Nebulizer versus metered dose inhaler with space chamber (MDI spacer) for acute asthma and chronic obstructive pulmonary disease exacerbation: attitudes of patients and healthcare providers in the COVID-19 era

Short-acting bronchodilators for asthma and chronic obstructive pulmonary disease (COPD) exacerbations are commonly delivered by nebulizers although administration using metered dose inhaler with space chamber (MDI spacer) has been shown to be equally efficacious. There are few studies examining patients’ and healthcare providers’ attitudes on the two administration methods in adults. This study explores patients’ and healthcare providers’ attitudes on the use of nebulizer versus MDI spacer for acute asthma and COPD exacerbations in adults. Patients admitted for asthma or COPD exacerbations, doctors, and nurses in a university-affiliated hospital were surveyed from 1 April 2021 to 30 September 2021 regarding their views on the effectiveness, ease of use, preparation and administration, side effects, and infection risk of the two administration methods. Ninety-nine patients, 103 doctors, and 650 nurses completed the survey. 60.6% of patients perceived nebulizer to be more effective. Patients who found nebulizer more comfortable were more likely to prefer nebulizer (OR 43.97, <i>p</i> = 0.01), while those who associated it with a greater infection risk were less likely to prefer nebulizer (OR 0.15, <i>p</i> = 0.03). 49.5% of doctors and 49.1% of nurses perceived nebulizer to be more effective, compared to 10.7% and 34.5%, respectively, for MDI spacer. Effectiveness and patient comfort influenced doctors’ and nurses’ preference for nebulizer while ease of preparation and administration influenced nurses’ preference only. Patients and healthcare providers perceived nebulizer to be more effective. Factors unique to each group influenced their preference for nebulizer.

用于哮喘及慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）急性加重的短效支气管扩张剂，临床常通过雾化器（nebulizer）给药；尽管已有研究证实，采用带储雾罐的定量吸入器（metered dose inhaler with space chamber, MDI spacer）给药的疗效与之相当。目前针对成人患者与医疗服务人员对这两种给药方式的态度相关研究尚少。本研究旨在探讨成人哮喘及COPD急性加重患者与医疗服务人员对雾化器与MDI储雾罐两种给药方式的使用态度。本研究于2021年4月1日至2021年9月30日期间，对某大学附属医院内因哮喘或COPD急性加重住院的患者、医师及护士开展问卷调查，调研对象需针对两种给药方式的有效性、易用性、准备与操作流程、不良反应及感染风险发表主观评价。最终共有99名患者、103名医师及650名护士完成问卷调研。60.6%的患者认为雾化器的疗效更佳。认为雾化器使用更舒适的患者更倾向于选择雾化器（比值比（odds ratio, OR）=43.97，P=0.01）；而认为雾化器存在更高感染风险的患者则更不愿选择雾化器（OR=0.15，P=0.03）。49.5%的医师与49.1%的护士认为雾化器疗效更佳，而认为MDI储雾罐疗效更佳的医师及护士占比分别为10.7%与34.5%。疗效与患者舒适度是影响医师及护士选择雾化器的因素，而仅准备与操作的便捷性会影响护士的选择倾向。患者与医疗服务人员均认为雾化器的疗效更优，且不同群体的独特影响因素会左右其对雾化器的选择偏好。