A LONG-TERM STUDY OF SYMPTOMS, SPIROMETRY AND SURVIVAL AMONGST HOME NEBULIZER USERS

Although home nebulizers are widely used to deliver bronchodilator med ication to patients with asthma and chronic obstructive pulmonary dise ase (COPD), the long-term benefits and hazards are unknown. The presen t authors have previously reported a prospective 12-month study of hom e nebulizer use involving 49 patients (15 asthma, mean forced expirato ry volume in 1 s/forced vital capacity (FEV(1)/FVC) 1 . 3/2 . 11; 34 C OPD, mean FEV(1)/FVC 0 . 7/1 . 8 1). Thirty-two of these patients were treated with long-term domiciliary nebulized bronchodilator treatment , the other 17 patients chose metered dose inhaler (MDI) therapy. The present paper reports the progress of these patients oiler 5 yr. Five- year survival was similar in both groups (nebulizer users 56%, MDI use rs 53%). Most deaths were due to respiratory failure (14 deaths) or lu ng cancer (four deaths). Survival was determined mainly by FEV(1) (R=0 . 54, P=0 . 0001) and age (R=-0 . 47, P=0 . 0007). Laboratory lung fu nction tests (16 nebulizer users) sheared that FEV(1) and FVC were sti ll higher than pre-nebulizer baseline measurements after 36 months of nebulizer use, but PEFR had fallen by 7%. Twenty-one of 23 surviving n ebulizer users completed a questionnaire after 36 months of treatment. All used their nebulizer at least once per day and 20 of 21 patients reported that they still obtained full benefit from each nebulized tre atment. The morning peak flow response to nebulized treatment was the same at baseline and at 36 months (48 1 min(-1)). All patients remaine d breathless (mean subjective score 4 . 8 on seven-point scale) but th e subjective response to nebulized treatment was unchanged at 36 month s. Tachyphylaxis did not develop among 13 patients who underwent repea ted reversibility studies using 200 mu g of salbutamol at 6, 12 and 36 months. It is concluded that home nebulizer therapy is safe and effec tive for a small number of carefully selected patients with severe ast hma or COPD, who have been evaluated by a rigorous home nebulizer asse ssment protocol prior to commencing home nebulizer therapy.