Alhaddad, Bothaina Jeragh; (2012) The use of nebulisers in the home: a study with patients and carers. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Introduction: Inhalational therapy is the mainstay of treatment for COPD, and nebuliser therapy is commonly prescribed for the management of severe COPD in the home. The success of inhalational therapy is multi-factorial and largely depends on the ability of the patient to use correctly the inhaler device. Whilst the problems with the use of pressurized metered dose inhalers and dry powder inhalers are documented in the literature, little is known about how COPD patients and their carers use nebulisers in the home. The aim of the study is to describe the experiences of COPD patients and their carers with the use of nebuliser therapy in the home and to identify their priorities and concerns in the context of current disease management, support and potential health services. Methods: The study was conducted in primary and intermediate settings within a strategic health region in the UK (North West London). A representative sample including patients with different durations of nebuliser use and different disease severity levels were recruited. Data were collected in the patients' homes on one occasion using semi-structured interviews, non-participant observations and survey methods. A mixed approach to data analysis was used to triangulate data from different methods. The Framework method was used to analyse the qualitative data and the Statistical Package for Social Sciences (SPSS) was used to analyse the quantitative data. Results: All patients experienced problems with the use of their nebulisers in the home during assembling, filling, cleaning and maintaining their device. The interviews revealed that factors such as: the complexity of setting up the equipment, lack of instructions on its assembly, poor manual dexterity costs and poor access to accessories contributed to the problems. Practical problems were frequently experienced by patients who had frequent hospital admissions, were treated by more than one doctor and used a facemask. Moreover, 30% of COPD patients were dependent on carers for vital assistance with the use of the nebuliser; on average, the carers spent 3.5 hours per week (range 1 - 10.5 hours) undertaking nebuliser-related activities. Carers performed a range of activities (mean 6, range 2 - 9), which included organisational and practical tasks and they frequently experienced difficulties (mean = 3, range 0 - 9) with providing practical assistance such as setting up, dismantling and cleaning the nebuliser parts. Several factors (timing of therapy, complexity of the dosing regimen, co-morbidities and deterioration in health status) affected the level of carers' involvement which ranged from taking full responsibility to providing assistance with particular aspects of nebuliser use when required. The patients and the carers were shown to be active decision-makers with regard to the need and use of their therapy and overall condition management. Conclusion: Improving health outcomes for COPD patients and their carers is a central goal of health policy in the UK. A holistic assessment of the use of nebuliser therapy identified that COPD patients and their carers frequently encountered practical problems with the use of nebulisers in the home which should inform healthcare providers to effectively support patients and their carers to optimise treatment outcomes.

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