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

Abstract

Background and aimHow patients use their nebulisers at home is vital to ensure effective treatment and optimal health outcomes for patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to identify the practicalities and problems associated with nebuliser use by patients with COPD at home, which may impact on the safety and effectiveness of therapy.Design and settingA cross-sectional descriptive study in which participants were recruited from two levels of care: primary care, involving 38 GP practices in North West London, and intermediate care with a major acute hospital.MethodIn-depth interviews were conducted with a representative sample of 50 patients with COPD using nebulisers in their home, recruited from general practice populations and at hospital discharge. A checklist was used to record activities and patients demonstrated use of their nebuliser. Qualitative procedures were employed to identify the range of problems experienced with nebuliser use.ResultsA wide range of practical issues was identified at all stages: problems prior to nebulisation: setting up equipment, lack of instructions, manual dexterity and time required. Problems during medication administration: inhalation technique, duration of nebulisation and understanding how to achieve optimal efficacy. Problems post-administration: inadequate cleaning of nebuliser components, access to accessories and use of damaged parts or self-repairs. Other problems included noise, weight and non-portability of equipment.ConclusionsPatients with COPD using nebulisers at home experienced problems with all aspects, many of which may be anticipated to compromise clinical outcomes. Healthcare providers should be aware of these problems to effectively support patients with COPD with the use of their nebulisers at home.

Maintenance Therapy with Nebulizers in Patients with Stable COPD: Need for Reevaluation

“…Nebulizers are not free of potential problems with their use or in achieving adequate technique. For example, basic nebulizer inhalation technique, such as sitting in an upright position during therapy, may not be practiced by all patients [51]. Another problem associated with nebulizers is their lack of portability; an electrical or compressed gas source is needed for operation.…”

“…When used in the home, nebulizer performance depends on the choice of an appropriate compressor [52,53], and some nebulizer manufacturers specify the compatible compressors for optimum performance. Poor efficiency, residual volume of 1-3 ml that cannot be nebulized, continuous aerosol generation with loss of aerosol to the environment that poses a health risk, inconveniently long treatment time, need for equipment setup and cleaning, increase in the concentration of the solution and decrease in its temperature during nebulizer operation, limited access to accessories, the use of damaged parts, and patients engaging in self-repairs, are other problems associated with nebulizer use [51]. Moreover, shear forces generated during jet nebulization may inactivate or denature the active drug or agent.…”

Development of an Orientation-independent Handheld Nebulizer

“…For several decades, nebulizers, convert liquid drugs into tiny airborne particles, have been used for medication through inhalation (McCallion et al, 1996;Dhand, 2002;Martin and Finlay, 2015;Mansour, 2018). Aerosol therapy through nebulizers is a well-established method for treatment of patients with pulmonary diseases, including, but not limited to, asthma (Zimo et al, 1989;O'Driscoll et al, 1992;Demoly et al, 1998;Hess, 2008), chronic obstructive pulmonary disease (COPD) (O'Driscoll et al, 1992;O'Driscoll, 1997;Alhaddad et al, 2015) and cystic fibrosis (Bos et al, 2016;Baravalle-Einaudi et al, 2017) in both hospital and home settings. The role of nebulizers in treating acute lung injury (Tuinman et al, 2012), ventilation associated pneumonia (Rouby et al, 2012), dyspnea (Boyden et al, 2015), as well as for systemic administration of macromolecules (Siekmeier and Scheuch, 2008) has also been reviewed.…”

Ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis

“…Furthermore it has a short administration time, with the drug usually delivered in one breath. Together these qualities mean the drug/device combination avoids many of the problems associated with nebulizers such as time-consuming administration [39], complex cleaning, sterilization and maintenance, and a decrease in the efficiency of drug delivery over time [40]. The device is already approved for the delivery of tobramycin and used in some countries for the treatment of cystic fibrosis patients in the form of the TOBI ® Podhaler™ (Novartis) [41,42] Ciprofloxacin DPI (Figure 2) is undergoing Phase III trials in patients with idiopathic or post-infectious NCFB, to assess its efficacy in reducing exacerbations in patients with evidence of respiratory pathogens who suffer from two or more exacerbations annually [31,32].…”