Chest
Volume 112, Issue 5, November 1997, Pages 1278-1282
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Clinical Investigations: Nebulizers
Home Nebulized Therapy for Patients with COPD: Patient Compliance With Treatment and Its Relation to Quality of Life

https://doi.org/10.1378/chest.112.5.1278Get rights and content

Study objectives

To assess compliance with home nebulized therapy in patients with COPD.

Design

Patients' home nebulizers were replaced with nebulizers that recorded the date and time of each treatment over a period of 4 weeks. Poor compliance was defined as taking <70%; of the prescribed dose (or <60%; for those prescribed treatments five or more times daily).

Setting

Patients were seen at the hospital COPD outpatient clinic. The compliance data obtained were recorded while they were at home.

Patients

Ninety-three patients aged 44 to 76 years (mean, 64.9 years) were recruited from the hospital nebulizer database.

Measurements

Patients completed a self-reported quality of life scale, the St. George's Respiratory Questionnaire (SGRQ), both before (SGRQ1) and after (SGRQ2) the 4-week study period to look at whether quality of life was either predictive of or subsequent to level of compliance.

Results

Data were obtained from 82 patients. Mean compliance was 57%; (range, 0 to 124%;). Thirty-six (44%;) patients were compliant and 46 (56%;) were poorly compliant. There was no difference between the two groups in age or sex distribution. Compliance was negatively correlated with the total score on the SGRQ2 (p=0.03).

Conclusion

The study shows that levels of compliance with nebulized therapy are low in a large proportion of patients with COPD and that patients with low levels of compliance report greater impairment in their quality of life.

Section snippets

Patients

Patients were recruited from a database at Guy's Hospital of patients using regular nebulized therapy at home. All patients had previously been assessed as to their suitability for nebulized therapy and had been prescribed a nebulizer on the basis of at least 10%; reversibility being achieved as well as subjective improvement. All patients with a diagnosis of asthma, emphysema, or chronic bronchitis between the ages of 40 and 75 years were approached by letter followed by a telephone call. A

Withdrawals

Eleven patients withdrew from the study: 7 female and 4 male. The mean age of this group was 64.4 years (±7.5). Four patients experienced worsening symptoms and felt safer using their own machine, four found the nebulizer hard to use, and the remaining three patients dropped out due to a hospital admission, diagnosis of lung cancer, and a nebulizer recording malfunction.

Patient Details

Eighty-two patients (88%;) completed the study. Forty-four (54%;) were male and 38 (46%;) were female. The mean age of the

DISCUSSION

One hundred percent compliance is probably an unrealistic target for most patients. It is therefore better to consider a level of compliance that will maintain the patient in good health, which is the required outcome of treatment. Eighty to 100%; has been suggested as a standard for full compliance.5 In this investigation, patients were considered to be “poor compliers” if they took <70%; of the overall treatment prescribed for them during the 4-week period. The physicians involved in the

REFERENCES (12)

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This study was supported by an educational grant from Allen and Hanbury's Division of Glaxo Wellcome, Inc.

Reprint requests: Mr. John Denyer, Medicaid Ltd, Hook Lane, Pagham, West Sussex, England P021 3PP

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