Chest
Volume 96, Issue 6, December 1989, Pages 1241-1246
Journal home page for Chest

Clinical Investigations
Nebulizer vs Spacer for Bronchodilator Delivery in Patients Hospitalized for Acute Exacerbations of COPD

https://doi.org/10.1378/chest.96.6.1241Get rights and content

This double-blind crossover study compared the efficacy of two methods of delivery (MDI-spacer and nebulizer) of inhaled albuterol to patients hospitalized for an acute exacerbation of COPD. Within 24 h of admission, 20 subjects (mean age, 69 years) with severe airflow obstruction (mean FEV1, 0.69 L) were subjected to a treatment with an MDI-spacer (0.36 mg of albuterol or placebo) followed by treatment with a nebulizer (2.5 mg of albuterol or placebo). Active drug was given by only one device (randomly assigned in a double-blind manner), and the entire sequence was repeated in 4 h, with active drug given in the alternate device. Spirometric data and the Borg dyspnea score were obtained before and 1 h after each sequence of treatments. Treatment resulted in significant improvements in the FEV1, FVC, and Borg score. The percent improvement in the FEV1 was slightly larger after treatment with the nebulizer (16.7 percent vs 13.4 percent). Improvements in the Borg score were slightly larger after treatment with the MDI-spacer (−1.08 vs −0.73). However, these differences were not statistically significant. This study suggests that the MDI-spacer system is an effective method of sympathomimetic delivery in this setting, provided patients are able to master the technique.

Section snippets

Subjects

Twenty patients admitted through the emergency room to medical wards for an acute exacerbation of COPD were studied. One additional subject was recruited for the study but was excluded when he was unable to perform adequate spirometry. All patients had a long history of chronic airflow obstruction and cigarette smoking. Patients with acute respiratory acidosis (pH<7.30) were excluded. Subjects were studied within 24 h of admission to the hospital. The project was approved by our institutional

Results

The 20 male patients participating in the study had an age range of 60 to 91 years, with a mean of 67.9±7.1 years. Their spirometry on admission showed an FEV1 of 0.71±0.26 L, an FVC of 1.77±0.52 L, and an FEV1/FVC ratio of a 0.41±0.11. Thus, the patients were quite elderly and had severe airflow obstruction. The arterial blood gas levels for the group were pH of 7.42±0.03, PaCO2 of 40±9 mm Hg, and PaO2 of 68±9 mm Hg. While of four of the 20 patients had a PaCO2 greater than 45 mm Hg, all of

Discussion

Many patients have difficulty employing the proper technique for using MDIs.8,9 Spacer/reservoir systems circumvent some of these difficulties. With proper use of MDIs, a much smaller dose of drug than that administered by nebulizer is equipotent for bronchodilation. However, patients with acute exacerbations of COPD are frequently tachypneic, and this makes optimal use of MDIs difficult. For this reason, many physicians have used nebulizers to deliver sympathomimetic medication in this setting.

ACKNOWLEDGMENTS

We thank Dr. David L. McArthur, who assisted with the statistical analysis, and Ms. Claudia Fischer, who helped collect the data.

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Supported in part by a grant from the Schering Corp. and the VA Research Service.

Schering Pharmaceutical supplied the InspirEase spacers, the active and placebo metered-dose inhalers, and albuterol solution.

Manuscript received January 9; revision accepted March 23.

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