Understanding Nebulizer Utilization by Patients and Healthcare Providers: A COPD Foundation Nebulizer Consortium Survey Study

Kathryn H Melamed,1 Sergio Martinez,2 Lisa Cambridge,3 David C Christiani,4 Jie Li,5 Jill Ohar,6 Rajiv Dhand,7 M Bradley Drummond,8 Arzu Ari,9 Lewis J Radonovich Jr,10 Donald Tashkin,1 Matthew Dartt,1 Arshan Perera,11 Judy Schloss,12 Lauren Cochran,13 David Mannino,2 Nicholas Locantore,2 Karmon Johnson,14 Melinda K Lacy,13 Ariel Berlinski,15 Kim Gilchrist,16 Igor Barjaktarevic,1 On behalf of the COPD Foundation Nebulizer Consortium1Division of Pulmonary & Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 2Research & Pulmonary Medicine, COPD Foundation Inc., Miami, FL, USA; 3Medical Science, PARI, Inc., Midlothian, VA, USA; 4Department of Environmental Health, Harvard TH Chan School of Public Health, Harvard Medical School, Cambridge, MA, USA; 5Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA; 6Division of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA; 7Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Tennessee Graduate School of Medicine, Knoxville, TN, USA; 8Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 9College of Health Professions, Texas State University, Round Rock, TX, USA; 10Biosecurity Programs, Blueprint Biosecurity, Washington, DC, USA; 11Medical Science, PARI Medical Holding GmbH, Starnberg, Germany; 12Respiratory Care, Monaghan Medical Corporation, Plattsburgh, NY, USA; 13Medical Affairs & Operations, Theravance Biopharma US, LLC, South San Francisco, CA, USA; 14Medical Affairs, Aerogen Ltd., Galway, Ireland; 15Division of Pediatric Pulmonary Disease, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 16Medical Affairs, Viatris Inc., Canonsburg, PA, USACorrespondence: Igor Barjaktarevic, Division of Pulmonary & Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, Email [email protected]: Inhaled medications are the mainstay of chronic obstructive pulmonary disease (COPD) management. While consensus guidelines for pharmacological management in COPD are well-established, few guidelines exist regarding inhaled medication delivery systems. The COPD Foundation Nebulizer Consortium conducted a cross-sectional survey of patients with COPD and healthcare providers to understand their perceptions and utilization of nebulized medications.Methods: An online survey was conducted from February 7 through April 9, 2024. Patients completed a 42-question survey, including demographic information, tobacco use, symptoms severity, and the role of nebulizers in their treatment. Healthcare providers responded to a 17-question survey about their clinical experience with nebulized medications.Results: We analyzed responses from 347 patients and 39 healthcare providers. Among patients, 76.4% (265/347) were ≥ 65 years old, 72.0% (250/347) were female, 93.4% (324/347) were white, 90.5% (314/347) had a current or former smoking history, 77.6% (263/339) reported at least one exacerbation in the past year, and 70.8% (240/339) used some form of supplemental oxygen. Nebulizer use was reported by 84.1% (292/347) of patients. Among nebulizer users, 94.5% (276/292) used short-acting while only 22.3% (65/292) used long-acting nebulized medications. Patients reported that hand-held inhaler devices were easier to use (69.8%, 171/245), but nebulized therapy led to better symptom control (64.9%, 159/245) and had lower copays (67.8%, 166/245). Among prescribers surveyed, most (82.1%, 32/39) believed nebulizers were preferable for patients experiencing exacerbations. Impediments to wider use of nebulizers included difficulties with insurance coverage (69.2%, 27/39), cost (53.8%, 21/39), and lack of combination nebulized drugs (46.2%, 18/39). Two-thirds of providers thought that nebulizers were underused.Conclusion: We demonstrate that while patients and providers both perceive nebulizers as preferred in clinical management of COPD, there is discordance between patient and provider perception of nebulizer use on the basis of cost and feasibility of use.Keywords: chronic obstructive pulmonary disease, COPD exacerbation, nebulizer, nebulized medication