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Abstract
Background Bronchiectasis is a chronic lung condition commonly affecting adults in middle to later years. Quality of life can be poor with a chronic, productive cough, dyspnoea and significant fatigue. Treatments aim to reduce symptoms, exacerbation frequency and severity, preserve lung function and improve health related quality of life. Regular, often twice daily nebulised antibiotics are commonly used in managing bronchiectasis. This patient population typically has severe bronchiectasis requiring multiple other medications. Little is known on patients’ views and preferences for such therapies. We aimed to assess this and define patient preferences and experiences.
Methods We conducted three focus groups and three single interviews to define patients’ experience of nebulised antibiotics. 19 patients and/or carers attended focus groups providing in-depth information of lived experience using inhaled antibiotics. Thematic data analysis (TA) was used to derive a patient experience survey and a further 120 adult bronchiectasis patients completed surveys.
Results Thematic analysis of the focus group data identified that many patients found nebulised therapy an imposition on their daily routine and this impaired adherence. Reducing treatment burden/time administering therapy was important. Others reported that nebulisation time was a period of rest, often incorporated into daily routines. The survey data showed although 70% of those currently taking nebulised antibiotics found them easy/very easy to administer, 10% found these hard/very hard to administer. 20% found taking the nebuliser in front of others “uncomfortable”. When nebulising, 47% excluded themselves in a separate room on a daily basis. 53% stopped nebulised therapy during vacations. If an inhaler that was as effective as nebulised therapy at preventing exacerbations was available 76% strongly agreed/agreed that they preferred an antibiotic delivered by an inhaler over a nebuliser if it was as effective at preventing exacerbations. 16% stated a preference for nebulised. Notably, only 10% wished to remain on nebulised therapy.
Conclusions Bronchiectasis patients do not fully adhere with current treatments based upon treatment burden, life experience and lay knowledge. Inhaled antibiotics via dry power devices are quicker and easier to use and preferred by patients providing they were at least as effective as current nebulised treatments.
I would prefer an inhaler to a nebuliser.