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 to COPD Management
Evidence-based practice (EBP) can help healthcare professionals improve chronic obstructive pulmonary disease (COPD) management by combining current research, clinical expertise, and patient-specific needs. In an inpatient pulmonary rehabilitation setting, the Iowa Model of Evidence-Based Practice provides a structured approach for evaluating COPD treatment concerns, comparing inhaler therapies, implementing appropriate interventions, and monitoring patient outcomes. Current evidence comparing Breztri Aerosphere (budesonide-glycopyrrolate-formoterol) with Trelegy Ellipta (fluticasone-umeclidinium-vilanterol) can be incorporated into this process to support informed decisions about exacerbation prevention, symptom management, adherence, and treatment safety.
COPD is a progressive respiratory condition characterized by persistent respiratory symptoms and airflow limitation. Common symptoms include chronic cough, sputum production, wheezing, and shortness of breath. The World Health Organization (WHO, 2024) identifies COPD as a major global health concern and reports that it remains a significant cause of illness and death worldwide.
In an inpatient pulmonary rehabilitation environment, patients with severe or recurrent exacerbations require coordinated management. Prescribers oversee pharmacological treatment and inhaler selection, while nurses contribute through patient education, symptom assessment, adherence monitoring, and evaluation of treatment responses. Applying an EBP model helps these professionals use research findings systematically rather than relying solely on routine practice.
Clinical Issues Related to COPD Diagnosis and Treatment
COPD is associated with substantial morbidity and mortality worldwide. The WHO (2024) reported more than 3.6 million COPD-related deaths in 2021, representing approximately 5% of all deaths globally. The burden is particularly significant in low- and middle-income countries, where many COPD-related deaths occur before age 70. Smoking is an important risk factor, particularly in high-income countries, although COPD can also result from exposure to air pollution, occupational hazards, and other environmental factors.
Medication selection is an important component of COPD management because inhaled therapies are used to control symptoms and reduce exacerbations. Single-inhaler triple therapies combine an inhaled corticosteroid (ICS), a long-acting muscarinic antagonist (LAMA), and a long-acting beta-2 agonist (LABA).
Breztri Aerosphere contains budesonide, glycopyrrolate, and formoterol, whereas Trelegy Ellipta contains fluticasone furoate, umeclidinium, and vilanterol. Comparative research has examined whether differences between these therapies affect exacerbation rates, pneumonia risk, symptoms, and other clinical outcomes.
Feldman et al. (2024) evaluated these single-inhaler triple therapies using real-world new-user cohort data. Their findings indicated differences in exacerbation outcomes between the therapies, while pneumonia risk was not substantially different. Such evidence is relevant to EBP because treatment decisions should consider both effectiveness and potential adverse outcomes.
Real-world evidence can complement randomized clinical trials by providing information about how treatments perform among broader patient populations in routine clinical practice. Feldman et al. (2025) emphasized the value of real-world evidence in informing COPD treatment strategies and supporting more individualized clinical decision-making.
The Iowa Model of Evidence-Based Practice
The Iowa Model of Evidence-Based Practice is a framework that helps healthcare organizations identify clinical problems, evaluate evidence, implement changes, and determine whether those changes improve outcomes. Dusin et al. (2023) identified evidence-based practice models as useful frameworks for translating research findings into healthcare practice.
The Iowa Model is particularly applicable to COPD management because COPD care involves multiple clinical decisions, including medication selection, inhaler technique, adherence, exacerbation prevention, patient education, and follow-up monitoring. The model encourages healthcare professionals to consider both organizational priorities and patient needs while evaluating evidence.
A COPD-related concern, such as recurrent exacerbations despite existing inhaler therapy, can serve as the clinical trigger for an EBP project. The healthcare team can then determine whether sufficient evidence exists to support a practice change. If the evidence supports a change, the intervention can be tested and monitored before being incorporated into routine practice.
Applying the Iowa Model to COPD Care
The first step is to identify the clinical problem. In this case, recurrent COPD exacerbations and differences in outcomes associated with single-inhaler triple therapies provide a reason to examine whether the current treatment approach should be modified.
The next step involves assembling a multidisciplinary team. Depending on the clinical setting, the team may include pulmonologists, nurse practitioners, registered nurses, pharmacists, respiratory therapists, and other healthcare professionals. Collaboration is important because COPD treatment requires attention to medication selection, inhaler technique, adherence, symptom monitoring, and patient education.
Research suggests that effective teamwork can contribute to improved outcomes in chronic disease management. Tandan et al. (2024), for example, examined the relationship between teamwork and clinical outcomes in chronic disease care and highlighted the importance of collaborative approaches.
After identifying the problem and establishing the team, healthcare professionals conduct a focused evidence search. The evidence is then critically evaluated to determine whether it is current, relevant, credible, and applicable to the patient population.
Evidence-Based Interventions for COPD Management
The literature review can inform several interventions designed to improve COPD outcomes. These interventions should address not only the medication prescribed but also the patient’s ability and willingness to use the therapy correctly.
Personalized inhaler education is an important intervention because incorrect inhaler technique can reduce medication delivery and limit treatment effectiveness. Nurses and respiratory therapists can demonstrate proper technique, observe patients using their devices, and provide corrective instruction when necessary.
Medication adherence monitoring can also help identify barriers to consistent treatment. Healthcare professionals can review medication-taking patterns, assess patient understanding, identify adverse effects, and discuss practical barriers that may interfere with adherence.
Pharmacological therapy should be individualized according to the patient’s clinical condition, treatment history, symptoms, exacerbation risk, and potential adverse effects. Comparative evidence regarding Breztri and Trelegy can be considered alongside the patient’s overall clinical profile rather than being used as the sole determinant of treatment selection.
| Intervention | Outcome to Monitor |
|---|---|
| Personalized inhaler education | Improved inhaler technique and symptom control |
| Medication adherence monitoring | Improved treatment persistence and reduced exacerbations |
| Individualized pharmacological therapy | Changes in symptoms, exacerbations, and hospitalizations |
| Ongoing clinical monitoring | Identification of adverse effects and treatment response |
Developing the PICOT Question
The PICOT framework provides a focused method for developing an evidence-based clinical question. For this COPD project, the question can be structured around the patient population, intervention, comparison, outcome, and time frame.
PICOT question: In patients with COPD (P), how does Breztri Aerosphere (I), compared with Trelegy Ellipta (C), influence the rate of COPD exacerbations (O) over six months (T)?
A clearly defined PICOT question helps narrow the literature search and ensures that the selected evidence directly addresses the clinical problem. It also makes it easier for the healthcare team to identify studies that evaluate comparable patient populations, treatments, and outcomes.
Conducting the Evidence Search
A comprehensive literature search can be conducted using databases such as PubMed, CINAHL, and the Cochrane Library. Search terms should reflect the major components of the clinical question, including COPD, single-inhaler triple therapy, Breztri, Trelegy, exacerbations, and pneumonia risk.
Researchers should evaluate studies based on their relevance to the clinical question, methodological quality, patient population, publication date, and applicability to clinical practice. One challenge in evidence retrieval is distinguishing studies that directly answer the PICOT question from those that address related but different aspects of COPD treatment.
| Database | Example Search Terms | Primary Considerations |
|---|---|---|
| PubMed | COPD, Breztri, Trelegy, triple therapy, exacerbation | Study relevance and methodological quality |
| CINAHL | COPD, inhaler therapy, medication adherence | Nursing and clinical applicability |
| Cochrane Library | COPD, triple inhaler therapy, exacerbation | Systematic reviews and high-level evidence |
Evaluating the Credibility of Evidence
Before applying research findings to practice, healthcare professionals should evaluate the credibility and relevance of each source. The CRAAP framework considers Currency, Relevance, Authority, Accuracy, and Purpose. These criteria can help determine whether a study provides sufficiently reliable evidence for clinical decision-making.
Duan et al. (2023) reviewed pharmacological approaches for stable COPD and provided information relevant to inhaled treatment strategies. Feldman et al. (2024) contributed real-world comparative evidence concerning single-inhaler triple therapies. Wang and Lin (2024) examined inhaler regimens in the context of COPD treatment and environmental considerations while discussing differences between inhaled corticosteroid options.
The evidence should be interpreted collectively rather than relying on a single study. Differences in study design, patient populations, treatment characteristics, and measured outcomes can influence findings. Clinical decisions should therefore integrate research evidence with patient preferences, clinical expertise, and individual risk factors.
Implementing and Evaluating the Practice Change
Once the evidence has been critically appraised, the healthcare team can determine whether a practice change is appropriate. If a change in inhaler therapy is selected, implementation should include provider education, patient-specific counseling, inhaler-technique assessment, and adherence monitoring.
Outcome measurement is essential because implementation alone does not demonstrate that an intervention has improved care. Relevant measures may include COPD exacerbation frequency, emergency department visits, hospitalizations, symptom control, medication persistence, inhaler technique, and adverse events.
The Iowa Model supports this iterative approach by encouraging healthcare teams to implement evidence-informed changes and evaluate whether the desired outcomes are achieved. If outcomes improve, the intervention may be incorporated into routine practice. If expected improvements are not observed, the team can reassess the evidence, identify barriers, and modify the intervention.
Role of Nurses in Evidence-Based COPD Management
Nurses have an important role throughout the EBP process. Although prescribers generally make medication decisions, nurses frequently have direct and repeated interactions with patients. This places nurses in a strong position to identify problems with adherence, inhaler technique, symptom control, and understanding of the treatment plan.
Patient education should be individualized and understandable. Nurses can explain why medications are prescribed, demonstrate correct inhaler use, reinforce adherence, and encourage patients to report worsening symptoms or adverse effects. Nurses can also communicate observations to prescribers and other members of the interdisciplinary team.
This collaborative role connects evidence-based research with day-to-day patient care and supports continuity across the inpatient and outpatient settings.
Conclusion
Applying the Iowa Model of Evidence-Based Practice provides a systematic approach to improving COPD management in an inpatient pulmonary rehabilitation setting. The model helps healthcare professionals identify clinical concerns, formulate focused questions, search and appraise research, implement evidence-informed interventions, and evaluate patient outcomes.
Evidence comparing Breztri Aerosphere and Trelegy Ellipta provides a basis for examining differences in COPD exacerbation outcomes and treatment safety. However, inhaler selection should be individualized and informed by current evidence, clinical judgment, patient characteristics, treatment response, and adherence considerations. Combining personalized inhaler education, adherence monitoring, multidisciplinary collaboration, and ongoing outcome evaluation can support a more consistent and evidence-informed approach to COPD care.
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. BMJ Open, 13(5), e071188. 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. BMJ, 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. https://doi.org/10.1136/bmj.r427
Howe, R. (2024). Evidence-based practice: PICO. University of Texas Health Science Center at San Antonio Libraries. 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. https://doi.org/10.1136/bmj.q2825
World Health Organization. (2024, November 6). Chronic obstructive pulmonary disease (COPD). https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
