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Clinical Characterization of Nursing Facility Residents With Chronic Obstructive Pulmonary Disease

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Objective and Design

To describe clinical characteristics, medication use, and low peak inspiratory flow rate (PIFR) (< 60 L/min) prevalence in nursing facility residents with chronic obstructive pulmonary disease (COPD).

Patients and Setting

Residents 60 years of age and older with a COPD diagnosis and ≥ 6 months’ nursing facility residence, were enrolled between December 2017 and February 2019 from 26 geographically varied United States nursing facilities.

Outcome Measures

Data, extracted from residents’ charts, included demographic/clinical characteristics, COPD-related medications, exacerbations and hospitalizations within the past 6 months, and functional status from the most recent Minimum Data Set. At enrollment, residents completed the modified Medical Research Council (mMRC) Dyspnea Scale and COPD Assessment Test (CAT™). Spirometry and PIFR were also assessed.


Residents’ (N = 179) mean age was 78.0 ± 10.6 years, 63.7% were female, and 57.0% had low PIFR. Most prevalent comorbidities were hypertension (79.9%), depression (49.2%), and heart failure (41.9%). The average forced expiratory volume in 1 second (FEV1) % predicted was 45.9% ± 20.9%. On the CAT, 78.2% scored ≥ 10 and on the mMRC Dyspnea Scale, 74.1% scored ≥ 2, indicating most residents had high COPD symptom burden. Only 49.2% were receiving a scheduled long-acting bronchodilator (LABD). Among those with low PIFR prescribed a LABD, > 80% used dry powder inhalers for medication delivery.


This study highlights underutilization of scheduled LABD therapy in nursing facility residents with COPD. Low PIFR was prevalent in residents while the majority used suboptimal medication delivery devices. The findings highlight opportunities for improving management and outcomes for nursing facility residents with COPD.

Keywords: Bronchodilators; Chronic obstructive pulmonary disease; Long-term care; Nursing facility; Peak inspiratory flow rate

Document Type: Research Article

Affiliations: 1: 1Insight Therapeutics, LLC, Norfolk, Virginia. 2: 2Brown University, Center for Gerontology and Health Care Research, Providence, Rhode Island. 3: 3Sunovion Pharmaceuticals, Incorporated, Marlborough, Massachusetts.

Publication date: May 1, 2021

More about this publication?
  • The Senior Care Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Senior Care Pharmacist® will want to consider joining ASCP.

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