Inhaled nebulised medications in palliative care - a survey among palliative care practitioners in Germany

Abstract

Background: In palliative care, alternative routes for drug application besides the oral and intravenous administration are frequently necessary. Up-to-date, very little is known about the familiarity, use and perceived relevance of inhalative medications for symptom control among palliative care practitioners.

Methods: We conducted an anonymous online survey among palliative care physicians throughout Germany between 09/2021 and 04/2022. The questionnaire covered participants' sociodemographics, as well as familiarity, perceived relevance and prescription practices regarding 21 nebulised drugs. Analysis was performed using methods of descriptive statistics.

Results: 108 fully completed questionnaires were analysed. Most of the participants were employed in palliative care for 5 + years. The administration of normal saline, mucoactive drugs, bronchodilators and steroids via nebulisation was a widely known and frequently used technique among the participants, as evidenced by its regular use in clinical routine. About 50% of the participants reported to know epinephrine and tranexamic acid for anti-oedematous or haemostyptic effects, respectively. Both drugs were considered "relevant" by more than 60% of the prescribers. Only a minority of participants reported to know and use nebulised opioids, iloprost, several antibiotics, heparin, ketamine and lidocaine.

Conclusions: Our survey shows that nebulised drugs are prescribed and considered relevant in palliative care. However, for several of the mentioned medications only limited data is available regarding use and effectivity. There is also uncertainty to what extent the existing data may be transferable into routine palliative care setting. Therefore, more evidence should be generated.

Trial registration: Not applicable.

Keywords: Inhalation; Inhalative; Nebulisation; Nebulised; Palliative care; Symptom control.

Fig. 1

Familiarity regarding nebulised drugs and frequency of their prescription. legend: Total bar height = proportion of participants who are familiar with a specific nebulised drug (percentage). Blue bar = proportion of participants who are familiar with a specific nebulised drug, but do not prescribe it. Brown and green bars = proportion of participants who are familiar with a specific nebulised drug and prescribe it “very often” (light brown), “often” (dark brown), “less often” (dark green) or “rarely” (light green). NS = normal saline, HS = hypertonic saline, Amb = ambroxol, Acc = acetyl cysteine, Sal = salbutamol, Ipr = ipratropium bromide, Bud = budesonide, Dex = dexpanthenol, Hep = heparin, Epi = epinephrine, Tran = tranexamic acid, Mo = morphine, HDM = hydromorphone, Fen = fentanyl, Ket = ketamine, Lid = lidocaine, Ilo = iloprost, Tob = tobramycin, Gent = gentamicin, Col = colistin, Azt = aztreonam

Fig. 2

Perceived relevance regarding nebulised drugs. legend: Brown and green bars = proportion of prescribers, who deem the relevance of a specific nebulised drug “very relevant” (light brown), “relevant” (dark brown), “less relevant” (light green) or “not relevant” (dark green). The absolute number of participants reporting to prescribe a specific drug is shown above each bar. NS = normal saline, HS = hypertonic saline, Amb = ambroxol, Acc = acetyl cysteine, Sal = salbutamol, Ipr = ipratropium bromide, Bud = budesonide, Dex = dexpanthenol, Hep = heparin, Epi = epinephrine, Tran = tranexamic acid, Mo = morphine, HDM = hydromorphone, Fen = fentanyl, Ket = ketamine, Lid = lidocaine, Ilo = iloprost, Tob = tobramycin, Gent = gentamicin, Col = colistin, Azt = aztreonam