Exacerbations and Decreased Lung Function Predict Nebulizer Use and Uptake in COPD and Tobacco Exposed Persons With Preserved Spirometry.
Academic Article
Overview
abstract
RATIONALE: Nebulizers are an alternative to handheld devices for inhaled therapies in chronic obstructive pulmonary disease (COPD). Understanding nebulizer utilization patterns is essential to developing therapy guidelines. OBJECTIVES: To describe characteristics of nebulizer users versus nonusers and factors associated with baseline nebulizer use and longitudinal uptake. METHODS: We analyzed SPIROMICS, a prospective cohort of 2,973 participants with or without tobacco use and/or COPD. We used cross-sectional multivariable logistic regression and interval-censored proportional hazard models to analyze factors associated with nebulizer use and uptake among tobacco-exposed participants with preserved spirometry (TEPS) and COPD from enrollment (Visit 1) through 4-7 years of follow-up (Visit 5). RESULTS: Nebulizer utilization was highest in advanced COPD, 49% of GOLD D participants at baseline. Nebulizer treatments were primarily as-needed short-acting bronchodilators. Baseline nebulizer use was associated with respiratory exacerbations in the prior year (one, OR 1.81, 95%CI [1.24,2.64]; two, OR 1.86, 95%CI [1.07,3.22]; three or more, OR 1.87, 95% CI [1.07,3.28]), lower FEV1 (OR 2.81 per Liter decrease, 95% CI [2.09, 3.77]), CAT score > 10 (OR 1.89, 95% CI [1.17, 3.03]), 6MWD distance (OR 1.03 per 10 meter lower 6MWD, 95% CI [1.02,1.05]), and a history of asthma (OR 2.41, 95%CI [1.76,3.30]). Longitudinal uptake was similarly associated with exacerbations, lower FEV1, CAT > 10, and asthma. Patterns were consistent between TEPS and COPD. CONCLUSION: Nebulizers were predominantly used by participants with frequent exacerbations, high symptom burden and advanced COPD, and long-acting nebulized medications were underutilized. Randomized controlled trials are needed compare nebulizers with hand-held devices.
