Home Nebulized Therapy for Patients with COPD
Patient Compliance With Treatment and Its Relation to Quality of Life
Complianee with medical advice in chronic respiratory disease has not been widely investigated. Most studies have concentrated on compliance with inhaled b-agonists and corticosteroid treatment using devices such as the Chronolog (Advanced Technology Products Corp; Lakewood, Colo) and the turbo-inhaler computer (Astra Draco; Lund, Sweden) but have largely ignored nebulized therapy. At Guy s Hospital, large numbers of COPD patients whose symptoms are not controlled by inhaled medication regularly use home nebulizers to administer b-agonists, anticholinergics, and corticosteroids. Prescribed regimens range from twice to six times daily. The cost of purchasing and upkeep of these nebulizer-compressor units is considerable. Before prescription, patients undergo a clinical assessment of reversibility to establish that they will benefit from their use. Given diat the patient’s condition is severe enough to warrant the use of regular nebulized therapy and considering the expense, it is important that the actual use of these units be assessed and efforts made to ensure that diey are used as prescribed. In addition, Bosley et al have previously shown that patients with poor compliance have a tendency to be depressed and feel unsupported. This study aimed to find out how and when patients use their home nebulizers. It also looked at whether people use them in relation to the severity of their symptoms and/or the impact of their chest disease on their lifestyle and activities. my canadian pharmacy.com
Materials and Methods
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 total of 129 patients were contacted. Ninety-three patients (72%) agreed to take part in the study. The mean (SD) age of this group was 64.9 years (7.7) [range, 44 to 77 years]. Most participants were suffering from chronic obstructive bronchitis with varying degrees of emphysema (74%). Nineteen patients had asthma, one had bronchiectasis, and one had fibrosis (rheumatoid arthritis). Eleven patients (12%) were using inhaled corticosteroids.
Thirty-six (28%) refused to take part: 16 were male and 20 were female. The mean age of this group was 65.3 years (7.9) [range, 42 to 75 years]. Twenty-one (58%) gave no reason or were not interested, 10 (28%) said they were not well enough, and 2 (6%) did’ not like the idea of questionnaires and interviews. There was no difference between those who accepted and those who refused to take part in terms of age and gender. Three of the thirty-six patients (8%) initially accepted but did not attend the appointment and were thus included in the refusals.