Capella FPX 4025 Assessment 2

Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Applying an EBP Model

Chronic Obstructive Pulmonary Disease (COPD) is a long-lasting illness that narrows the airways. It can cause long-term complications, including shortness of breath. The patient suffers from a chronic cough and frequent respiratory exacerbations. The World Health Organization (WHO) reports that COPD is a worldwide health problem. Statistics project it as a leading cause of illness and mortality (WHO, 2024).

This article examines how an Evidence-Based Practice (EBP) approach can address a critical aspect of COPD treatment. It highlights its role in enhancing patient outcomes through evidence-based clinical decision-making. This EBP project is intended for an inpatient pulmonary rehabilitation unit where patients with recurrent or severe COPD exacerbations undergo intensive therapy. The interventions primarily focus on prescribers. They determine the inhaler treatments and optimize treatment regimens. Nursing professionals are responsible for providing patient education and monitoring adherence.

Issue Associated with the Diagnosis

COPD is the main reason of demise globally. It resulted in 3.6 million deaths in 2021, accounting for almost 5% of all worldwide mortality. A majority of those aged under 70 who die with COPD are from low- and middle-income countries (LMICs). More than 70% of COPD deaths in developed countries are due to smoking (WHO, 2024). A comparative analysis evaluated the efficacy and safety of Breztri Aerosphere (budesonide-glycopyrrolate-formoterol), a twice-daily metered-dose inhaler, and Trelegy Ellipta (fluticasone-umeclidinium-vilanterol), a once-daily dry-powder inhaler, in patients with COPD treated in routine clinical practice. The research highlights the dilemma of selecting an effective inhaler for patients with COPD.

Breztri Aerosphere raises exacerbation rates. Both inhalers pose an equal threat of pneumonia. It is an important safety factor for patients with COPD. Integrating an EBP framework safeguards that treatment decisions reflect the latest research. It optimizes safety and outcomes while minimizing risks. Feldman et al. (2024) compared the efficacy and safety of Breztri with Trelegy Ellipta in patients with COPD. Breztri was linked with a greater risk of COPD complications but showed no difference in pneumonia risk. It is given a higher risk of exacerbation and environmental impact. Trelegy Ellipta is beneficial as it reduces the risk of COPD exacerbations without increasing the risk of pneumonia. An EBP ensures they receive a safer inhaler, reducing COPD exacerbations. Real-world data analysis enables the personalization of treatment decisions. It is leading to improved outcomes (Feldman et al., 2025).

EBP Model and Its Steps

The Iowa Model of EBP offers a systematic approach to managing recurrent COPD exacerbations. The framework empowers staff with a process for identifying clinical problems. It chooses interventions based on solid research and evaluates their effectiveness (Dusin et al., 2023). By integrating research findings with organizational priorities and patient care, the Iowa Model safeguards that clinical choices align with current evidence. It is well-suited to address the increased risk of exacerbation associated with Breztri. It creates change by identifying a particular issue. The model encourages building a team. It involves gathering and analyzing relevant data, piloting practice changes and evaluating the outcomes of those changes. With the complex nature of COPD care, the Iowa Model serves as a guide for addressing clinical issues and driving long-term practice advancement. Its stepwise nature allows for the integration of EBP. It enables sustained improvement in patient care.

The link between frequent COPD exacerbations and budesonide-glycopyrrolate-formoterol was identified through clinical assessment and patient data analysis. Findings revealed that Breztri was associated with a higher rate of flare-ups without offering any advantages over Trelegy. To resolve this dilemma, an interdisciplinary team comprising pulmonologists, respiratory therapists, pharmacists, and nurse practitioners was formed to explore alternative therapeutic modalities. It is designed to support patient education and institute evidence-based interventions to facilitate better management of COPD.

Literature highlights the effectiveness of working teams in minimizing exacerbations, enhancing medication compliance, and developing individualized therapy plans based on current clinical recommendations (Tandan et al., 2024). A comprehensive critical assessment of peer-reviewed literature was done. It addresses comparative effectiveness of inhaler therapy, strategies to prevent COPD exacerbations and ways to improve patient adherence. The most important interventions were chosen, and these are individualized inhaler instruction, tracking of adherence and tailored pharmacologic therapy.

A real-world, quantitative study employing a new-user cohort design was initiated in patients with COPD to assess the effect of switching from Breztri to Trelegy Ellipta on the rate of exacerbations, symptom improvement, and drug persistence. Patient outcomes were monitored through exacerbation rates, hospitalization due to pneumonia during treatment and treatment adherence to determine real-world efficacy between Breztri Aerosphere and Trelegy Ellipta. Since the cohort study yielded positive results, the new care strategy was incorporated into routine clinical practice, accompanied by monitoring and provider education to ensure its ongoing success. The Iowa Model was an ideal framework for this endeavor. It provides a structured approach to managing COPD exacerbations, fostering interdisciplinary collaboration and optimizing care strategies.

Application of the Model to Evidence Search

The Iowa Model outline was utilized to investigate the relative efficacy of Breztri Aerosphere and Trelegy Ellipta in minimizing COPD exacerbations. It enhances symptom management and improves patient adherence. The issue-driven trigger emerged through an analysis of clinical outcomes in a new-user cohort investigation leveraging longitudinal commercial US claims data. This evaluation showed that Breztri Aerosphere and Trelegy Ellipta were associated with an increased risk of COPD exacerbations, without demonstrating greater efficacy than Trelegy Ellipta.

It indicates the need for EBP prescribing practices. In response to this issue, a multidisciplinary team was convened to assess intervention strategies. The PICOT (Patient, Intervention, Comparison, Outcome) format was utilized to create a defined research question. In patients with COPD (P), how does Breztri Aerosphere (I), compared to Trelegy Ellipta (C), affect COPD exacerbation frequency (O) over six months (T)? The mnemonic device facilitates the modification of targeted research questions and guides systematic evidence searches by identifying key components (Howe et al., 2024).

A literature examination was conducted using records such as PubMed, CINAHL, and the Cochrane Library. The exploration strategy integrated specific expressions. It includes “COPD,” “Single Inhaler Triple Therapy (SITT),” “Budesonide-Glycopyrrolate-Formoterol,” “Fluticasone-Umeclidinium-Vilanterol,” “COPD Exacerbation,” and “pneumonia risk.” This methodical approach led to the identification of quality clinical practice guidelines and systematic reviews. However, several challenges emerged during the search process. Two primary obstacles involved establishing rigorous quality control criteria for study selection and ensuring that the retrieved evidence applied to COPD patient populations.

Credibility and Relevance of Resources

Three key resources were identified to support evidence-based decision-making: peer-reviewed comparative studies on Breztri Aerosphere and Trelegy Ellipta as well as clinical guidelines for managing COPD. Duan et al. (2023) explore and compare the efficacy of Breztri Aerosphere with triple therapy using Trelegy Ellipta in the treatment of COPD. The FULFIL trial found that triple therapy reduces moderate to severe exacerbations, delays lung function decline and improves symptoms of COPD compared to Breztri Aerosphere therapy. Trelegy Ellipta provides better clinical outcomes than Breztri Aerosphere. The second study, by Feldman et al. (2024), compared the efficacy and safety of Breztri with those of Trelegy Ellipta in patients with COPD.

Breztri was linked with a greater hazard of COPD complications but showed no difference in pneumonia risk, given its higher risk of exacerbation. The study’s credibility is strengthened, as it is published in the British Medical Journal (BMJ), a peer-reviewed, high-impact journal. Its use of real-world clinical data enhances generalizability. It makes it highly applicable to everyday practice. The last study by Wang and Lin (2024), examine Breztri Aerosphere and Trelegy Ellipta in triple therapy for COPD, focusing on exacerbation reduction, pneumonia risk, and clinical outcomes. Budesonide is associated with a lower risk of pneumonia, while fluticasone provides slightly better symptom control.

Budesonide can be safer in terms of pneumonia risk, whereas fluticasone offers better symptom relief. Each resource was critically assessed using the CRAAP criteria (Currency, Relevance, Authority, Accuracy, and Purpose) to guarantee validity. All studies were recent, peer-reviewed and published by authoritative sources. It enhances their reliability. Their direct focus on COPD exacerbation care made them superior to lower-tier evidence. It reinforces the team’s role in guiding clinical decision-making.

Conclusion

The Iowa Model of EBP provides a framework for addressing COPD exacerbations by integrating research findings into clinical decision-making. This paper highlights the importance of selecting appropriate inhaler therapy based on evidence. It demonstrates that Trelegy Ellipta offers superior outcomes compared to Breztri Aerosphere in reducing the frequency of exacerbations. It improves symptom control and enhances patient adherence.

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

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

Capella FPX 4025 Assessment 2

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

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)