DOMICILIARY NEBULIZER THERAPY - A VALUABLE OPTION IN CHRONIC ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Domiciliary nebulisers are in widespread use for patients who have sev ere chronic airways disease, both asthma and chronic obstructive pulmo nary disease (COPD). We report a study of the use of domiciliary nebul isers designed to assess practical problems and the value of such ther apy in preventing hospital admissions. A total of 405 patients underwe nt a structured interview at home and their case records were reviewed . Technical performance of the nebuliser compressors was assessed. The mean (SD) age of those interviewed was 64.5 (12) years 185 patients h ad a physician diagnosis as asthma, and 208 had COPD.87% patients used their nebuliser at least once daily. Side effects, reported by 54% we re related to frequency of use and commoner in younger patients. 29 su bjects (7%) died within 2 years of receiving their nebuliser. Among th e survivors, the 2 year periods before and after supply of the nebulis er were compared. The percentage of patients requiring hospital admiss ion for exacerbations of lung disease feel from 56% to 46% (p < 0.01) but the number and duration of admissions was unchanged. Those whose a dmission duration increased had more severely impaired spirometry when the nebuliser was supplied and had lower activity scores and higher b reathlessness scores at the time of interview indicating more severe d isease. Approximately half of the compressors were malfunctioning and patients' understanding of the principles of nebuliser treatment was p oor. The provision of domiciliary nebuliser can influence hospital adm ission in patients with obstructive airways disease. There is also a n eed for improved patient education and for technical support which may require the development of a nurse-run nebuliser service.