IN LONG-TERM CARECOPD

An overview of COPD signs, symptoms, and causes, followed by a discussion of management strategies for LTC facilities

COPD = chronic obstructive pulmonary disease; LTC = long-term care. Not an actual patient.

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~28 mil 4th

WHAT IS COPD?

COPD, which stands for chronic obstructive pulmonary disease, is a progressive respiratory disease that makes it hard to breathe over time. The term COPD includes two different respiratory conditions: chronic bronchitis and emphysema.1

Chronic bronchitis is a condition where the airways have increased swelling or mucus production, while emphysema is defined as damage to the air sacs of the lungs.2

COPD affects approximately 28 million people

in the United States3,4

It is the fourth leading cause of death after

heart disease and cancer5

COPD is one of the leading causes of 30-day hospital readmissions

in skilled nursing facility (SNF) residents6

Within LTC facilities, an estimated 1 in 5 residents has COPD7

No Sunovion product has been shown or indicated to impact mortality or have an impact on hospital readmissions in prospective, randomized, placebo-controlled trials.

However, COPD is widely undertreated in LTC7,8

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COPD is often caused by something that irritates the lungs over time.2

WHAT CAUSES COPD?

In the United States, cigarette smoking is a factor in approximately 80% of COPD cases. Other irritants that can lead to COPD include9:

Fire smoke10

Chemical fumes2

Dust2

Genetics also play a role in COPD

Some people have genes that put them at a higher risk for COPD, even if they don’t smoke11

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HOW TO SPOT SYMPTOMS AND PROGRESSION OF COPD12*

Severe COPD Very Severe COPDModerate COPDMild COPD

• Typically involves severe restraint of respiration, shortness of breath, and frequent COPD exacerbations

• Exercise is difficult at this point

• Increased risks, including COPD exacerbations that may result in a reduced quality of life

• Shortness of breath significantly reduces quality of life

• May walk slower than other people their age, and have to stop to catch their breath

• Worsening airflow limitation

• Shortness of breath upon exertion

• May experience shortness of breath when hurrying or walking up a slight hill

• May or may not experience cough or mucus

What are the common symptoms of COPD?Patients with COPD may experience any of the following13:

• Shortness of breath

• Sputum (a mixture of saliva and mucus) production

• Persistent difficult or labored breathing that worsens with exercise and over time

• Chronic cough

• Wheezing and chest tightness

Exacerbations can cause added damage to the lungs, so it’s important to monitor them closely14

No Sunovion product has been shown or indicated to impact exacerbations in prospective, randomized, placebo-controlled trials.

* COPD severity as determined by pulmonary function. Please note: diagnosis, prognosis, and treatment should be based on a combination of pulmonary function, patient symptoms, and exacerbation risk.

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WHAT ARE EXACERBATIONS?

Over the course of the disease, it is common for patients to experience exacerbations.

Exacerbations are a serious worsening of symptoms that require additional therapy, and may lead to hospitalization14,15

Quality measures in LTC Quality measures are reporting tools that assess health care performance to ensure quality of care for all Americans.16

Quality of care may be determined by various quality-of-life indicators, including:

Physical mobility17

Activities of daily living17

30-day hospital readmission rates following discharge to an LTC facility18

Centers for Medicare and Medicaid Services (CMS) reduce Medicare payment rates for SNFs that fail to meet standards for readmission rates19

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WHAT IS THE RECOMMENDED TREATMENT FOR COPD?

While there is no cure for COPD, it is a disease that can be managed.2

Bronchodilators are recommended by experts as the starting therapy for COPD patients. Bronchodilators are a type of medicine that help relax the muscles around the airways, making breathing easier.13,20

There are 2 types of bronchodilators20:

SHORT-ACTING BRONCHODILATORS21

• Work quickly to relieve symptoms

• Last approximately 4-6 hours; may require multiple doses per day

• Often referred to as a “rescue” since it provides quick relief of symptoms

LONG-ACTING BRONCHODILATORS21

• Help control symptoms

• Effective for 12 hours or more; may require 1 or 2 doses per day

• Often referred to as a “maintenance” medication

Overuse of rescue inhalers may be an indication that the patient’s medication is not working as well as it did in the past22

• Depending on the patient’s condition, a short-acting medication may need to be used in conjunction with a long-acting therapy. All patients should have access to a short-acting beta2-agonist as needed for rescue therapy12

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60% 17%39%

LONG-ACTING BRONCHODILATORS ARE RECOMMENDED FOR COPD MAINTENANCE TREATMENT12,13

Bronchodilators—especially long-acting bronchodilators—are underused in LTC settings, according to the Society for Post-Acute and Long-Term Care Medicine.12

Among residents with COPD7:

received no respiratory treatment at all

received a nebulized SABA monotherapy

received no long-acting agents

Expert recommendations* advise prescribing long-acting bronchodilators on a regular basis, with a goal to manage symptoms long term.12,13

• Long-acting bronchodilators are preferred over short-acting bronchodilators as maintenance therapy (except for patients with only occasional breathlessness)12,13

* Recommendations were sourced from documents published by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), a committee made up of leading experts from around the world, and the AMDA-Society for Post-Acute and Long-Term Care Medicine.

AMDA and GOLD do not endorse any specific treatments.

SABA = short-acting beta2-agonist.

References: 1. COPD Foundation. What is COPD? https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx. Accessed August 28, 2019. 2. American Thoracic Society. Chronic obstructive pulmonary disease (COPD). https://www.thoracic.org/patients/patient-resources/resources/copd-intro.pdf. Published 2019. Accessed August 28, 2019. 3. Morbidity & mortality: 2012 chartbook on cardiovascular, lung, and blood diseases. National Institutes of Health; 2012:1-116. 4. Wheaton AG, Cunningham TJ, Ford ES, Croft JB. Centers for Disease Control and Prevention (CDC). Employment and activity limitations among adults with chronic obstructive pulmonary disease—United States, 2013. MMWR Morb Mortal Wkly. 2015; 64(11):289-311. 5. Kochanek KD, Murphy S, Xu J, Arias E. Mortality in the United States, 2016. NCHS Data Brief. 2017; 293:1-8. 6. 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. 7. 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. 8. Patel M, Steinberg K, Suarez-Barcelo M, Saffel D, Foley R, Worz C. 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. 9. COPD National Action Plan. National Institutes of Health; 2017: 1-68. 10. Centers for Disease Control and Prevention. Protect yourself from wildfire smoke. https://www.cdc.gov/features/wildfires/index.html. Accessed August 28, 2019. 11. Berndt A, Leme AS, Shapiro SD. Emerging genetics of COPD. EMBO Mol Med. 2012;4(11):1144-1155. 12. 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. 13. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2019:1-139. 14. Niewoehner DE. Clinical practice. Outpatient management of severe COPD. N Engl J Med. 2010;362(15):1407-1416. 15. American Thoracic Society. Exacerbation of COPD. Am J Respir Crit Care Med. 2014;189:11-16. 16. Centers for Medicare & Medicaid Services. Quality initiatives, general information. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/index.html. Accessed February 1, 2018. 17. Centers for Medicare & Medicaid Services. Long-term care facility resident assessment instrument 3.0 user’s manual. Baltimore, MD: Centers for Medicare & Medicaid Services, US Dept of Health and Human Services October 2017. 18. Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program: Frequently Asked Questions. Centers for Medicare & Medicaid Services; 2019:1-5. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Other-VBPs/SNF-VBP-FAQs-Final.PDF. Accessed August 28, 2019. 19. Centers for Medicare & Medicaid Services. Overview of the skilled nursing facility value-based purchasing program. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1621.pdf. Accessed August 28, 2019. 20. Cleveland Clinic. Bronchodilators & asthma. https://my.clevelandclinic.org/health/treatments/17575-bronchodilators—asthma. Accessed August 28, 2019. 21. COPD Foundation. Optimal care for COPD including getting the most out of your medications. Version 3.1. Washington, DC: COPD Foundation; April 2016. 22. Fan VS, Gylys-Colwell I, Locke E, et al. Overuse of short-acting beta-agonist bronchodilators in COPD during periods of clinical stability. Respir Med. 2016;116:100-106.

Not an actual patient.

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are registered trademarks of Sumitomo Dainippon Pharma Co., Ltd. Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd. ©2019 Sunovion Pharmaceuticals Inc. All rights reserved. 10/19 RESP-US-00160-19