Effectiveness of Vibrating Mesh Versus Small Volume Nebuliser in Chronic Obstructive Pulmonary Disease (COPD)
Effectiveness of Vibrating Mesh Versus Small Volume Nebuliser in Chronic Obstructive Pulmonary Disease (COPD)
When patients get an attack of COPD, one of the main treatments is regular nebulised
 medications called bronchodilators. These medications act by opening up the airways allowing
 patients to breathe easier and to reduce shortness of breath. Newer nebulisers may increase
 the amount of medication that gets into the lungs compared to the standard nebuliser usually
 used in hospital. This study is being done to assess whether increasing the amount of
 medication getting into the lungs using these newer nebulisers will help patients recover
 from a COPD exacerbation.
COPD is a common chronic respiratory disease. It is characterised by repeated episodes of
 acute worsening of symptoms of cough, wheeze and breathlessness called exacerbations.
 Exacerbations result in patients having to present to hospital for treatment. In Ireland more
 than one-fifth of all inpatient hospital days for the treatment of respiratory complaints are
 for the treatment of COPD. The administration of bronchodilators (medication to open the
 airway) is a central component of the treatment of COPD exacerbation. In the hospital setting
 these are most commonly administered via a nebuliser. The standard of care in our institution
 is the Hudson micromist small volume nebuliser.

 However, previous studies have shown that Vibrating mesh (VM) nebulisers result in greater
 deposition of medication to the lungs compared to small volume nebulisers. In addition they
 resulted in greater improvements in lung function and breathlessness.

 This study will assess the efficacy of the Aerogen Ultra VM nebuliser in a real-world
 setting. The VM nebuliser is readily available for use in the clinical setting and is used to
 administer bronchodilator therapy, within the terms of its CE Mark. This nebuliser is already
 in routine use in hospitals within the Royal College of Surgeons in Ireland (RCSI) hospital
 group.

 Patients hospitalised with an exacerbation of COPD will be recruited. There will be two study
 groups. Group 1 (VM Group): will receive bronchodilator (salbutamol 2.5mg/ipratropium 0.5mg)
 by Vibrating Mesh Nebuliser (Aerogen Ultra) with facemask and Group 2 (Standard Hospital
 Care): will receive bronchodilator by small volume nebuliser (Hudson Micromist) via facemask
 as per standard care.

 Both groups will receive bronchodilator therapy four times a day which has already been
 prescribed by their medical team, and in accordance with recommended guidelines for treatment
 of COPD exacerbations. Patients will use the nebuliser for the duration of hospital stay or a
 maximum of 7 days. Lung function and breathlessness scores will be recorded. The aim of this
 study is to demonstrate that better medication delivery by VM nebulizer during an
 exacerbation of COPD will lead to greater bronchodilation, shorter recovery time and reduced
 hospital length of stay.
Inclusion Criteria:

 -  Admission with acute exacerbation of COPD within 24 hours of presentation to hospital

 -  Age >40

 -  Confirmed COPD diagnosis (FEV1/FVC <0.70 on spirometry)

 -  Willing to participate in the study and provide informed consent

 Exclusion Criteria:

 -  Admission for reason other than COPD exacerbation e.g. Heart Failure

 -  Acute confusion as per clinical team

 -  Allergy or contraindication to combined bronchodilator medication

 -  Severe respiratory sepsis as evident by temperature >38 degrees and/or lobar pneumonia
 on Chest Radiograph

 -  Sustained tachycardia >120bpm

 -  Patients with very advanced COPD, admitted for palliative or long term care

 -  Patients re-admitted within 90 days who have already been enrolled in the study.