Chest
Clinical Investigations: NebulizersHome Nebulized Therapy for Patients with COPD: Patient Compliance With Treatment and Its Relation to Quality of Life
Section snippets
Patients
Patients were recruited from a database at Guy's Hospital of patients using regular nebulized therapy at home. All patients had previously been assessed as to their suitability for nebulized therapy and had been prescribed a nebulizer on the basis of at least 10%; reversibility being achieved as well as subjective improvement. All patients with a diagnosis of asthma, emphysema, or chronic bronchitis between the ages of 40 and 75 years were approached by letter followed by a telephone call. A
Withdrawals
Eleven patients withdrew from the study: 7 female and 4 male. The mean age of this group was 64.4 years (±7.5). Four patients experienced worsening symptoms and felt safer using their own machine, four found the nebulizer hard to use, and the remaining three patients dropped out due to a hospital admission, diagnosis of lung cancer, and a nebulizer recording malfunction.
Patient Details
Eighty-two patients (88%;) completed the study. Forty-four (54%;) were male and 38 (46%;) were female. The mean age of the
DISCUSSION
One hundred percent compliance is probably an unrealistic target for most patients. It is therefore better to consider a level of compliance that will maintain the patient in good health, which is the required outcome of treatment. Eighty to 100%; has been suggested as a standard for full compliance.5 In this investigation, patients were considered to be “poor compliers” if they took <70%; of the overall treatment prescribed for them during the 4-week period. The physicians involved in the
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Cited by (64)
Chronic Obstructive Pulmonary Disease Exacerbations: A Need for Action
2018, American Journal of MedicineCitation Excerpt :Increase in physical activity and pulmonary rehabilitation have also been associated with a decrease in the risk of exacerbation.77 Patients tend to exhibit poor adherence to inhaled medication for COPD: only about half of patients are adherent,78–81 despite adherence being significantly associated with reductions in risk of death, hospital admission due to exacerbations,82 and quality of life.78 Real-world evidence indicates that ICS therapy is often misused and does not follow guideline recommendations.83,84
Protein stability in pulmonary drug delivery via nebulization
2015, Advanced Drug Delivery ReviewsCitation Excerpt :Niven et al. found that nebulizer cooling did not only reduce protein degradation but also markedly reduced output rates [5]. He concluded that cooling was not feasible for routine operation as already long treatment times would be further extended, which is inacceptable as prolonged treatment times may have a negative impact on life quality of chronically ill patients and are associated with reduced compliance [83,145]. In general US nebulizers are considered not suitable for the pulmonary delivery of proteins [119].
That's cool! - Nebulization of thermolabile proteins with a cooled vibrating mesh nebulizer
2014, European Journal of Pharmaceutics and BiopharmaceuticsCitation Excerpt :The IAR is the principal measure regarding treatment time. As prolonged treatment times may have negative impact on life quality of chronically ill patients and are associated with reduced compliance [27,28], IAR was included into nebulizer performance evaluation. An acceptable procedure to reduce TRES should not markedly reduce IAR or DE.
Clinical and economic impact of non-adherence in COPD: A systematic review
2014, Respiratory MedicineCitation Excerpt :Adherence was measured using a self-reported questionnaire where patients with a score of ≥4 (on a 5-point Likert scale) were considered adherent. Both studies showed that the SGRQ total, symptoms and impact scores were negatively correlated with adherence, although the association with symptoms and impact scores did not achieve statistical significance in the Corden et al. study, which may be due to the relatively small study population [26]. On the other hand, note that the Takemura et al. study applied a method of self-reported adherence that may have biased patient adherence in a positive direction and thereby have resulted in an overestimation [25].
This study was supported by an educational grant from Allen and Hanbury's Division of Glaxo Wellcome, Inc.
Reprint requests: Mr. John Denyer, Medicaid Ltd, Hook Lane, Pagham, West Sussex, England P021 3PP