image: Sidney Braman, MD: This is a foundational study because we did not know how comfortable doctors were in educating patients about hand-held small volume nebulizers. view more
Credit: Sidney Braman
ATS 2016, SAN FRANCISCO - The American Thoracic Society and Sunovion Pharmaceuticals Inc. (Sunovion) today announced the results of a survey of pulmonologists and pulmonology fellows to determine physicians' knowledge, attitudes, and practices related to chronic obstructive pulmonary disease (COPD) management, with particular attention to the use of hand-held small volume nebulizers. A small volume nebulizer is a device powered by air that aerosolizes medications for delivery to patients.
This study is the first of two separate landmark studies focused on attitudes and experiences related to these devices. The results of the second study, seeking similar insights from COPD patients including users of hand-held small volume nebulizers, will be published in the future.
"We realized there was no baseline information about the level of knowledge and comfort pulmonologists have with using hand-held small volume nebulizers, which inhalation medicines and devices are most appropriate for which patients, or even how comfortable doctors are in educating their patients about their use," said Sidney Braman, MD, FCCP, professor of medicine, Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai Medical Center in New York and lead author on the survey abstract presented at ATS. "We did not know what doctors felt they did and did not know. That's why this is such a landmark study - it's oundational."
While there are well-established protocols for step-up care as COPD progresses, there are no guidelines to help physicians and patients determine the most appropriate delivery method for achieving an optimal clinical outcome.
Key findings of the survey include:
- Seven in ten of those surveyed said they believe that hand-held small volume nebulizers are more effective than either a dry powder or metered-dose inhaler (DPI/MDI) in the management of acute exacerbations of COPD.
- Nearly two-thirds of respondents also believe hand-held small volume nebulizers are more effective than DPI/MDI in treating those with severe COPD.
- While 98 percent of health care providers surveyed reported that they are at least somewhat knowledgeable about treatment devices, only about half reported that they were extremely or very knowledgeable about treatment devices.
- Approximately half of the respondents believed that hand-held small volume nebulizers are essential for some patients. Less than one-third said they were extremely/very knowledgeable about which patients should use them.
- Seven in ten of those surveyed reported that they typically discuss how to use a device during a patient's first visit, but only 20 percent felt they were extremely/very knowledgeable about how to clean and maintain hand-held small volume nebulizers to prevent infections. Less than 10 percent reported discussing with their patients how to clean and store devices.
- More than four out of five respondents reported interest in receiving additional education about COPD treatment devices and would like to learn more about the various types of hand-held small volume nebulizers.
"Sunovion is committed to improving the lives of people with COPD and other serious medical conditions, and we are proud to partner with ATS on this project," said Antony Loebel, M.D., Executive Vice President and Chief Medical Officer at Sunovion. "This and the forthcoming patient survey will provide valuable insights into what doctors want to know about using hand-held small volume nebulizers when treating their patients with COPD. We hope that these data will contribute to educational programs, leading to informed treatment decisions and better outcomes for patients."
About the Survey
The online survey, designed by a steering committee that was comprised of ATS clinicians and scientists, was conducted by Harris Poll between January 7 and January 29, 2016. Pulmonologists with a declared interest in COPD identified from the ATS membership roster and attendance list at ATS 2014 and 2015 were solicited to participate via email. In all, 205 U.S. pulmonologists and fellows completed the survey.
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A7816 - Results of a Pulmonologist Survey Regarding Attitudes and Practices with Inhalation Devices for COPD
S. S. Braman, MD (New York, NY, United States of America)
B. W. Carlin, MD (New York, NY, United States of America)
R. Dhand, MD (New York, NY, United States of America)
N. A. Hanania, MD (New York, NY, United States of America) D. A. Mahler, MD (New York, NY, United States of America) J. A. Ohar, MD (New York, NY, United States of America) V. Pinto-Plata, MD (New York, NY)
T. Shah, MD (New York, NY) M. Turenne, Ms (New York, NY)
D. Eubanks, EdD, RRT, FCCP (Hon) (New York, NY)
Abstract Body
Background:
For COPD patients there are well-established protocols for step-up care as the disease progresses. Inhalational medications have been preferred and clinicians have a number of methods of delivery to choose from, including small volume nebulizers. Currently, there are no guidelines on when to use these delivery devices and what patient types would benefit to achieve the best clinical outcomes. We sought to determine physicians' knowledge, attitudes and practices regarding the treatment of COPD with particular attention to the use of small volume nebulizers.
Methods:
An online survey was designed by a steering committee including ATS clinicians and scientists and conducted by Harris Poll between January 7 and January 29, 2016. More than 6,200 pulmonologists and fellows from around the world were solicited via email from the ATS membership roster as well as from attendees of the ATS 2015 conference, and a total of 205 pulmonologists and fellows in the U.S. completed the survey. The robust sample size (n>100) supported quantitative analysis.
Results:
83% of respondents reported interest in receiving additional education on COPD treatment devices, and 84% agree they would like to learn about different types of nebulizers. 98% reported they are at least somewhat knowledgeable about treatment devices, while 54% reported they are extremely/very knowledgeable. Seven in ten (70%) reported they typically discuss how to use a device during patients' first visit. Only 9% discuss how to clean and store devices and 20% feel extremely/very knowledgeable about how to clean and maintain a hand-held nebulizer to prevent infections. 31% are extremely/very knowledgeable about which patients should use a hand-held nebulizer. 56% feel that hand-held (small volume) nebulizers are essential for some patients. For patients with more severe COPD, as measured by an mMRC grade of 4, 63% believe hand-held nebulizers are more effective than DPI/MDI. 70% stated that hand-held nebulizers are more effective than DPI/MDI in the management of acute exacerbations.
Conclusions:
Our findings suggest that U.S. pulmonologists and fellows are interested in expanding their understanding of nebulizers in the management of COPD. Although most typically discuss device use during a patient's first visit, storage and cleaning are discussed by few. While the majority (66%) are at least knowledgeable about which COPD patients should be prescribed hand-held nebulizers, 84% would like to learn about different types of nebulizers. The survey findings suggest that greater education and consensus are required to guide clinicians regarding optimal device selection.