Exacerbations and Decreased Lung Function Predict Nebulizer Use and Uptake in COPD and Tobacco Exposed Persons With Preserved Spirometry

Jane C Fazio; Andrew W Hong; Daniela Markovic; R Graham Barr; Eugene R Bleecker; Russell P Bowler; David J Couper; Jeffrey L Curtis; M Bradley Drummond; Spyridon Fortis; MeiLan K Han; Victor Kim; Fernando J Martinez; Jill Ohar; Victor E Ortega; Robert Barnes Iii; J Michael Wells; Sheiphali A Gandhi; Prescott G Woodruff; Nirupama Putcha; Christopher B Cooper; Donald P Tashkin; Russell G Buhr; Igor Barjaktarevic; SPIROMICS investigators

doi:10.15326/jcopdf.2025.0714

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Exacerbations and Decreased Lung Function Predict Nebulizer Use and Uptake in COPD and Tobacco Exposed Persons With Preserved Spirometry

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Exacerbations and Decreased Lung Function Predict Nebulizer Use and Uptake in COPD and Tobacco Exposed Persons With Preserved Spirometry

Jane C Fazio, Andrew W Hong, Daniela Markovic, R Graham Barr, Eugene R Bleecker, Russell P Bowler, David J Couper, Jeffrey L Curtis, M Bradley Drummond, Spyridon Fortis, …

Chronic obstructive pulmonary diseases, Vol.13(2), pp.111-124

03/2026

DOI: 10.15326/jcopdf.2025.0714

PMID: 41771268

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Abstract

Nebulizers are an alternative to handheld devices for inhaled therapies in chronic obstructive pulmonary disease (COPD). Understanding nebulizer utilization patterns is essential to developing therapy guidelines. To describe characteristics of nebulizer users versus nonusers and factors associated with baseline nebulizer use and longitudinal uptake. We analyzed SPIROMICS, a prospective cohort of 2,973 participants with or without tobacco use and/or COPD. We used cross-sectional multivariable logistic regression and interval-censored proportional hazard models to analyze factors associated with nebulizer use and uptake among tobacco-exposed participants with preserved spirometry (TEPS) and COPD from enrollment (Visit 1) through 4-7 years of follow-up (Visit 5). Nebulizer utilization was highest in advanced COPD, 49% of GOLD D participants at baseline. Nebulizer treatments were primarily as-needed short-acting bronchodilators. Baseline nebulizer use was associated with respiratory exacerbations in the prior year (one, OR 1.81, 95%CI [1.24,2.64]; two, OR 1.86, 95%CI [1.07,3.22]; three or more, OR 1.87, 95% CI [1.07,3.28]), lower FEV (OR 2.81 per Liter decrease, 95% CI [2.09, 3.77]), CAT score > 10 (OR 1.89, 95% CI [1.17, 3.03]), 6MWD distance (OR 1.03 per 10 meter lower 6MWD, 95% CI [1.02,1.05]), and a history of asthma (OR 2.41, 95%CI [1.76,3.30]). Longitudinal uptake was similarly associated with exacerbations, lower FEV , CAT > 10, and asthma. Patterns were consistent between TEPS and COPD. Nebulizers were predominantly used by participants with frequent exacerbations, high symptom burden and advanced COPD, and long-acting nebulized medications were underutilized. Randomized controlled trials are needed compare nebulizers with hand-held devices.

nebulizer

outcomes

medication delivery systems

pulmonary physiology

COPD

Details

Title: Subtitle: Exacerbations and Decreased Lung Function Predict Nebulizer Use and Uptake in COPD and Tobacco Exposed Persons With Preserved Spirometry
Creators: Jane C Fazio - University of California, Los Angeles
Andrew W Hong - University of California, Los Angeles
Daniela Markovic - University of California, Los Angeles
R Graham Barr - Columbia University
Eugene R Bleecker - Mayo Clinic in Arizona
Russell P Bowler - Cleveland Clinic
David J Couper - University of North Carolina at Chapel Hill
Jeffrey L Curtis - University of Michigan
M Bradley Drummond - University of North Carolina at Chapel Hill
Spyridon Fortis - University of Iowa
MeiLan K Han - University of Michigan
Victor Kim - Temple University
Fernando J Martinez - Boston Medical Center
Jill Ohar - Wake Forest University
Victor E Ortega - Mayo Clinic in Arizona
Robert Barnes Iii - University of Utah
J Michael Wells - University of Alabama at Birmingham
Sheiphali A Gandhi - University of California, San Francisco
Prescott G Woodruff - University of California, San Francisco
Nirupama Putcha - Johns Hopkins University
Christopher B Cooper - University of California, Los Angeles
Donald P Tashkin - University of California, Los Angeles
Russell G Buhr - University of California, Los Angeles
Igor Barjaktarevic - University of California, Los Angeles
SPIROMICS investigators
Resource Type: Journal article
Publication Details: Chronic obstructive pulmonary diseases, Vol.13(2), pp.111-124
DOI: 10.15326/jcopdf.2025.0714
PMID: 41771268
NLM abbreviation: Chronic Obstr Pulm Dis
ISSN: 2372-952X
eISSN: 2372-952X
Publisher: COPD FOUNDATION
Grant note: HHSN268200900019C / NHLBI NIH HHS HHSN268200900020C / NHLBI NIH HHS U24 HL141762 / NHLBI NIH HHS HHSN268200900015C / NHLBI NIH HHS GSK Chiesi Polarean R01 HL144718 / NHLBI NIH HHS Takeda Pharmacuetical Company L30HL134025 / National Institutes of Health/National Heart, Blood, and Lung Institute
Language: English
Electronic publication date: 02/25/2026
Date published: 03/2026
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
Record Identifier: 9985141959602771

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