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Pulse Home Health Care practices skilled health care procedures firmly rooted in the latest research and best practice policies. We routinely mail bulletins to physicians and other medical referral sources to highlight how we help patients and to explain the scientific basis for different services. On our home health website we share selected physician bulletins about Pulse's Home Health Services. If you have questions about how home health could help you, please contact us today.

Sixty Percent of Patients with

COPD Do Not Adhere to Therapy

COPD AdherenceThe American Journal of Health System Pharmacy recently published a review addressing special considerations in elderly patients with COPD. (1)  A number of challenges were discussed:

  • Sixty percent of patients with COPD are not adhering to prescribed therapy.(2)  In many cases, the patients themselves are not aware of their non-adherence. 
  • A study of 300 patients seen in pulmonology clinics finds that 43% of dry powder inhaler users and 75% of pressurized metered-dose inhaler (pMDI) users demonstrate incorrect inhaler technique.(3)  Seventy-nine percent of patients were unable to use pMDI correctly after reading the package insert.(4)  Technique errors often develop over time and go unrecognized. (5)  Virchow and colleagues conclude that patients who learn to use their inhaler devices require repeated assessment and instruction to reinforce technique. (6)
  • Top reasons for therapy non-adherence are misunderstanding of the therapy, misunderstanding of the disease, cost, and lack of follow-up.(7)  Both compromised inhaler technique and medication nonadherence prove to be enough to jeopardize clinical outcomes and add to the economic burden of the disease.(8)   

When you see elderly patients with COPD, please remember Pulse Home Health Care as a top ally in COPD management.  Through multiple, in-home visits, Pulse nurses work to ensure patient understanding of the disease and therapy, identify obstacles to adherence, and overcome those obstacles.  Through education, assessment, and therapy options, we work to prevent emergency room visits, improve function, prolong independence, and improve longevity.

Teaching and Case Management: Research has shown weekly educational visits over two months to improve self-reported quality of life,9 decrease hospitalizations by 27%, and decrease emergency department visits by 21%. (10)  In addition to reinforcing teaching on medication adherence and proper equipment use, nurses can review risk factors, teach patients to recognize symptoms of exacerbation, coach patients on nutritional interventions, and help patients develop an emergency action plan.  Where cost is revealed to be an obstacle to adherence, we can help patients better utilize their insurance and community resources. 
Skilled Monitoring: Where there is a likelihood of exacerbation, you can order Pulse Home Health Care nurses to assess your patient’s response to medications, assess for edema, listen for changes in heart condition, assess for sudden changes in mental status, and report relevant information to the physician.  If you have a patient making non-emergency visits to the emergency department or an increased number of calls to your office, this may be a sign that your patient would benefit from skilled monitoring and teaching plus our 24-hour on-call service.
 Physical & Occupational Therapy:  Even after hospital discharge, early exercise training at home improves exercise tolerance, dyspnea scores, and quality of life, and in-home exercise training reduces the number of subsequent exacerbations.(11,12) Therapists can also teach energy conservation techniques that improve independence at home.  
Nursing Assistants: During periods when it may be unsafe for your patient to perform ADLs independently or when your patient is unable, we send aides to assist with personal care needs.  This may include bathing, light housekeeping, meal preparation, etc.  


  1. Barrons R, Pegram A, Borries A. Inhaler device selection: special considerations in elderly patients with chronic obstructive pulmonary disease. Am J Health Syst Pharm. 2011; 68 (13): 1221-1232.
  2. Restrepo R, Alvarez M, Wittenbel L. Medication adherence issues in patients treated for COPD. Int J COPD. 2008; 3: 371-84.
  3.  Khassawneh B, Al-Ali M, Alzoubi K. Handling of inhaler devices in actual pulmonary practice: metered-dose inhaler versus dry powder inhalers. Respir Care. 2008; 53: 324-8.
  4. Crompton G, Dewar M, Allbut H, et al. Inhaler preference and technique in inhaler naïve subjects; a comparison of HFA and conventional devices. Thorax. 2000; 55 (suppl 3): A61.
  5. Chapman K, Boulet L, Rea R. Physician self-audit of asthma control in primary practice: the implications for implementation of guidelines. Am J Respir crit CareMed. 2004; 169: A362.
  6. Virchow J, Crompton G, Dal Negro R, et al. Importance of inhaler devices in the management of airway disease. Respir Med. 2008; 102: 10-9.
  7. Bourbeau J, Bartlett S. Patient adherence in COPD. Thorax. 2008; 63: 831-8.
  8. Kenny J. Economic considerations in chronic obstructive pulmonary disease treatment. Am Health Drug Benefits. 2008; 1 (suppl 8): 18-22.
  9. Bourbeau J; Julien M, Maltais F, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003; 163 (5): 585-91.
  10. Gadoury M, Schwartzman K, Rouleau M. et al. Self-management reduces both short- and long-term hospitalisation in COPD. Eur Respir J. 2005; 26 (5): 853-7.
  11. Salman G, Mosier M, Beasley B, et al. Rehabilitation for patients with chronic obstructive pulmonary disease: meta-analysis of randomized controlled trials. J Gen Intern Med. 2003: 18 (3): 213-21.
  12. Murphy N, Bell C, Costello R. Extending a home from hospital care programme for COPD exacerbations to include pulmonary rehabilitation. Respir Med. 2005; 99(10): 1297-302.

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Pulse Home Health Care

HomeCare Elite
2009     2010
Named as one of the top 500 agencies nationwide

2325 Severn Ave, Ste 5 Pulse Home Health CareMetairie LA 70001 Pulse Home Health Care(504) 831-7778

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