIGHTS 

In a study of 27,106 LTC residents with COPD

17%

did not receive respiratory treatments for COPD2

In a study of Medicare patients with COPD

69%

of those with more severe COPD and multiple comorbidities did not receive a long-acting COPD maintenance medication9

In another study of LTC residents with COPD

60%

of patients did not receive long-acting COPD maintenance therapy2

UTIBRON NEOHALER has not been shown or indicated to reduce exacerbations and/or hospitalizations in prospective, randomized, placebo-controlled trials.


LTC residents with COPD often have more advanced disease. For these patients, AMDA recommends maintenance therapy with long-acting bronchodilators, such as a LABA or LAMA alone or in combination.7


AMDA guidelines summary

AMDA recommends maintenance therapy in LTC.

Read a summary about the guidelines
 

AMDA does not endorse any specific treatments.

COPD=chronic obstructive pulmonary disease.
LABA=long-acting beta2-adrenergic agonist.
LAMA=long-acting muscarinic antagonist.
LTC=long-term care.
SABA=short-acting beta2-agonist.

SEE CLINICAL GUIDELINES HIGHLIGHTS 


References:
1. Walsh EG, Wiener JM, Haber S, Bragg A, Freiman M, Ouslander JG. Potentially avoidable hospitalizations of dually eligible Medicare and Medicaid beneficiaries from nursing facility and home- and community-based services waiver programs. J Am Geriatr Soc. 2012;60:821-829.
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. Patel M, Steinberg K, Suarez-Barcelo M, et al. Chronic obstructive pulmonary disease in post-acute/long-term care settings: seizing opportunities to individualize treatment and device selection. J Am Med Dir Assoc. 2017;18(6):553.e17-553.e22. 
4. Ouslander JG, Diaz S, Hain D, Tappen R. Frequency and diagnoses associated with 7- and 30-day readmission of skilled nursing facility patients to a nonteaching community hospital. J Am Med Dir Assoc. 2011;12(3):195-203.  
5. Simoni-Wastila L, Blanchette CM, Qian J, et al. Burden of chronic obstructive pulmonary disease in Medicare beneficiaries residing in long-term care facilities. Am J Geriatr Pharmacother. 2009;7(5):262-270.  
6. Ford ES, Murphy LB, Khavjou O, Giles WH, Holt JB, Croft JB. Total and state-specific medical and absenteeism costs of COPD among adults aged ≥18 years in the United States for 2010 and projections through 2020. CHEST. 2015:147(1):31-45.
7. AMDA-The Society for Post-Acute and Long-term Care Medicine. COPD Management in the Post-Acute and Long-term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA; 2016. 
8. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2018 report. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2018:1-123. 
9. Make B, Dutro MP, Paulose-Ram R, et al. Undertreatment of COPD: A retrospective analysis of US managed care and Medicare patients. Int J Chron Obstruct Pulmon Dis. 2012:7:1-9.

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 all LABAs, including indacaterol, one of the active ingredients in UTIBRON NEOHALER.

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



All LABAs, including indacaterol, are contraindicated in patients with asthma without the use of a long-term asthma-control medication; UTIBRON NEOHALER is also contraindicated in patients with a history of hypersensitivity to indacaterol, glycopyrrolate, or to any of the ingredients.

UTIBRON NEOHALER should not be initiated in patients with acutely deteriorating 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.

UTIBRON NEOHALER should not be used more often, at higher doses than recommended, or in conjunction with other medicines 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 of acute respiratory symptoms. Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs. Patients using UTIBRON NEOHALER should not use another medicine containing a LABA for any reason.

Immediate hypersensitivity reactions have been reported with UTIBRON NEOHALER. If signs occur, discontinue immediately and institute alternative therapy. UTIBRON NEOHALER should be used with caution in patients with severe hypersensitivity to milk proteins.

As with other inhaled medicines, UTIBRON NEOHALER can produce paradoxical bronchospasm that may be life threatening. If paradoxical bronchospasm occurs following dosing with UTIBRON NEOHALER, it should be treated immediately with an inhaled, short-acting bronchodilator; UTIBRON NEOHALER should be discontinued immediately and alternative therapy instituted.

Indacaterol, like other beta2-adrenergic agonists, can produce a clinically significant cardiovascular effect in some patients as measured by increases in pulse rate, systolic or diastolic blood pressure, or symptoms. UTIBRON NEOHALER 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-adrenergic agonists, indacaterol should be administered with extreme caution in patients being treated with monoamine oxidase inhibitors, tricyclic antidepressants, or other 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-adrenergic agonists, UTIBRON NEOHALER should be used with caution in patients treated with additional adrenergic drugs, non-potassium-sparing diuretics, and beta-blockers.

UTIBRON NEOHALER, 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.

UTIBRON NEOHALER should be used with caution in patients with narrow-angle glaucoma and in patients with urinary retention. Prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (e.g., eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) and of urinary retention (e.g., difficulty passing urine, painful urination), especially in patients with prostatic hyperplasia or bladder-neck obstruction. Patients should be instructed to consult a physician immediately should any of these signs or symptoms develop.

The most common adverse events reported in ≥1% of patients taking UTIBRON NEOHALER, and occurring more frequently than in patients taking placebo, were nasopharyngitis (4.1% vs 1.8%), hypertension (2.0% vs 1.4%), back pain (1.8% vs 0.6%), and oropharyngeal pain (1.6% vs 1.2%).

UTIBRON capsules must not be swallowed as the intended effects on the lungs will not be obtained. UTIBRON capsules are only for oral inhalation and should only be used with the NEOHALER device.

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 UTIBRON NEOHALER.



Indication
 

UTIBRON® NEOHALER® (indacaterol and glycopyrrolate) is a combination of indacaterol and glycopyrrolate indicated for the long-term, maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.

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