Domiciliary nebulised bronchodilator therapy in chronic obstructive pulmonary disease

Regular nebulised bronchodilator therapy in the home is commonly prescribed for patients with chronic obstructive pulmonary disease (COPD). If this therapy is administered inappropriately it exposes patients to potential side effects and has considerable financial cost to the health service. In a recent large audit in Liverpool we found that many patients with mild to moderate disease have obtained nebulisers from a variety of different sources including hospitals, primary care physicians, relatives and even the small advertisements of local papers.1 In this review the current rationale and recommendations for domiciliary nebulised bronchodilator therapy for patients with COPD are discussed. In 1997, the British Thoracic Society published guidelines concerning the supply, use and maintenance of nebuliser-compressor systems for chronic therapy in the patient's home.2 It was recommended that in the management of patients with COPD, such treatment should be reserved for only the minority in whom bronchodilator therapy, when effectively administered at a high dose from a handheld inhaler device, fails to provide adequate symptomatic relief. These guidelines also state that nebuliser provision should be made only after a full assessment by either a respiratory physician or trained hospital specialist or general practitioner.