Use of inhaled devices during a hospital exacerbation of COPD: a summary of an interdisciplinary audit held at ICS Maugeri Pavia, Italy (March-June 2019)

  • Michele Vitacca | michele.vitacca@icsmaugeri.it Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy. http://orcid.org/0000-0002-9389-7915
  • Cinzia Lastoria Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia, Italy.
  • Monica Delmastro Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia, Italy.
  • Domenico Fiorenza Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.
  • Pasquale De Cata Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia, Italy.
  • Barbara Fusar Poli Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia, Italy.
  • Sonia Gilè Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Montescano (PV), Italy.
  • Paola Prometti Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.
  • Mara Paneroni Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.
  • Cristina Bianchi Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia, Italy.
  • Elena Mandora Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Guinea.
  • Roberta Porri Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia, Italy.
  • Claudio Fracchia Department of Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.

Abstract

To date treatment protocols in Respiratory and or Internal departments across Italy for treatment of chronic obstructive pulmonary disease (COPD) patients at hospital admission with relapse due to exacerbation do not find adequate support in current guidelines. Here we describe the results of a recent clinical audit, including a systematic review of practices reported in literature and an open discussion comparing these to current real-life procedures. The process was dived into two 8-hour-audits 3 months apart in order to allow work on the field in between meeting and involved 13 participants (3 nurses, 1 physiotherapist, 2 internists and 7 pulmonologists). This document reports the opinions of the experts and their consensus, leading to a bundle of multidisciplinary statements on the use of inhaled drugs for hospitalized COPD patients. Recommendations and topics addressed include: i) monitoring and diagnosis during the first 24 h after admission; ii) treatment algorithm and options (i.e., short and long acting bronchodilators); iii) bronchodilator dosages when switching device or using spacer; iv) flow measurement systems for shifting to LABA+LAMA within 48 h; v) when nebulizers are recommended; vi) use of SMI to deliver LABA+LAMA when patient needs SABA <3 times/day independently from flow limitation; vii) use of DPI and pre-dosed MDI to deliver LABA+LAMA or TRIPLE when patient needs SABA <3 times/day, with inspiratory flow > 30 litres/min; viii) contraindication to use DPI; ix) continuation of LABA-LAMA when patient is already on therapy; x) possible LABA-LAMA dosage increase; xi) use of SABA and/or SAMA in addition to LABA+LABA; xii) use of SABA+SAMA restricted to real need; xiii) reconciliation of drugs in presence of comorbidities; xiv) check of knowledge and skills on inhalation therapy; xv) discharge bundle; xvi) use of MDI and SMI in tracheostomized patients in spontaneous and ventilated breathing.

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Published
2020-02-12
Info
Issue
Section
Physiotherapy - Original Articles
Keywords:
Relapse, inhaled therapy, devices, COPD
Statistics
  • Abstract views: 223

  • PDF: 171
  • Supplementary: 28
How to Cite
Vitacca, M., Lastoria, C., Delmastro, M., Fiorenza, D., De Cata, P., Fusar Poli, B., Gilè, S., Prometti, P., Paneroni, M., Bianchi, C., Mandora, E., Porri, R., & Fracchia, C. (2020). Use of inhaled devices during a hospital exacerbation of COPD: a summary of an interdisciplinary audit held at ICS Maugeri Pavia, Italy (March-June 2019). Monaldi Archives for Chest Disease, 90(1). https://doi.org/10.4081/monaldi.2020.1176