Evaluation of patients' experiences transitioning to the breelib nebulizer for inhaled iloprost therapy for pulmonary arterial hypertension

Abstract

Rationale: Inhaled Iloprost is an effective treatment for Pulmonary Arterial Hypertension (PAH) that requires patients to administer their own inhalations via a nebuliser. This can be a time consuming task for patients with multiple inhalations required each day. The new Breelib nebulizer has been shown to reduce inhalation time and we anticipated that this would lead to a better experience for patients. Methods: A prospective observational study was used to determine changes in reported outcomes of patients who had transitioned from an I-neb nebulizer to Breelib nebuliser for Iloprost administration. Outcomes were assessed prior to transition and one-week post transition to the Breelib nebulizer. Outcomes included disease specific Health Related Quality of Life (HRQL) with emPHasis-10, treatment satisfaction using the Treatment Satisfaction with Medicines Questionnaire (TSMED), fatigue using the Fatigue Severity Scale (FSS) and sleep quality with the Medical Outcomes Study sleep (MOS-sleep). Semi-structured interviews were also conducted to further explore patient’s experience of using the nebulised medication and analysed using thematic analysis. Results: Twenty-nine participants enrolled in the study (7 male; 22 female; idiopathic PAH 58%). There was a significant improvement in sleep adequacy (p=0.006). No other significant differences were found however scores for emPHasis-10 (mean: pre 31.7 and post 30.9), sleep disturbance and fatigue severity (mean: pre 48.9 and post 44.9) improved pre and post Breelib transition. Interviews with four participants identified Breelib as being easy to use compared to their previous experience, reduced inhalation time and being able to fit inhaler treatment around life. Conclusions: This small descriptive study suggests that transition to the Breelib nebulizer improves HRQL, fatigue and sleep adequacy; which may be related to decreased time spent self-administering inhaled therapy. Interviews described how inhaled PAH therapy limited everyday life and prevented patients from participating in many enjoyable activities. However, the benefits of transitioning to Breelib such as less preparation time were highly valued by patients and family members.