Can a nebulizer help a Chronic Obstructive Pulmonary Disease (COPD) patient breathe better?

From the Guidelines

Yes, nebulizers can help COPD patients breathe better, especially during exacerbations or for those who have difficulty using inhalers. Nebulizers deliver medication directly to the lungs in a fine mist, which can help open airways and reduce inflammation. Common medications used in nebulizers for COPD include:

• Bronchodilators (e.g., albuterol, ipratropium)
• Corticosteroids (e.g., budesonide) Typical regimen: Use the nebulizer 2-4 times daily, or as prescribed by your doctor. Each treatment usually takes 5-15 minutes. To use a nebulizer:

1. Fill the medicine cup with the prescribed medication
2. Connect the tubing and mouthpiece
3. Turn on the machine and breathe normally through the mouthpiece until the medication is gone Nebulizers are particularly helpful for patients who have difficulty using inhalers or during COPD exacerbations, as they work by delivering a higher dose of medication directly to the airways, helping to relax muscles, reduce inflammation, and clear mucus, thus improving breathing 1. Always clean your nebulizer after each use to prevent infection and ensure proper functioning. It is recommended that hand-held inhalers should be used in increasing doses up to 1 mg salbutamol or equivalent, and nebulizers should be considered for higher doses or for patients who require combined β-agonist and anticholinergic therapy 1. The choice of device should be individualized, taking into account the patient's breathing patterns, side-effect profiles, and personal preferences 1. In severe cases, nebulised salbutamol (2.5–5 mg) or terbutaline (5–10 mg) or ipratropium bromide (500 µg) should be given 4–6 hourly for 24–48 hours or until the patient is improving clinically 1.

From the FDA Drug Label

In controlled 12-week studies in patients with bronchospasm associated with chronic obstructive pulmonary disease (chronic bronchitis and emphysema) significant improvements in pulmonary function (FEV1 increases of 15% or more) occurred within 15 to 30 minutes, reached a peak in 1 to 2 hours, and persisted for periods of 4 to 5 hours in the majority of patients, with about 25% to 38% of the patients demonstrating increases of 15% or more for at least 7 to 8 hours. Following a 3 mg dose of nebulized albuterol, the maximum albuterol plasma level at 0. 5 hours was 2.1 ng/mL (range, 1.4 to 3. 2 ng/mL). There was a significant dose-related response in FEV1 (forced expiratory volume in one second) and peak flow rate.

Yes, a nebulizer can help a Chronic Obstructive Pulmonary Disease (COPD) patient breathe better, as evidenced by significant improvements in pulmonary function, including increases in FEV1, in patients with bronchospasm associated with COPD 2. The use of a nebulizer with medications such as ipratropium bromide and albuterol can provide rapid and sustained relief from bronchospasm, with improvements in FEV1 and peak flow rate 3. Key benefits of nebulizer use in COPD patients include:

• Rapid onset of action
• Significant improvements in pulmonary function
• Sustained relief from bronchospasm
• Increased peak flow rate

From the Research

Nebulizer Use in COPD Patients

• Nebulizers can be used by patients with Chronic Obstructive Pulmonary Disease (COPD) who are unable to use other inhalers 4
• Studies have shown that nebulizers can provide significant improvements in symptoms and quality of life for COPD patients, particularly when used in conjunction with other inhalers 5, 6
• Nebulized therapy has been found to be similar in efficacy to other inhalers, such as pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs), and may be preferred by some patients due to its ease of use and convenience 6, 7

Comparison of Nebulizers to Other Inhalers

• A study comparing nebulizers to pMDIs found that both methods of delivering medication were effective, but that concomitant use of both nebulizer and inhaler provided the most significant improvements in quality of life indices 5
• Another study found that nebulized short-acting dual bronchodilator therapy was not significantly different from dry powder long-acting single inhalation of a LABA and a LAMA in terms of bronchodilating effects over 6 hours 7

Patient Preference and Satisfaction

• A pilot study found that patients with stable COPD preferred the InnoSpire Go mesh nebulizer over their own compressor driven jet nebulizer, and reported improved quality of life and satisfaction with the device 8
• The study also found that treatment time was significantly shorter with the InnoSpire Go mesh nebulizer, and that patients reported lower Borg dyspnea scores before and after exercise when using the device 8