Capella 4025 Assessment 2
Capella 4025 Assessment 2
Name
Capella university
NURS-FPX4025 Research and Evidence-Based Decision Making
Prof. Name
Date
Applying an Evidence-Based Practice (EBP) Model
Chronic Obstructive Pulmonary Disease (COPD) is a persistent and progressive illness marked by airflow limitation, commonly resulting in breathing difficulties and recurrent respiratory infections. Patients frequently experience symptoms such as chronic coughing and exacerbations that degrade their quality of life. According to the World Health Organization (WHO, 2024), COPD remains a significant global health concern and is predicted to become one of the leading causes of death worldwide. This project explores how an Evidence-Based Practice (EBP) model can be applied to improve the management of COPD within an inpatient pulmonary rehabilitation unit. These units care for individuals with advanced or frequently worsening COPD symptoms. Medical professionals, particularly prescribers, are essential in optimizing inhaler prescriptions, while nurses contribute by delivering educational interventions and ensuring patient adherence to treatment protocols.
Diagnosis-Related Concerns
COPD is a major contributor to global mortality, with 3.6 million deaths recorded in 2021, representing nearly 5% of all deaths globally. A significant number of COPD-related deaths among individuals under 70 years old occur in low- and middle-income countries (LMICs), while smoking remains a major risk factor in high-income regions (WHO, 2024). The clinical challenge lies in selecting the most effective inhaler therapy. A comparative analysis of Breztri Aerosphere (budesonide-glycopyrrolate-formoterol), administered twice daily, and Trelegy Ellipta (fluticasone-umeclidinium-vilanterol), taken once daily, highlights significant differences in outcomes. Breztri is associated with a heightened risk of exacerbations, while both inhalers pose similar pneumonia risks. Based on recent findings, Breztri may lead to more complications without delivering superior benefits, suggesting Trelegy as a safer alternative. These findings, supported by Feldman et al. (2024), emphasize the importance of adopting an EBP model that incorporates real-world data to personalize COPD treatments and enhance patient safety.
Evidence-Based Practice Model and Process Steps
The Iowa Model of Evidence-Based Practice serves as a practical framework to address recurrent COPD exacerbations by aligning clinical interventions with research evidence. This model guides clinicians in recognizing clinical concerns, forming interdisciplinary teams, reviewing relevant literature, piloting evidence-based changes, and evaluating outcomes (Dusin et al., 2023). The Iowa Model aligns seamlessly with the complexities of COPD care, offering structured steps for quality improvement.
The association between increased exacerbation risks and the use of Breztri was identified via clinical evaluations and patient health data. Recognizing this issue, a collaborative team—consisting of pulmonologists, respiratory therapists, pharmacists, and nurse practitioners—was formed to evaluate safer treatment options. Emphasis was placed on patient education and implementing individualized treatment regimens based on current best practices. According to Tandan et al. (2024), interdisciplinary collaboration leads to more consistent medication adherence and improved clinical results. A thorough review of peer-reviewed research informed the selection of interventions, including personalized inhaler instruction, adherence monitoring, and customized pharmacotherapy. A new-user cohort study was conducted to evaluate the clinical impact of switching from Breztri to Trelegy on exacerbation rates, symptom control, and medication persistence. Results supported integrating Trelegy into standard practice, alongside education and monitoring strategies guided by the Iowa Model.
Table 1
Implementation Steps of the Iowa Model in COPD Management
| Iowa Model Step | Action in COPD Project |
|---|---|
| Identify Trigger | Clinical observations linked Breztri with increased exacerbations. |
| Form a Team | Pulmonologists, pharmacists, respiratory therapists, and nurses collaborated to address inhaler safety. |
| Evidence Review | Literature review focusing on inhaler comparison and exacerbation risks. |
| Pilot Change | Introduced Trelegy as an alternative in a cohort of COPD patients. |
| Evaluate Outcomes | Monitored exacerbation rates, pneumonia incidence, and adherence metrics. |
| Implement Practice Change | Adopted Trelegy as standard therapy based on improved clinical outcomes. |
Model Application for Evidence Search
To explore the comparative efficacy of Breztri Aerosphere and Trelegy Ellipta, the Iowa Model was employed to conduct a focused inquiry. Initial triggers were based on longitudinal cohort data that demonstrated higher exacerbation risks without additional benefits from Breztri. A multidisciplinary team convened to construct a focused clinical question using the PICOT format: In COPD patients (P), how does Breztri Aerosphere (I) compare to Trelegy Ellipta (C) in affecting the frequency of exacerbations (O) over a six-month period (T)?
Following this, a systematic literature search was carried out through databases such as PubMed, CINAHL, and the Cochrane Library. Keywords included “COPD,” “triple inhaler therapy,” “Breztri Aerosphere,” “Trelegy Ellipta,” “COPD exacerbations,” and “pneumonia risk.” While the strategy yielded useful guidelines and reviews, some challenges arose. These included setting strict inclusion criteria to maintain research quality and ensuring that evidence was applicable to the COPD population under investigation (Howe, 2024).
Source Credibility and Relevance
Three major resources were deemed essential for guiding treatment decisions. The first study by Duan et al. (2023) examined the comparative performance of triple therapies and concluded that Trelegy outperformed Breztri in minimizing exacerbations and improving overall symptom control. The second article by Feldman et al. (2024), published in the British Medical Journal, provided robust real-world data indicating that Trelegy led to fewer complications compared to Breztri. Lastly, Wang and Lin (2024) analyzed both inhalers and reported that fluticasone (in Trelegy) offers superior symptom management, while budesonide (in Breztri) poses a lower pneumonia risk.
Each of these resources was evaluated using the CRAAP criteria, confirming their timeliness, relevance, and authority. Their peer-reviewed status and publication in reputable journals further validated their use in clinical decision-making. These studies directly contribute to improving COPD management, making them reliable and applicable for practice changes.
Conclusion
Utilizing the Iowa Model of EBP enables healthcare providers to address COPD exacerbations systematically and improve patient outcomes. The structured methodology of the model, paired with robust evidence, supports the recommendation of Trelegy Ellipta over Breztri Aerosphere. By integrating clinical data with evidence-based decision-making, healthcare teams can enhance treatment safety, reduce exacerbation rates, and increase adherence among COPD patients.
References
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
Dusin, J., Melanson, A., & Mische-Lawson, L. (2023). Evidence-based practice models and frameworks in the healthcare setting: A scoping review. British Medical Journal Open, 13(5). https://doi.org/10.1136/bmjopen-2022-071188
Capella 4025 Assessment 2
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
Feldman, W. B., Wang, S. V., & Kesselheim, A. S. (2025). Real-world evidence is a vital tool for informing treatment strategies in chronic obstructive pulmonary disease. BMJ, r427–r427. https://doi.org/10.1136/bmj.r427
Howe, R. (2024). LibGuides: Respiratory Care: Evidence-Based Practice: PICO. Libguides.uthscsa.edu. https://libguides.uthscsa.edu/c.php?g=625986\&p=4364976
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
Capella 4025 Assessment 2
Wang, M.-T., & Lin, C. W. (2024). Environmentally friendly inhaler regimens for COPD. BMJ, q2825. https://doi.org/10.1136/bmj.q2825
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)