Domiciliary Nebuliser Therapy — A Valuable Option in Chronic Asthma and Chronic Obstructive Pulmonary Disease?

Abstract

Domiciliary nebulisers are in widespread use for patients who have severe chronic airways disease, both asthma and chronic obstructive pulmonary disease (COPD). We report a study of the use of domiciliary nebulisers designed to assess practical problems and the value of such therapy in preventing hospital admissions. A total of 405 patients underwent a structured interview at home and their case records were reviewed. Technical performance of the nebuliser compressors was assessed. The mean (SD) age of those interviewed was 64.5 (12) years. 185 patients had a physician diagnosis of asthma, and 208 had COPD. 87% patients used their nebuliser at least once daily. Side effects, reported by 54%, were related to frequency of use and commoner in younger patients. 29 subjects (7%) died within 2 years of receiving their nebuliser. Among the survivors, the 2 year periods before and after supply of the nebuliser were compared. The percentage of patients requiring hospital admission for exacerbations of lung disease fell from 56% to 46% (p < 0.01) but the number and duration of admissions was unchanged. Those whose admission duration increased had more severely impaired spirometry when the nebuliser was supplied and had lower activity scores and higher breathlessness scores at the time of interview indicating more severe disease. Approximately half of the compressors were malfunctioning and patients' understanding of the principles of nebuliser treatment was poor. The provision of domiciliary nebuliser can influence hospital admission in patients with obstructive airways disease. There is also a need for improved patient education and for technical support which may require the development of a nurse-run nebuliser service.

Patients’ practices and experiences of using nebuliser therapy in the management of COPD at home

“… 15 17 18 Blockage of inlet filters and lack of servicing affect compressor performance. 14 In this study, discoloured filters were observed and a lack of servicing of the compressor was especially prominent.…”

“…In the few studies investigating nebuliser use by patients with COPD in the home, problems have been reported with assembling nebuliser equipment 13 and gauging how long to nebulise fluids. 14 Inadequate cleaning of equipment after use has been highlighted in several studies. 13–18 While a number of problems have been identified, a comprehensive study of home nebuliser use, from the perspectives of patients with COPD, to identify potential contributory factors that may lead to treatment failure, has not been undertaken.…”