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Am Fam Physician. 1998;57(9):2255-2259

Home nebulizer therapy is frequently recommended for use in patients with chronic obstructive pulmonary disease (COPD) who do not respond adequately to therapy with a metered-dose inhaler. Home programs are established, and patients and family members are educated about using the nebulizer despite the fact that few studies have assessed the compliance of patients with this treatment regimen. Corden and associates evaluated the significance of compliance in patients receiving home nebulizer therapy.

The four-week study included 93 patients who were already established on a home nebulizer program. Home nebulizers were installed that recorded the date, time, duration of treatment and inhalation time without patient knowledge of the recording capabilities. Patients completed a quality-of-life survey specifically designed for COPD patients before the study period and at its conclusion. Compliant patients were defined as patients who took at least 70 percent of the recommended treatments (in those prescribed up to four treatments daily) or at least 60 percent of treatments (in those prescribed five or more treatments daily).

Only 44 percent of the patients were compliant with their regimen. In over one half of the patients, there were times that the nebulizer was turned on but no inhalations were performed. Also, 21 percent of the patients did not use the equipment at all on at least 50 percent of days during the study period. The quality-of-life data showed a direct correlation between higher compliance and higher scores on the survey.

The authors conclude that there was poor compliance with home nebulizer therapy, which had a significant impact on the quality of life in patients with COPD. Poor compliance in COPD patients has been shown to increase rates of morbidity. It is vital that physicians assist their patients to comply with home nebulizer therapy in order to improve their quality of life and decrease the impact of this disease on the patients.

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