Quality of life measurements and bronchodilator responsiveness in prescribing nebulizer therapy in COPD

Abstract

Nebulized bronchodilators are widely regarded as the optimal treatment for maintenance therapy in patients with severe chronic obstructive pulmonary disease (COPD). The aim of the study was to assess whether detailed physiological, functional and quality of life-related measurements can assist in determining the requirement for nebulized bronchodilator therapy in patients with moderate to severe COPD. This was an unblinded, randomized, crossover study that compared intermediate (120 mcg ipratropium bromide and 600 mcg of salbutamol using metered dose inhaler (MDI) and spacer) and high dose (nebulized 500 mcg ipratropium bromide and 2.5 mg salbutamol) bronchodilator therapy, on physiological, functional and quality of life-related measurements in patients with COPD. A total of 25 patients (12 female), mean (SD) age 68 (7) years, FEV(1) 45 (10) % predicted completed the study. There was no statistically significant difference between the treatments in the pre- and post-bronchodilator lung function values, six-minute walk distance, breathlessness score or quality of life questionnaires. Fifteen patients preferred bronchodilator therapy with nebulizer and 10 with MDI and spacer. In 20 patients at least one positive response in quality of life score, lung function or six-minute walk, was observed on the preferred treatment. Only a proportion of patients with moderate or severe COPD prefer nebulized bronchodilator therapy. This study found that none of the parameters singly or in combination were consistently predictive of patients' preference for nebulized bronchodilator therapy. Therefore, we suggest that clinicians institute a trial of stepping up to an intermediate dose of bronchodilators prior to introducing nebulized therapy.

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

“…Brophy et al ( [42]; n = 25 with COPD) found no statistically significant difference between treatment with ipratropium bromide and albuterol via inhalers and nebulizers in measures of lung function, 6-min walk distance, breathlessness score, or quality-of-life score. Nonetheless, the majority of patients in this crossover trial (60%) reported a preference for nebulizers; no explanation for this finding was provided by the investigators.…”

Arformoterol tartrate in the treatment of COPD

“…The use of a nebulizer may also involve some technical aspects that may complicate the management plan and cost of treatment, which includes not only the cost of medication but the cost of acquiring and maintaining the nebulizer. Moreover, even though only a proportion of patients with moderate or severe COPD prefer nebulized bronchodilator therapy [38], data from a real-life study demonstrated that the most effective regimen for managing COPD and improving patient quality of life appeared to be the combined use of a nebulizer in the morning and at night, and an inhaler in the afternoon and evening [39].…”

The Impact of Pursed-lips Breathing Maneuver on Cardiac, Respiratory, and Oxygenation Parameters in COPD Patients

“…The study conducted by Solanes et al, [ 13 ] showed the importance of using lung rehabilitation programs to increase activity tolerance, improving quality of life, and reducing the clinical symptoms of COPD. Although breathing exercises in the form of pursed-lip breathing may be useful to reduce the symptoms of dyspnea and improve pulmonary function and quality of life, objective evaluation based on pulse oximetry, respirogram, and arterial blood gas analysis indicates contradictory results and pursed-lip breath exercises is not considered as a major component of the lung rehabilitation program, because their usefulness is still uncertain [ 14 ] [ 15 ].…”