Capella FPX 4025 Assessment 3

Applying the PICO(T) Process

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease that is hard to breathe and predisposes to exacerbations. Treatment is key in symptom control and avoiding disease progression. COPD is the leading cause of mortality in the United States, with an estimated 16 million adults affected (CDC, 2024). The selection of appropriate treatment contributes importantly to better patient outcomes. This paper compares Breztri Aerosphere’s efficacy to Trelegy Ellipta’s in managing moderate to severe COPD over six months. It measures their ability to reduce the frequency of exacerbation and control symptoms.

Explaining a Diagnosis

COPD is a chronic lung disease involving airflow limitation, chronic inflammation, and repeated exacerbations. COPD has enormous effects on the patient’s prognosis, which comprises impaired lung function, chronic respiratory symptoms, and vulnerability to acute exacerbations and other related risks such as hospitalization and death. It is a contributing factor to 3.6 million deaths per year and about 5% of total global mortality. More than 70% of smoking-attributable COPD deaths in developed countries, however, are from low- and middle-income countries (LMICs) due to limited healthcare access and environmental conditions (WHO, 2024).

COPD has several complications, including chronic respiratory infections, pulmonary hypertension, and progressive respiratory failure. The worst aspect is that of the exacerbation, which causes longer hospitalization and a faster progression of the disease in the lungs. Low-income individuals, older adults, and those who are unable to attend to their health properly are also more at risk because they may present their conditions late, get inadequate treatment, or be exposed to environmental factors such as polluted air or toxic working conditions (Gaffney et al., 2020).

Socioeconomic disparities also affect COPD outcomes since patients with low status may have poor adherence to their medications, fewer chances to attend pulmonary rehabilitation, or high SMOKING rates depending on social factors. For instance, a poor urban COPD patient with frequent exacerbations may be due to long-term environmental exposure and poor healthcare access (Gaffney et al., 2020). Closing these gaps through education, access to care, and targeted care delivery is what is required to enhance COPD care. 

PICO(T) Research Question

A well-structured research question using the PICO(T) framework helps guide evidence-based practice in COPD management. Given the high exacerbation rates and safety concerns associated with inhaler therapy, the following PICO(T) question was developed: “ In patients with COPD (P), how does Breztri Aerosphere (I), compared to Trelegy Ellipta (C), affect COPD exacerbation frequency (O) over six months (T)?”

Each component of the PICO(T) framework is addressed within this question:

• P (Patient/Population): Patients diagnosed with COPD, particularly those with recurrent exacerbations.
• I (Intervention): Use Breztri Aerosphere, a commonly prescribed inhaler therapy.
• C (Comparison): Trelegy Ellipta, another inhaler option shown to reduce exacerbations more effectively.
• O (Outcome): The frequency of COPD exacerbations is a key factor in determining treatment efficacy.
• T (Timeframe): Six months, allowing adequate assessment of treatment effectiveness and patient adherence.

This research question addresses a significant clinical issue by evaluating real-world data on inhaler effectiveness and safety. It aligns with evidence-based practice principles by directly comparing treatment options to optimize patient outcomes in COPD management.

Literature Search

Extensive searching was performed to identify evidence to compare the efficacy of Breztri Aerosphere and Trelegy Ellipta’s efficacy in lowering COPD exacerbation. Different academic databases, such as PubMed, CINAHL, Cochrane Library, and Google Scholar, were accessed to acquire many high-quality sources. The first search strategy used terms like “COPD,” “Breztri Aerosphere,” “Trelegy Ellipta,” “triple inhaler therapy,” “prevention of exacerbations in COPD,” “adherence to inhalers,” and “risk of pneumonia in COPD patients.” Boolean operators (AND, OR) were employed to narrow the search to research the distinctive therapy with inhalers for COPD instead of general respiratory therapy.

To assess credibility, the studies were examined on CRAAP criteria (Currency, Relevance, Authority, Accuracy, and Purpose), preferably peer-reviewed journal articles, systematic reviews, and meta-analyses published in the last five years. Evidence from prominent organizations, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD), was used to validate clinical application (GOLD, 2023). The search process was filtered using full-text availability, English language, and published adult patient studies. First, a plethora of general COPD treatment texts were accessed. By adding special keywords such as “COPD inhaler therapy effectiveness” and “real-world outcomes of Trelegy vs. Breztri,” the searches were limited to research that could be used directly to answer the research question. This ensured that only the best and most appropriate evidence was chosen to inform evidence-based practice in COPD inhaler therapy.

Relevant Articles

Different sources guided the research comparing the efficacy of Breztri Aerosphere and Trelegy Ellipta in COPD care. The first source, Feldman et al. (2024), compares Breztri and Trelegy Ellipta among patients with COPD. According to the study, although the inhalers are connected with comparable dangers of pneumonia, there was elevated exacerbation in Breztri. This article is extremely valid, as it is authored in a peer-reviewed high-impact journal, based on actual clinical practice, and provides informative outcomes towards treatment of COPD exacerbation prevention.

The second source, Duan et al. (2023), is a systematic review of efficacy comparison between Breztri Aerosphere and Trelegy Ellipta. The review depicts Trelegy as superior to Breztri Aerosphere in preventing moderate-to-severe COPD exacerbations and patient outcomes. The source is reliable because it employs good methodology and peer-reviewed high-quality studies from well-established journals, hence being highly relevant to clinical decision-making in COPD management.

Another significant source is Wang and Lin (2024), which examines the efficacy of triple inhaler treatment (Trelegy Ellipta) relative to dual therapy (Breztri). The trial concluded that Trelegy was a significant factor in reducing exacerbations and slowing lung function loss. The strength of this article lies in its strong randomized control trial design, published by a trustworthy medical agency, which renders it relevant to clinicians looking for evidence-based guidance for COPD management. Finally, Tandan et al. (2024) discuss the interdisciplinary management of COPD and how the nursing staff is most involved in maximizing inhaler therapy.

The paper has evidence-based pragmatic recommendations and emphasizes patient education and compliance monitoring, thereby being of the highest relevance to enhancing patient outcomes in the care of COPD. Together, these resources offer a strong and evidence-based foundation for developing informed clinical decisions in inhaler therapy management of COPD, ultimately resulting in enhanced patient care and outcomes.

Analyzing Evidence

The available data from four studies gives a clear and definite answer to the formulated PICO(T) question on Breztri Aerosphere and Trelegy Ellipta for COPD treatment. Feldman et al. (2024) present the fact that Trelegy Ellipta offers better chances of preventing COPD exacerbations as well as improving patients’ outcomes over Breztri and Duan et al. (2023) re-establish the effectiveness of Trelegy in preventing moderate to severe-exacerbations. Further evidence for this is the FULFIL trial by Wang & Lin (2024), which confirmed that Trelegy effectively reduces exacerbation to a high degree and prevents further decline of lung function.

Tandan et al. (2024) also dwelled on the nurses’ role in addressing ineffective treatment with inhalers through patient education and follow-up. All these articles indicate that Trelegy Ellipta is more effective than other drugs in the event of COPD exacerbation. The review assumes that reduced exacerbations will lead to improved patient outcomes, and compliance must be attained to do so. The review also assumes that the findings from real-life and clinical trial studies can be generalized to all patients.

Conclusion

Although both Breztri Aerosphere and Trelegy Ellipta are effective in managing COPD, the data analysis indicates that Trelegy has better outcomes in terms of reducing exacerbations and overall patient improvement. Supportive information from other sources, like systematic reviews and randomized control trials, supports the effectiveness of Trelegy. Compliance and patient education within interdisciplinary care are crucial for the highest treatment outcomes. Based on these findings, it is recommended that more research be conducted into how evidence-based management of COPD can benefit the patient.

References

Centers for Disease Control and Prevention (CDC). (2024, June 12). COPD. Chronic Disease Indicators. https://www.cdc.gov/cdi/indicator-definitions/chronic-obstructive-pulmonary-disease.html 

Duan, R., Li, B., & Yang, T. (2023). Pharmacological therapy for stable chronic obstructive pulmonary disease. Chronic Diseases and Translational Medicine, 9(2). https://doi.org/10.1002/cdt3.65

Capella FPX 4025 Assessment 3

Feldman, W. B., Suissa, S., Kesselheim, A. S., Avorn, J., Russo, M., Schneeweiss, S., & Wang, S. V. (2024). Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: New user cohort study. British Medical Journal, 387. https://doi.org/10.1136/bmj-2024-080409 

Gaffney, A. W., Hawks, L., White, A. C., Woolhandler, S., Himmelstein, D., Christiani, D. C., & McCormick, D. (2020). Health care disparities across the urban‐rural divide: A national study of individuals with COPD. The Journal of Rural Health, 38(1), 207–216. https://doi.org/10.1111/jrh.12525 

GOLD. (2023). Global Initiative for Chronic Obstructive Lung Disease – GOLD. Global Initiative for Chronic Obstructive Lung Disease – GOLD. https://goldcopd.org/ 

Tandan, M., Dunlea, S., Cullen, W., & Bury, G. (2024). Teamwork and its impact on chronic disease clinical outcomes in primary care: A systematic review and meta-analysis. Public Health, 229, 88–115. https://doi.org/10.1016/j.puhe.2024.01.019

Wang, M.-T., & Lin, C. W. (2024). Environmentally friendly inhaler regimens for COPD. BMJ, q2825. https://doi.org/10.1136/bmj.q2825

Capella FPX 4025 Assessment 3

WHO (2024, November 6). Chronic Obstructive Pulmonary Disease (COPD). World Health Organisation. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)