The role of nebulized therapy in the management of COPD: Evidence and recommendations

Rajiv Dhand, Myrna Dolovich, Bradley Chipps, Timothy R. Myers, Ruben Restrepo, Judith Rosen Farrar

    Research output: Contribution to journalArticle

    40 Citations (Scopus)

    Abstract

    Current guidelines recommend inhalation therapy as the preferred route of drug administration for treating chronic obstructive pulmonary disease (COPD). Previous systematic reviews in COPD patients found similar clinical outcomes for drugs delivered by handheld inhalers - pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs) - and nebulizers, provided the devices were used correctly. However, in routine clinical practice critical errors in using handheld inhalers are highly prevalent and frequently result in inadequate symptom relief. In comparison with pMDIs and DPIs, effective drug delivery with conventional pneumatic nebulizers requires less intensive patient training. Moreover, by design, newer nebulizers are more portable and more efficient than traditional jet nebulizers. The current body of evidence regarding nebulizer use for maintenance therapy in patients with moderate-to-severe COPD, including use during exacerbations, suggests that the efficacy of long-term nebulizer therapy is similar, and in some respects superior, to that with pMDI/DPIs. Therefore, despite several known drawbacks associated with nebulized therapy, we recommend that maintenance therapy with nebulizers should be employed in elderly patients, those with severe disease and frequent exacerbations, and those with physical and/or cognitive limitations. Likewise, financial concerns and individual preferences that lead to better compliance may favor nebulized therapy over other inhalers. For some patients, using both nebulizers and pMDI/DPI may provide the best combination of efficacy and convenience. The impact of maintenance nebulizer treatment on other relevant clinical outcomes in patients with COPD, especially the progressive decline in lung function and frequency of exacerbations, needs further investigation.

    Original languageEnglish (US)
    Pages (from-to)58-72
    Number of pages15
    JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
    Volume9
    Issue number1
    DOIs
    StatePublished - Feb 2012

    Fingerprint

    Nebulizers and Vaporizers
    Chronic Obstructive Pulmonary Disease
    Dry Powder Inhalers
    Metered Dose Inhalers
    Therapeutics
    Drug Administration Routes
    Respiratory Therapy
    Pharmaceutical Preparations
    Compliance
    Disease Progression
    Maintenance
    Guidelines

    Keywords

    • Aerosol drug delivery device (ADDD)
    • Aerosols
    • Chronic obstructive pulmonary disease (COPD)
    • Dry powder inhaler (DPI)
    • Exacerbations
    • Inhaler
    • Nebulizer
    • Pressurized metered dose inhaler (pMDI)

    ASJC Scopus subject areas

    • Pulmonary and Respiratory Medicine

    Cite this

    The role of nebulized therapy in the management of COPD : Evidence and recommendations. / Dhand, Rajiv; Dolovich, Myrna; Chipps, Bradley; Myers, Timothy R.; Restrepo, Ruben; Rosen Farrar, Judith.

    In: COPD: Journal of Chronic Obstructive Pulmonary Disease, Vol. 9, No. 1, 02.2012, p. 58-72.

    Research output: Contribution to journalArticle

    Dhand, Rajiv ; Dolovich, Myrna ; Chipps, Bradley ; Myers, Timothy R. ; Restrepo, Ruben ; Rosen Farrar, Judith. / The role of nebulized therapy in the management of COPD : Evidence and recommendations. In: COPD: Journal of Chronic Obstructive Pulmonary Disease. 2012 ; Vol. 9, No. 1. pp. 58-72.
    @article{24ae12a7c23a4e0fbc5d976d477d70fc,
    title = "The role of nebulized therapy in the management of COPD: Evidence and recommendations",
    abstract = "Current guidelines recommend inhalation therapy as the preferred route of drug administration for treating chronic obstructive pulmonary disease (COPD). Previous systematic reviews in COPD patients found similar clinical outcomes for drugs delivered by handheld inhalers - pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs) - and nebulizers, provided the devices were used correctly. However, in routine clinical practice critical errors in using handheld inhalers are highly prevalent and frequently result in inadequate symptom relief. In comparison with pMDIs and DPIs, effective drug delivery with conventional pneumatic nebulizers requires less intensive patient training. Moreover, by design, newer nebulizers are more portable and more efficient than traditional jet nebulizers. The current body of evidence regarding nebulizer use for maintenance therapy in patients with moderate-to-severe COPD, including use during exacerbations, suggests that the efficacy of long-term nebulizer therapy is similar, and in some respects superior, to that with pMDI/DPIs. Therefore, despite several known drawbacks associated with nebulized therapy, we recommend that maintenance therapy with nebulizers should be employed in elderly patients, those with severe disease and frequent exacerbations, and those with physical and/or cognitive limitations. Likewise, financial concerns and individual preferences that lead to better compliance may favor nebulized therapy over other inhalers. For some patients, using both nebulizers and pMDI/DPI may provide the best combination of efficacy and convenience. The impact of maintenance nebulizer treatment on other relevant clinical outcomes in patients with COPD, especially the progressive decline in lung function and frequency of exacerbations, needs further investigation.",
    keywords = "Aerosol drug delivery device (ADDD), Aerosols, Chronic obstructive pulmonary disease (COPD), Dry powder inhaler (DPI), Exacerbations, Inhaler, Nebulizer, Pressurized metered dose inhaler (pMDI)",
    author = "Rajiv Dhand and Myrna Dolovich and Bradley Chipps and Myers, {Timothy R.} and Ruben Restrepo and {Rosen Farrar}, Judith",
    year = "2012",
    month = "2",
    doi = "10.3109/15412555.2011.630047",
    language = "English (US)",
    volume = "9",
    pages = "58--72",
    journal = "COPD: Journal of Chronic Obstructive Pulmonary Disease",
    issn = "1541-2555",
    publisher = "Informa Healthcare",
    number = "1",

    }

    TY - JOUR

    T1 - The role of nebulized therapy in the management of COPD

    T2 - Evidence and recommendations

    AU - Dhand, Rajiv

    AU - Dolovich, Myrna

    AU - Chipps, Bradley

    AU - Myers, Timothy R.

    AU - Restrepo, Ruben

    AU - Rosen Farrar, Judith

    PY - 2012/2

    Y1 - 2012/2

    N2 - Current guidelines recommend inhalation therapy as the preferred route of drug administration for treating chronic obstructive pulmonary disease (COPD). Previous systematic reviews in COPD patients found similar clinical outcomes for drugs delivered by handheld inhalers - pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs) - and nebulizers, provided the devices were used correctly. However, in routine clinical practice critical errors in using handheld inhalers are highly prevalent and frequently result in inadequate symptom relief. In comparison with pMDIs and DPIs, effective drug delivery with conventional pneumatic nebulizers requires less intensive patient training. Moreover, by design, newer nebulizers are more portable and more efficient than traditional jet nebulizers. The current body of evidence regarding nebulizer use for maintenance therapy in patients with moderate-to-severe COPD, including use during exacerbations, suggests that the efficacy of long-term nebulizer therapy is similar, and in some respects superior, to that with pMDI/DPIs. Therefore, despite several known drawbacks associated with nebulized therapy, we recommend that maintenance therapy with nebulizers should be employed in elderly patients, those with severe disease and frequent exacerbations, and those with physical and/or cognitive limitations. Likewise, financial concerns and individual preferences that lead to better compliance may favor nebulized therapy over other inhalers. For some patients, using both nebulizers and pMDI/DPI may provide the best combination of efficacy and convenience. The impact of maintenance nebulizer treatment on other relevant clinical outcomes in patients with COPD, especially the progressive decline in lung function and frequency of exacerbations, needs further investigation.

    AB - Current guidelines recommend inhalation therapy as the preferred route of drug administration for treating chronic obstructive pulmonary disease (COPD). Previous systematic reviews in COPD patients found similar clinical outcomes for drugs delivered by handheld inhalers - pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs) - and nebulizers, provided the devices were used correctly. However, in routine clinical practice critical errors in using handheld inhalers are highly prevalent and frequently result in inadequate symptom relief. In comparison with pMDIs and DPIs, effective drug delivery with conventional pneumatic nebulizers requires less intensive patient training. Moreover, by design, newer nebulizers are more portable and more efficient than traditional jet nebulizers. The current body of evidence regarding nebulizer use for maintenance therapy in patients with moderate-to-severe COPD, including use during exacerbations, suggests that the efficacy of long-term nebulizer therapy is similar, and in some respects superior, to that with pMDI/DPIs. Therefore, despite several known drawbacks associated with nebulized therapy, we recommend that maintenance therapy with nebulizers should be employed in elderly patients, those with severe disease and frequent exacerbations, and those with physical and/or cognitive limitations. Likewise, financial concerns and individual preferences that lead to better compliance may favor nebulized therapy over other inhalers. For some patients, using both nebulizers and pMDI/DPI may provide the best combination of efficacy and convenience. The impact of maintenance nebulizer treatment on other relevant clinical outcomes in patients with COPD, especially the progressive decline in lung function and frequency of exacerbations, needs further investigation.

    KW - Aerosol drug delivery device (ADDD)

    KW - Aerosols

    KW - Chronic obstructive pulmonary disease (COPD)

    KW - Dry powder inhaler (DPI)

    KW - Exacerbations

    KW - Inhaler

    KW - Nebulizer

    KW - Pressurized metered dose inhaler (pMDI)

    UR - http://www.scopus.com/inward/record.url?scp=84856595409&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84856595409&partnerID=8YFLogxK

    U2 - 10.3109/15412555.2011.630047

    DO - 10.3109/15412555.2011.630047

    M3 - Article

    C2 - 22292598

    AN - SCOPUS:84856595409

    VL - 9

    SP - 58

    EP - 72

    JO - COPD: Journal of Chronic Obstructive Pulmonary Disease

    JF - COPD: Journal of Chronic Obstructive Pulmonary Disease

    SN - 1541-2555

    IS - 1

    ER -