Exacerbations and Decreased Lung Function Predict Nebulizer Use and Uptake in COPD and Tobacco Exposed Persons With...

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.

We aimed to describe characteristics of nebulizer users versus nonusers and factors associated with baseline nebulizer use and longitudinal uptake.

We analyzed the Subpopulations and Intermediate Outcome Measures in COPD Study, a prospective cohort of 2973 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).

Nebulizer utilization was highest in advanced COPD, 49% of Global initiative for chronic Obstructive Lung Disease (GOLD) Group 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 (1, odds ratio [OR] 1.81, 95% confidence interval [CI] [1.24, 2.64]; 2, OR 1.86, 95% CI [1.07, 3.22]; 3 or more, OR 1.87, 95% CI [1.07, 3.28]), lower forced expiratory volume in 1 second (FEV1) (OR 2.81 per liter decrease, 95% CI [2.09, 3.77]), COPD Assessment Test (CAT) score >10 (OR 1.89, 95% CI [1.17, 3.03]), 6-minute walk distance (6MWD) (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 score >10, and asthma. Patterns were consistent between TEPS and COPD.

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 to compare nebulizers with hand-held devices.