No data exists on use of continuously nebulized bronchodilators in COPD exacerbation. We investigated the outcome of continuously versus intermittently nebulized albuterol in the treatment of these patients.
Experimental, randomized, prospective, two-group study. 15 patients admitted with COPD exacerbation were enrolled in the study. 7 patients were randomized to the intermittent and 8 to the continuous group. Patients received either nebulized albuterol 2.5mg every 4 hours or continuously nebulized albuterol at 5mg /hr for 4 hours followed by 2.5mg intermittently every 4 hours in addition to standard therapy for COPD exacerbation. Patients had baseline bedside spirometry, notation of heart rate, blood pressure, oxygen saturation and amount of oxygen supplementation required. Data were collected again at 4 hours, day 2 and day 3.
Data were analyzed using a 2-tail T-test; 95% confidence intervals were also calculated. There was no statistically significant difference between the groups regarding baseline FVC, FEV1 and absolute/percent change of FEV1 at 4 hours. The difference in the change of FVC at 4 hours approached statistical significance: 0.25L ± 0.21L (intermittent) and –0.013L ± 0.28L (continuous); P-value 0.060. Percent change in FVC at 4 hours was statistically greater in the intermittent (21.22% ± 30.73) as compared to continuous group (–0.85% ± 73.38); P-value 0.043. The difference in the absolute change of FVC on day 2 approached statistical significance: 0.45L ± 0.33L (intermittent) and 0.02L ± 0.42L (continuous); P-value 0.051.
The percentage change of FVC at 4 hours was better in the intermittent group. There was also a trend towards a better improvement of absolute FVC in the intermittent group at 4 hours and on day 2. This suggests a possible decrease in air trapping in this group.
Treating COPD exacerbation with continuous albuterol nebulization was not superior to the standard treatment.
I.D. Wollak, None.