Observing COPD Nebulizer Use Reveals Counseling Opportunity

Patients with chronic obstructive pulmonary disease (COPD) must clear major hurdles before and after initiating nebulizer use.

Physically or mentally compromised by their disease, many COPD patients experience difficulty setting up the nebulizer, understanding how to use it, executing proper technique, and estimating how long they need to nebulize fluids. For example, patients may inadequately clean the nebulizer, use damaged parts, or attempt to repair the device themselves.

A study published in BMJ Open Respiratory Research details the issues surrounding home nebulizer use. It included COPD patients receiving budesonide or ipratropium/albuterol nebulizers, and it excluded those with mental health issues (including cognitive impairment) or another illness when referring general practitioners believed the comorbid illness would interfere with therapy.

Researchers invited 180 eligible patients and ultimately enrolled 21 men and 29 women with an average age of 71 years and average nebulizer use duration of 9 years. The participant group used 12 different devices and had 38 different primary care providers.

Participants were observed assembling, using, and cleaning their personal devices, and researchers used a pre-made checklist to determine each patient’s competence.

Notably, 50% to 80% of patients used improper breathing technique. Furthermore, 3 of 4 patients ignored manufacturers’ recommended maintenance and part replacement. Markedly, almost every patient failed to properly conduct 3 specific steps in nebulizer use:

• Running saline through the nebulizer before use (44/50)
• Cleaning the nebulizer with disinfectant daily (46/50)
• Ensuring the vaporizer head spun freely (47/50)

These deficits present opportunities for patient counseling from pharmacists. Ultimately, technique breakdown is driven by patients’ inability to use their devices as intended and knowledge gaps about proper device use.

Ensuring patient adherence can effectively improve quality of life and prevent costly COPD exacerbations. This study supports exploring nebulizer use in patients as a targeted intervention in care settings across the pharmacy profession.