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Intelligent Nebuliser Benefits Patients With Chronic Obstructive Pulmonary Disease: Presented at ERS

By David Owen

STOCKHOLM, SWEDEN -- September 20, 2007 -- An "intelligent' nebuliser that provides feedback and adapts drug delivery to breathing pattern appears to have benefits for patients with chronic obstructive pulmonary disease (COPD), according to a study presented here at the Annual Congress of the European Respiratory Society (ERS).

Nicola Goodman, RN, Respiratory Physiologist and Senior Research Assistant, Respiratory Clinical Trials Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom and her colleagues evaluated a device that employs new adaptive aerosol delivery (AAD) technology.

This technology aims to overcome a shortcoming of traditional jet nebulisers: the difficulty in predicting how much of the medication placed in the nebuliser cup is actually delivered to the patient.

With the new system, the amount of drug inhaled depends on the patient's breathing pattern. Sensors within the nebuliser handpiece monitor the patient's breathing pattern to detect pressure changes during inspiration and expiration. These sensors determine when to pulse the aerosol delivery of medication during the first part of inspiration. Throughout the treatment, the sensors monitor the preceding three breaths and adapt to the patient's inspiratory and expiratory pattern.

"The device provides active feedback to the patient regarding treatment progression. The system is also fitted with an on-board patient logging system, allowing adherence to treatment and compliance to the correct use of the device to be monitored," Ms. Goodman explained.

In a 3-month study, 98 COPD patients aged 53 to 80 years used the device to deliver corticosteroids and/or bronchodilator therapy. The median age of the patients was 68 years; 36 were male.

Quality of life, ease of use and patient satisfaction were assessed via the Chronic Respiratory Questionnaire and a device-handling questionnaire both before and after the 3 months of AAD use. These same questionnaires were used to evaluate the patient's usual nebuliser; results were then compared.

"Patients expressed statistically significant preferences that favoured AAD over their previous nebuliser for six out of seven ease-of-use questions, and all ten satisfaction questions. Patients found the AAD nebuliser to be significantly easier to use, showed significantly greater satisfaction and conferred a clinically significant improvement in dyspnoea when compared with the patient's previous nebuliser," the authors reported.

"The clinically and statistically significant improvement in dyspnoea, and statistically significant improvement in fatigue seen in this study could reflect increased aerosol delivery to the lung over the study period, possibly resulting from increased adherence to treatment and/or compliance to correct use of the device," said Ms. Goodman. The device could be of value in future clinical trials to establish whether lack of response to a drug is due to poor drug efficacy or poor adherence/compliance, she added.


[Presentation title: Can the Use of Adaptive Aerosol Delivery Technology Increase the Quality of Life for Patients With COPD? Abstract 3591]

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