The study by Turner et al of 985 patients using home nebulizers reported that 50.6% of patients were adherent and 49.4% were nonadherent with their prescribed regimen. They also reported that adherence was not related to the effects of illness on daily functioning. This finding may contrast with the present one as these patients were put into adherent and nonadherent groups according to whether they fell above or below the median of 25 min of treatment per day. Using the median as a cutoff, by definition, places 50% of patients in each group and patients who might be considered clinically to be taking sufficient treatment might therefore be classed as nonadherent. Furthermore, these patients were aware that their compliance was being monitored and behavior is likely to be modified in response to observation. Improvement in compliance while being observed returns to baseline when intervention is over. In the present study, patients were unaware that compliance was being monitored and, in addition, information was available on whether the nebulizer was used when it was switched on.
The recording of no inhalation while a nebulizer is switched on may be due to the patient switching on a nebulizer and subsequently not using it, ineffective use of the mouthpiece (by nose-breathing), or failing to connect the mouthpiece to the compressor. The l atter is unlikely as the same patients showed good inhalation data on other occasions and most patients tended to leave the connection tube in place between treatments. www.mycanadianpharmacy.com
From the day-by-day use of the nebulizer, it was found that a substantial proportion of patients (21%) took no treatment at all for half of the study period. This is surprising in view of the severity of illness of this group of patients. Only eight patients (10%) used their nebulizer as prescribed for >80% of the days. This compares with studies of medication taken via inhalers in asthma. Bosley et al found that only 14% of patients taking inhaled bronchodilators and corticosteroids took the correct dose on 80% of days (on a twice daily regimen). Mawhinney et al found that only 1% of patients used their inhalers correctly for >75% days (on a four times daily regimen).
Poor compliance in patients with COPD has been associated previously with increased levels of morbidity. The present finding that patients using regular nebulized medication are no more likely to take their treatment as prescribed than other patient groups is of particular concern. This is because the levels of morbidity for this group are already high and these patients also report high levels of impairment in their quality of life. In addition, since the cost of prescribing and maintaining these machines is high, it is important that efforts are made to improve patients’ responses to their illness.
Tags: COPD, home nebulized therapy, patient compliance