Nebulizer use in tobacco-exposed SPIROMICS participants with or at risk of COPD

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Rationale: Nebulizers are an alternative to handheld devices for providing inhaled therapy. We identified factors and trends associated with nebulizer use in SPIROMICS. Methods: SPIROMICS is a prospective cohort study with 2,981 enrolled participants across four strata, both never-smokers and smokers with and without COPD. We use stratified logistic and linear mixed models to analyze nebulizer use among tobacco-exposed subjects with preserved spirometry (TEPPS) and those with COPD at enrollment visit 1 (V1) and after 4-7 years of follow-up at visit 5 (V5). Results: Of COPD participants, regular nebulizer use is reported in 9.5% to 21.5% at V1 and V5, respectively. A majority of participants in GOLD stage 4 (53.9%) and GOLD group D (50.7%) use nebulizers regularly. When adjusted for comorbidities and previous exacerbations, baseline nebulizer use is not associated with decreased FEV1, CAT, or SGRQ scores but is correlated with increased prospective exacerbations. Among those who did not use nebulizers at V1, initiation during subsequent visits is correlated with higher rates of future exacerbations. At V5, 32.9% report daily nebulizer use, of which only 0.9% are long-acting bronchodilators. Among TEPPS, 3.6% and 7.7% report nebulizer use at V1 and V5, respectively; of regular users, only 6.4% use long-acting medications at V5. In multivariate analysis, nebulizer use among TEPPS at V5 is not associated with age, history of asthma, smoking exposure, or FEV1 but is with increased symptoms and exacerbations during follow-up. Conclusion: Nebulizer use occurs among most participants with advanced COPD, and less so among TEPPS, yet long-acting drugs are underutilized. Nebulizer use is correlated with exacerbations.

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