Chest
Clinical InvestigationsNebulizer vs Spacer for Bronchodilator Delivery in Patients Hospitalized for Acute Exacerbations of COPD
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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Cited by (64)
Which inhaled pharmacological treatments for COPD acute exacerbations in hospital?
2017, Revue des Maladies RespiratoiresChronic Obstructive Pulmonary Disease
2008, Critical Care Medicine: Principles of Diagnosis and Management in the AdultUse of wet nebulized inhaled respiratory medications under criteria-based reimbursement guidelines in a publicly funded seniors' pharmacare program in Nova Scotia, Canada
2007, American Journal Geriatric PharmacotherapyThe use of bronchodilators in the treatment of airway obstruction in elderly patients
2006, Pulmonary Pharmacology and TherapeuticsDevice selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology
2005, ChestCitation Excerpt :These studies reported no significant differences in pulmonary function between nebulizers and MDIs with spacer/holding chambers (Fig 5). One study62 compared MDI used alone with DPI use and also found no significant difference in peak expiratory flow rate (PEFR). However, as the deposition efficiency of the DPI tested was approximately half that of the MDI tested, the authors elected to compare DPI doses that were twice that for the MDI, with the intent of producing equal responses.
Pharmacologic therapy for acute exacerbations of chronic obstructive pulmonary disease: A review
2004, Critical Care Nursing Clinics of North AmericaCitation Excerpt :All published COPD guidelines [2–5,8,9] support inhaled bronchodilator therapy as the preferred route of administration. The published guidelines [2–5,8,9] (see Table 1), several trials [34–38], and a meta-analysis [39] (including trials referenced separately in this review article) support equivalent efficacy for MDI used in conjunction with spacer devices versus nebulized therapy, as long as the patients' clinical status permits appropriate use of MDI with a spacer. Mechanically ventilated patients were not included in these studies.
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.