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 (120mcg ipratropium bromide and 600mcg 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, FEV₁ 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. Chronic Respiratory Disease 2008; 5: 13—18

Keywords

bronchodilators COPD nebulizers

References

Brandli O. Maintenance and servicing of nebulisers. Eur Respir Rev 1994; 4: 102—3.

Hosker HS , Teale C. , Greenstone MA , Muers MF Assessment and provision of home nebulizers for chronic obstructive pulmonary disease (COPD) in the Yorkshire region of the U.K. Resp Med 1995; 89: 47—52.

Melani AS , Sestini P. , Aiolfi S. et al. GENebu Project: home nebulizer use and maintenance in Italy . Eur Respir J 2001; 18: 758—763.

O'Driscoll BR Nebulisers for chronic obstructive pulmonary disease. Thorax 1997; 52 (Suppl 2): S49—52.

British Thoracic Society. Current best practice for nebuliser treatment. British Thoracic Society Nebulizer Project Group. Thorax 1997; 52(Suppl 2): S1—106.

Boe J. , Dennis JH , O'Driscoll BR et al. European Respiratory Society Guidelines on the use of nebulizers . Eur Respir J 2001; 18: 228—42.

British Thoracic Society. Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004; 59(Suppl 1): 1—232.

O'Driscoll BR , Kay EA , Taylor RJ , Bernstein A.

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

Resp Med 1990; 84: 471—77.

Teale C. , Morrison JF , Muers MF , Pearson SB Response to nebulized ipratropium bromide and terbutaline in acute severe asthma. Resp Med 1992; 86: 215—18.

10.

Morrison JF , Jones PC , Muers MF Assessing physiological benefit from domiciliary nebulized bronchodilators in severe airflow limitation. Eur Respir J 1992; 5: 424—29.

11.

Zigmond AS , Snaith RP The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361—70.

12.

Guyatt GH , Townsend M. , Pugsley SO et al. Bronchodilators in chronic air-flow limitation. Effects on airway function, exercise capacity, and quality of life. Am Rev Respir Dis 1987; 135: 1069—74.

13.

Ware JEJ , Sherbourne CD The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473—83.

14.

American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis 1991; 144: 1202—18.

15.

Siafakas NM , Vermeire P. , Pride NB et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J 1995; 8: 1398—420.

16.

Nisar M. , Walshaw M. , Earis JE , Pearson MG , Calverley PM Assessment of reversibility of airway obstruction in patients with chronic obstructive airways disease. Thorax 1990; 45: 190—4.

17.

Redelmeier DA , Bayoumi AM , Goldstein RS , Guyatt GH Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med 1997; 155: 1278—82.

18.

Jenkins SC , Heaton RW , Fulton TJ , Moxham J. Comparison of domiciliary nebulized salbutamol and salbutamol from a metered-dose inhaler in stable chronic airflow limitation. Chest 1987; 91: 804—7.

19.

Gervais A. , Begin P. Bronchodilatation with a metered-dose inhaler plus an extension, using tidal breathing vs jet nebulization. Chest 1987; 92: 822—24.

20.

Mestitz H. , Copland JM , McDonald CF Comparison of outpatient nebulized vs metered dose inhaler terbutaline in chronic airflow obstruction. Chest 1989 ; 96: 1237—40.

21.

Hansen NC Terbutaline as powder inhalation from Bricanyl Turbuhaler compared to terbutaline as nebulizer solution in severe chronic airways obstruction . Eur Respir J 1989; 2: 716—20.

22.

Morrison JF , Jones PC , Muers MF Assessing physiological benefit from domiciliary nebulized bronchodilators in severe airflow limitation . Eur Respir J 1992; 5: 424—29.

23.

Goldman JM , Teale C. , Muers MF Simplifying the assessment of patients with chronic airflow limitation for home nebulizer therapy. Resp Med 1992; 86: 33—38.

24.

Williams TJ , Greer L. , Jarvis A. The role of body plethysmography data in assessing the bronchodilator response to nebulized salbutamol. Am J Respir Crit Care Med 1996; 153: A324(Abstract).