Introduction

Treatment of chronic obstructive pulmonary disease (COPD) includes corticosteroids and bronchodilators administered through inhalation devices like inhalers and nebulizers. Factors such as ease of device usage, availability, patient age, accurate usage of the device, portability, physicians’ and patients’ preference determine the choice of device. Dry powder inhalers (DPIs) and pressurized metered dose inhalers (pMDIs) have certain limitations like needing hand-breath coordination, ability to perform rapid and deep inspiration and may not be the choice in case of elderly and hospitalized patients. Nebulizers do not need special breathing technique but need longer time for administration of drugs. The perspectives of the patient as well as the family caregiver hold value towards the choice of inhalation device.

Aim

To assess the attitudes and perceptions of the patients and their family caregivers toward nebulization therapy for the management of COPD in Indian population.

Method

Study Design

• A cross-sectional, multicenter, quantitative survey 

  Patient Profile

• COPD patients aged >40 years
• Having COPD for >2 years
• Received nebulization in last 3 months
• Used DPI or pMDI
• Belonging to socioeconomic class (SEC) A or B

Treatment Strategy

• A structured questionnaire was answered via an online survey platform by the patients and family caregivers
• The overall duration of one-on-one interviews was less than 30 mins
• Data collected from the patients included usage of home nebulization, frequency and duration of use, satisfaction with the use of device, benefits and concerns regarding the use of nebulizers
• Information from caregivers included number of years involved in assisting the COPD patients as well as the number of hours per week they spend in assisting them, cleaning the nebulizers, their opinion on the frequency and duration of nebulization therapy, benefits and concerns while using the nebulizers for the patients
• Subgroup analysis of COPD patients using nebulizers daily for home maintenance (for >3 weeks) was also performed

Results

• The survey included 103 COPD patients aged between 40-80 years
• About 46% suffered from COPD symptoms for >5 years
• The majority of family caregivers were children (40%) and spouse (36%)
• About 85% of the family caregivers had spent more than 6 months as caregivers
• Overall, 47% of patients were using medications via inhalers in addition to nebulization
• About 54% used nebulizers for >8 weeks, and 27% used nebulizers on a daily basis for home maintenance
• Nearly 77% of the patients were satisfied with nebulization therapy and higher satisfaction was reported by SEC B group (86% vs 69% in SEC A group) and by males (79% vs 74% in females)
• Long-term relief with nebulizers as compared to previous inhalers was reported by 72%, whereas 65% reported immediate relief with nebulizers compared to inhaled therapy
• About 64% felt comfortable and had a better control of symptoms with the use of nebulizer
• Improvement in the quality-of-life of patients post-nebulization therapy was reported by 70% family caregivers
• According to a majority of patients (61%), the benefits of nebulizers outweighed the inconvenience associated with their usage
• Ease of use, feeling of personal well-being and better control with nebulizers were reported by 86%, 86% and 85% respectively
• Among the patients who used nebulizers on a daily basis as home maintenance therapy, 93% reported easier breathing
• Reduced hospitalization visits post-nebulization therapy was reported by 76% of the family caregivers
• Major concerns regarding nebulizers stated by patients were time-consuming procedure (50%), feeling of dependency (49%), social embarrassment (48%), device being bulky or non-portable (45%) and device being noisy (43%) and by family caregivers were social embarrassment (45%), multiple daily use (45%) and feeling of dependency (43%)
• Nearly 73% were compliant with their recommended frequency of the nebulizer

Conclusion

• This first-of-its-kind survey in India, wherein the perspectives and attitudes of COPD patients as well as their family caregivers were taken into consideration, demonstrated high satisfaction, better control of symptoms and reduced hospitalization with nebulization therapy.
• The patients preferred nebulizers to inhalers with respect to ease of use and comfort.

Int J Chron Obstruct Pulmon Dis. 2022 Sep 14;17:2277–2288.