Home nebulizers: can optimal therapy be predicted by laboratory studies?

Regular nebulised terbutaline in chronic obstructive airways disease: dose‐response studies fail to detect tolerance.

“…The observation that baseline changes occur within the first week of nebuliser therapy may have implications for the design of 'nebuliser trials'. Recent studies have suggested that home recording of PEFR may be the most appropriate objective assessment of response to a home nebuliser (O'Driscoll et al, 1990;Teale et al, 1990) but the most appropriate duration of measurement of PEFR at home is not known. Our results suggest that a 1 week period of measurement may be adequate although this requires confirmation as the results of single laboratory measurements of PEFR may differ from those of multiple recordings of PEFR at home.…”

“…Increasing doses of inhaled P2-adrenoceptor agonists have been shown to produce further bronchodilatation in asthma (Barnes & Pride, 1983;Lipworth et al, 1988;Nelson etal., 1983;Prior & Cochrane, 1982) and chronic obstructive airways disease (COAD) (Corris etal., 1983, Vathenan et al, 1988a and regular nebulised bronchodilators have been shown to improve home PEFR in COAD (O'Driscoll et al, 1990). However concerns remain over side effects (Harvey et al, 1981) and the possible development of tolerance.…”

Is nebulized saline a placebo in COPD?

“…Based on the patients' observations and the results of previous studies, we believe that the therapeutic effect of nebulized saline may be produced by enhanced sputum clearance. A previous study at this hospital showed a similar subjective response to nebulized saline (given at 7 am) but the previous study also reported an improvement in FEV1 and PEF [13]. Patients in the previous study received nebulized saline on awakening, prior to their first bronchodilator treatment of he day.…”

Domiciliary nebulised bronchodilator therapy in chronic obstructive pulmonary disease

“…This is because the acute response, in terms of both FEV 1 and symptom scores, correlates poorly with the longer-term PEF and symptom responses. 10 Following this initial assessment, those patients with symptomatic improvement and PEF increase of >15% compared to values obtained on standard inhaled therapy should be considered for long term home treatment with nebulised bronchodilators (previous studies have shown high correlation between peak flow and symptom response among patients undergoing placebo-controlled nebuliser trials). 10 Great care should be exercised before home therapy is initiated, at the physician's discretion, for those patients who derive symptomatic benefit from the nebuliser trial, but who do not achieve a 15% increase in peak flow measurements.…”