Capella 4025 Assessment 2
Capella 4025 Assessment 2
Student 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 progressive respiratory illness that leads to the narrowing of airways and chronic respiratory issues such as persistent cough and difficulty breathing. As per the World Health Organization (WHO), COPD is a major global health concern and is projected to remain one of the top causes of morbidity and mortality worldwide (WHO, 2024). This evidence-based practice initiative is tailored for an inpatient pulmonary rehabilitation setting, where patients with recurrent or severe COPD exacerbations receive focused treatment. This EBP approach centers around prescribers, who manage inhaler therapy regimens, while nurses play a vital role in patient education and monitoring treatment adherence.
Issues Related to Diagnosis
COPD continues to be one of the leading causes of death globally, with over 3.6 million deaths recorded in 2021—accounting for approximately 5% of total global mortality. A significant number of deaths in those under 70 years occur in low- and middle-income countries (LMICs), while smoking remains the main contributing factor in high-income nations (WHO, 2024). A comparative clinical evaluation assessed the performance of Breztri Aerosphere (budesonide-glycopyrrolate-formoterol) versus Trelegy Ellipta (fluticasone-umeclidinium-vilanterol) in managing COPD symptoms. The findings revealed a greater exacerbation risk associated with Breztri, although both medications carried a comparable risk of pneumonia.
An evidence-based approach ensures that treatment aligns with the most current research, focusing on safety, efficacy, and minimizing complications. In their study, Feldman et al. (2024) found Breztri increased exacerbation risks without improving pneumonia outcomes, while Trelegy demonstrated better safety and effectiveness in managing exacerbations. Leveraging real-world data supports personalized inhaler therapy decisions that improve COPD outcomes (Feldman et al., 2025).
EBP Model and Steps Involved
The Iowa Model of Evidence-Based Practice provides a structured framework for addressing COPD-related complications. This model guides healthcare professionals in identifying clinical concerns, selecting evidence-based interventions, and evaluating results (Dusin et al., 2023). It incorporates institutional priorities and patient needs, making it highly relevant for resolving issues such as increased exacerbation risks linked to Breztri. The model advocates for teamwork, critical data analysis, and pilot testing changes in clinical routines.
Given COPD’s complex care demands, the Iowa Model facilitates long-term, evidence-informed improvements. Clinical assessments identified the frequent exacerbations tied to Breztri, prompting a multidisciplinary team—including pulmonologists, pharmacists, respiratory therapists, and nurse practitioners—to explore alternative inhaler options. Evidence suggests that collaborative interventions improve medication adherence, reduce exacerbations, and support individualized care plans (Tandan et al., 2024).
Following a thorough literature review on inhaler effectiveness, patient adherence strategies, and exacerbation prevention, three key interventions were implemented: patient-specific inhaler education, adherence tracking, and tailored pharmacological plans. A new-user cohort study compared Breztri and Trelegy outcomes over time, focusing on exacerbation frequency, symptom control, and medication persistence. Due to favorable results with Trelegy, this new treatment plan was adopted, with continued provider education and outcome monitoring, demonstrating the Iowa Model’s value in guiding systematic, team-based care enhancements.
| Key Interventions | Outcomes Measured |
|---|---|
| Personalized inhaler education | Symptom control improvement |
| Medication adherence monitoring | Reduction in COPD exacerbation rates |
| Tailored pharmacologic therapy (switch to Trelegy) | Decreased hospitalizations and improved treatment persistence |
Evidence Search Using the Iowa Model
The Iowa Model was employed to assess the comparative effectiveness of Breztri Aerosphere and Trelegy Ellipta in reducing COPD flare-ups. Real-world evidence was sourced from a longitudinal new-user cohort using U.S. commercial claims data, which revealed Breztri’s lack of advantage over Trelegy in managing exacerbations. These insights prompted the formation of a multidisciplinary team to investigate intervention alternatives.
Using the PICOT framework, the research question was formulated as follows: In patients with COPD (P), how does Breztri Aerosphere (I), compared to Trelegy Ellipta (C), influence the rate of COPD exacerbations (O) over six months (T)? This structured approach facilitated a comprehensive literature review utilizing databases like PubMed, CINAHL, and the Cochrane Library. Keywords included “COPD,” “Single Inhaler Triple Therapy,” “Budesonide-Glycopyrrolate-Formoterol,” and “pneumonia risk.” The search encountered obstacles such as ensuring study relevance and verifying quality based on rigorous criteria.
| Database | Search Terms | Challenges |
|---|---|---|
| PubMed, CINAHL, Cochrane | “COPD,” “SITT,” “Breztri,” “Trelegy,” “exacerbation,” “pneumonia risk” | Ensuring population relevance, applying quality standards |
Credibility and Relevance of Selected Resources
Three highly credible resources supported the EBP intervention. Duan et al. (2023) demonstrated that Trelegy Ellipta, as part of triple therapy, leads to fewer exacerbations and better symptom control than Breztri. Feldman et al. (2024) offered real-world evidence, confirming Breztri’s higher risk profile without added pneumonia benefit. Published in the peer-reviewed BMJ, the study’s reliability is bolstered by high-impact factor credentials and real-world applicability. Lastly, Wang and Lin (2024) investigated the safety of inhaler regimens and concluded that fluticasone provides superior symptom control, while budesonide carries a lower pneumonia risk. Each study met the CRAAP criteria (Currency, Relevance, Authority, Accuracy, and Purpose), strengthening the foundation for clinical decision-making.
| Study | Key Findings | Evaluation |
|---|---|---|
| Duan et al. (2023) | Trelegy Ellipta more effective than Breztri in reducing COPD symptoms and exacerbations | High-quality, peer-reviewed |
| Feldman et al. (2024) | Breztri linked to increased exacerbations; pneumonia risk comparable | Real-world data, BMJ-published |
| Wang & Lin (2024) | Fluticasone better for symptoms, budesonide safer for pneumonia | Balanced safety/efficacy |
Conclusion
The Iowa Model of Evidence-Based Practice offers a systematic way to address complications associated with COPD management. This review reinforces the need for inhaler choices that reflect current research. Evidence indicates that Trelegy Ellipta is more effective than Breztri Aerosphere in reducing exacerbation rates, enhancing symptom relief, and promoting treatment adherence. Incorporating this evidence into daily practice through structured models and multidisciplinary collaboration ensures improved patient outcomes.
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
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 Organization. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)