Pulse May 2019 issue - Page 19

Mobile app aims to help improve inhaler technique for patients with asthma and COPD on Fostair® (beclometasone and formoterol). ADVERTORIAL FEATURE Poor adherence in asthma patients contributes to uncontrolled asthma symptoms, mortality and morbidity, impaired quality of life, exacerbations and urgent healthcare intervention. 1 Inhaler misuse has also been associated with The main features of the Patient Support increased risk of hospitalisation, emergency App are: hospital visits, courses of oral steroids and • Technique training – Patients can record poor disease control. 2 It can often be caused their own technique and compare it to by patients forgetting how to use their inhalers videos of device technique best practice, appropriately and sometimes introducing new rate their technique and share their 3 errors with time. findings with their HCP. Repeated video instruction has been shown to • Reminders – Patients can receive improve inhaler device technique in patients ‘dose due’ reminders to help improve with asthma and COPD, 4,5 and observation of adherence. technique by a healthcare professional or by • Daily motivational messages – Patients asthma patients themselves can be useful to can choose to receive daily messages detect problems. 6 Also, a reminder to use the reminding them of the of the benefits inhaler is an effective strategy for improving of regular treatment. 1 adherence. • Milestones – Patients can view Chiesi has launched a mobile app to help ‘milestones’ of consecutive days where all improve device technique and adherence in doses have been taken. adult patients with asthma or COPD, who have been prescribed maintenance therapy with Fostair® (beclometasone and formoterol). The Fostair® Patient Support App can be downloaded at www.chiesirespiratory.co.uk as well as the App store and Google Play. REFERENCES 1. Foster JM et al. Inhaler reminders improve adherence with controller treatment in primary care patients with asthma. Journal of Allergy and Clinical Immunology (2014);134(6):1260-1268. 2. Melani SA et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respiratory Medicine (2011);105:930-938. 3. Amin AN, et al. Confidence in correct inhaler technique and its association with treatment adherence and health status among US patients with chronic Fostair 100/6 and 200/6 Prescribing Information Please refer to the full Summary of Product Characteristics (SPC) before prescribing. Presentation: Each Fostair pressurised metered dose inhaler (pMDI) 100/6 dose contains 100 micrograms (mcg) of beclometasone dipropionate (BDP) and 6mcg of formoterol fumarate dihydrate (formoterol). Each Fostair pMDI 200/6 dose contains 200mcg of BDP and 6mcg of formoterol. Each Fostair NEXThaler 100/6 dry powder inhaler (DPI) dose contains 100mcg of BDP anhydrous and 6mcg of formoterol. Each Fostair NEXThaler 200/6 DPI dose contains 200mcg of BDP anhydrous and 6mcg of formoterol. Indications: Asthma: Regular treatment of asthma where use of an inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) combination is appropriate: patients not adequately controlled on ICS and as needed short-acting beta2-agonist, or patients already adequately controlled on both ICS and LABA. COPD (Fostair 100/6 only): Symptomatic treatment of patients with severe COPD (FEV 1 <50% predicted normal) and a history of repeated exacerbations, who have significant symptoms despite regular therapy with long-acting bronchodilators. Dosage and administration: For inhalation in adult patients (≥18 years). Asthma: Maintenance And Reliever Therapy (Fostair 100/6 only) can be taken as a regular maintenance treatment and as needed in response to asthma symptoms: 1 inhalation twice daily plus 1 additional inhalation as needed in response to symptoms. If symptoms persist after a few minutes, an additional inhalation is recommended. The maximum daily dose is 8 inhalations. Fostair 100/6 may also be used as maintenance therapy (with a separate short-acting bronchodilator as needed). Fostair 200/6 should be used as maintenance therapy only. Maintenance therapy: Fostair 100/6: 1–2 inhalations twice daily. Fostair 200/6: 2 inhalations twice daily. The maximum daily dose is 4 inhalations. Patients should receive the lowest dose that effectively controls their symptoms. COPD (Fostair 100/6 only): 2 inhalations twice daily. Fostair pMDI can be used with the AeroChamber Plus® spacer device. BDP in Fostair is characterised by an extrafine particle size distribution which results in a more potent effect than formulations of BDP with a non- extrafine particle size distribution (100mcg of BDP extrafine in Fostair are equivalent to 250mcg of BDP in a non-extrafine formulation). When switching patients from previous treatments, it should be considered that the recommended total daily dose of BDP for Fostair is lower than that for non-extrafine BDP containing products and should be adjusted to the needs of the individual patient. However, patients who are transferred between Fostair NEXThaler and Fostair pMDI do not need dose adjustment. Contraindications: Hypersensitivity to the active substances or to any of the excipients. Warnings and precautions: Use with caution in patients with cardiac arrhythmias, aortic stenosis, hypertrophic obstructive cardiomyopathy, ischaemic heart disease, severe heart obstructive pulmonary disease. Patient Prefer Adherence. 2017; 11: 1205-1212. 4. McElnay JC et al. Audiovisual demonstration for patient counselling in the use of pressurised aerosol bronchodilator inhalers. I Clin Pharm Ther. 1989;14(2):135-144. 5. van der Palen J et al: Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines. Patient Educ Couns. 1997; 32:S87-S95. 6. Haughney J et al. Achieving asthma control in practice: Understanding the reasons for poor control. Respir Med 2008; 102(12):1681-1693. failure, congestive heart failure, occlusive vascular diseases, arterial hypertension, severe arterial hypertension, aneurysm, thyrotoxicosis, diabetes mellitus, phaeochromocytoma and untreated hypokalaemia. Caution should also be used when treating patients with known or suspected prolongation of the QTc interval (QTc > 0.44 seconds). Formoterol itself may induce QTc prolongation. Potentially serious hypokalaemia may result from beta2-agonist therapy and may also be potentiated by concomitant treatments (e.g. xanthine derivatives, steroids and diuretics). Formoterol may cause a rise in blood glucose levels. Fostair should not be administered for at least 12 hours before the start of anaesthesia, if halogenated anaesthetics are planned as there is risk of arrhythmias. Use with caution in patients with pulmonary tuberculosis or fungal/viral airway infections. Increase in pneumonia and pneumonia hospitalisation in COPD patients receiving ICS. Clinical features of pneumonia may overlap with symptoms of COPD exacerbations. Fostair treatment should not be stopped abruptly. Medical attention should be sought if treatment ineffective. Treatment should not be initiated during exacerbations or acutely deteriorating asthma. Fostair treatment should be discontinued immediately if the patient experiences a paradoxical bronchospasm. Fostair is not intended for initial management of asthma. Systemic effects of ICS may occur, particularly at high doses for long periods, but are less likely than with oral steroids. These include Cushing’s syndrome, Cushingoid features, adrenal suppression, decrease in bone mineral density, cataract and glaucoma and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression and aggression. Consider referral of patients reporting blurred vision or visual disturbances to an ophthalmologist as causes may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy. Prolonged treatment with high doses of ICS may result in adrenal suppression and acute adrenal crisis. Lactose in Fostair NEXThaler contains small amounts of milk proteins, which may cause allergic reactions. Interactions: Possibility of systemic effects with concomitant use of strong CYP3A inhibitors (e.g. ritonavir, cobicistat) cannot be excluded and therefore caution and appropriate monitoring is advised. Beta-blockers should be avoided in asthma patients. Concomitant administration of other beta-adrenergic drugs may have potentially additive effects. Concomitant treatment with quinidine, disopyramide, procainamide, phenothiazines, antihistamines, monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants can prolong the QTc interval and increase the risk of ventricular arrhythmias. L-dopa, L-thyroxine, oxytocin and alcohol can impair cardiac tolerance towards beta2-sympathomimetics. Hypertensive reactions may occur following co- administration with MAOIs including agents with similar properties (e.g. furazolidone, procarbazine). Concomitant treatment with xanthine derivatives, steroids or diuretics may The Chiesi Fostair® Patient Support App is not intended to replace the advice of healthcare professionals. Patients are encouraged to speak to their treating Doctor, Nurse or Pharmacist if they have any questions regarding their treatment or condition. This feature has been sponsored by Chiesi Limited. For more information visit www.chiesirespiratory.co.uk. potentiate a possible hypokalaemic effect of beta2-agonists. Hypokalaemia may increase the likelihood of arrhythmias in patients receiving digitalis glycosides. Presence of ethanol in Fostair pMDI may cause potential interaction in sensitive patients taking metronidazole or disulfram. Fertility, pregnancy and lactation: Fostair should only be used during pregnancy or lactation if the expected benefits outweigh the potential risks. A risk/benefit decision should be taken to discontinue/abstain from therapy in the mother or discontinue breastfeeding. Effects on driving and operating machinery: Fostair is unlikely to have any effect on the ability to drive and use machines. Side effects: Common: pneumonia (in COPD patients), pharyngitis, oral candidiasis, headache, dysphonia, tremor. Uncommon: influenza, oral fungal infection, oropharyngeal candidiasis, nasopharyngitis, oesophageal candidiasis, vulvovaginal candidiasis, gastroenteritis, sinusitis, rhinitis, granulocytopenia, allergic dermatitis, hypokalaemia, hyperglycaemia, hypertriglyceridaemia, restlessness, dizziness, otosalpingitis, palpitations, prolongation of QTc interval, ECG change, tachycardia, tachyarrhythmia, atrial fibrillation, sinus bradycardia, angina pectoris, myocardial ischaemia, blood pressure increased, hyperaemia, flushing, cough, productive cough, throat irritation, asthmatic crisis, exacerbation of asthma, dyspnoea, pharyngeal erythema, diarrhoea, dry mouth, dyspepsia, dysphagia, burning sensation of the lips, nausea, dysgeusia, pruritus, rash, hyperhidrosis, urticaria, muscle spasms, myalgia, C-reactive protein increased, platelet count increased, free fatty acids increased, blood insulin increased, blood ketone body increased, blood cortisol decrease, oropharyngeal pain, fatigue, irritability, cortisol free urine decreased, blood potassium increased, blood glucose increased, ECG poor r-wave progression. Rare: ventricular extrasystoles, paradoxical bronchospasm, angioedema, nephritis, blood pressure decreased. Very rare: thrombocytopenia, hypersensitivity reactions, including erythema, lips, face, eyes and pharyngeal oedema, adrenal suppression, glaucoma, cataract, peripheral oedema, bone density decreased. Unknown frequency: psychomotor hyperactivity, sleep disorders, anxiety, depression, aggression, behavioural changes, blurred vision. (Refer to SPC for full list of side effects). Legal category: POM Price and Pack: £29.32 1x120 actuations Marketing authorisation (MA) No(s): PL 08829/0156, PL 08829/0175, PL 08829/0173, PL 08829/0174 MA holder: Chiesi Ltd, 333 Styal Road, Manchester, M22 5LG. Date of Preparation: Aug 2018. AeroChamber Plus® is a registered trademark of Trudell Medical International. Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Chiesi Ltd on 0800 0092329 (UK), 1800 817459 (IE) or PV.UK@Chiesi.com. UK-FTB-1800011 | March 2019