2007 OPEN FORUM Abstracts
USE OF I-NEB® INSIGHT™ FOR TRAINING AND FOLLOW UP OF PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION
C. Nickerson1, K. Nikander1
The I-neb®Adaptive Aerosol Delivery (AAD®; Respironics Ltd, UK) System is approved for the delivery of iloprost inhalation solution (CoTherix, USA) to patients with pulmonary arterial hypertension (PAH). I-neb Insight™ consists of hardware/software designed to be used with I-neb. Insight includes a patient logging system (PLS) and breathing monitor (BM) functions that can be used to view information on past treatments and to train patients using real time data. We report two patient cases and show how a clinical educator used Insight to evaluate treatment issues when using I-neb to deliver 5.0 µg of iloprost.
Case 1: This 40 year old female with PAH reported long treatment times within 5 days of training that “consumed most of her time and energy”, and she was not managing her prescribed 6 treatments a day. The PLS data was analyzed and is shown in Fig 1.
The patient’s mean treatment times ranged between 15-19 min. The educator evaluated her cleaning and care of I-neb and observed a treatment being taken. During the treatment the educator noted that her respiratory rate was 24 bpm and mean inhalation time <1 s per breath.
The educator provided a visual demonstration of proper use of I-neb using the Insight BM function. After re-training she was able to achieve a 3-3.5 s inhalation time. She reported that the visual feedback allowed her to better understand what the educator was verbally instructing her to do. A week later the PLS data showed less variability in treatment times (mean 8-10 min). She also reported that the training session made a huge impact on her energy levels.
Case 2: This 52 year old male with PAH initially had a treatment time ranging between 6-10 min. Ten days later he called the patient services center to report treatment times ranging between 18-20 min. The analysis of the PLS data is shown in Fig 2.
The first 3.5 days of treatments were within the expected range, then the treatment times increased - a classic symptom of a blocked mesh due to poor cleaning. He was instructed to complete the weekly cleaning procedure. Upon follow-up he reported that the treatment time had returned to the initial range.
Patients have been shown to achieve higher compliance with AAD System devices compared with conventional nebulizers. I-neb Insight now offers additional benefits over other systems by addressing usage issues in a minority of patients.
The two case reports highlight the value of I-neb Insight in training and follow up of patients.