title: Better adherence to a transdermal tulobuterol patch than inhaled salmeterol in elderly chronic obstructive pulmonary disease patients.
abstract: BACKGROUND
  Inhaled long-acting β2-agonists (LABA) are often poorly adhered to by elderly patients with chronic obstructive pulmonary disease (COPD). We hypothesized that older age and compromised cognitive function might contribute to poor adherence to inhaled medications among COPD patients, and that transdermally delivered medications could improve adherence, exercise tolerance and quality of life (QOL).
  
  
  OBJECTIVE
  To compare adherence and effects on health outcomes between transdermal and inhaled LABA.
  
  
  METHODS
  A total of 44 treatment-naïve, elderly Japanese patients with moderate-to-severe COPD were treated with a transdermal tulobuterol patch (TP; 2 mg, once a day) or inhaled salmeterol (50 µg, twice a day) in a randomized crossover manner. The primary outcomes were adherence to the LABA medications and changes in QOL measured by the St George's Respiratory Questionnaire. Secondary outcomes were changes in 6-min walk distance (6MWD) and spirometric values.
  
  
  RESULTS
  The overall adherence rate was 90.3 ± 1.6% for TP and 75.5 ± 2.9% for salmeterol (P < 0.001). Adherence to salmeterol was correlated with age and Mini-Mental State Examination (MMSE) score (P < 0.05 and P < 0.01, respectively), although that to TP was relatively constant regardless of age and MMSE score. 6MWD and QOL were significantly improved from baseline after TP, but not after salmeterol treatment (P < 0.05). Similar degrees of increase in spirometric values occurred after treatment with TP and salmeterol.
  
  
  CONCLUSIONS
  Adherence levels were higher overall with TP than with inhaled salmeterol, and more stable across age groups and MMSE levels. TP might be a favorable treatment option for COPD patients with poor adherence to an inhaled LABA.
authors: Division of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
authors: Hideaki
authors: H
authors: Mochizuki
authors: Yuta
authors: Y
authors: Nanjo
authors: Hideki
authors: H
authors: Takahashi
mesh_terms: D000279:Administration, Cutaneous; D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018592:Cross-Over Studies; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007320:Inspiratory Capacity / Q000187:drug effects; D008297:Male; D008450:Maximal Midexpiratory Flow Rate / Q000187:drug effects; D055118:Medication Adherence; D008609:Mental Status Schedule; D011653:Pulmonary Diffusing Capacity / Q000187:drug effects; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D011788:Quality of Life; D012115:Residual Volume / Q000187:drug effects; D000068299:Salmeterol Xinafoate; D013147:Spirometry / Q000379:methods; D013726:Terbutaline / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014109:Total Lung Capacity / Q000187:drug effects; D016896:Treatment Outcome; D014797:Vital Capacity / Q000187:drug effects; D016138:Walking / Q000502:physiology
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists; C010809:tulobuterol; D000068299:Salmeterol Xinafoate; D013726:Terbutaline; D000420:Albuterol