Randomized controlled trial of a breath-activated nebulizer in patients with exacerbation of COPD.

BACKGROUND Exacerbations of COPD (ECOPD) are characterized by increased dyspnea due to dynamic pulmonary hyperinflation. This study sought to determine whether the AeroEclipse II breath-activated nebulizer (BAN) would produce greater bronchodilator responses than a continuous flow small-volume nebulizer (SVN) in patients with ECOPD. METHODS Prospective randomized controlled trial. Forty patients with ECOPD were recruited to participate in the trial. The primary study outcomes were inspiratory capacity (IC) and dyspnea via the Borg scale. Subjects were randomized to receive bronchodilator from either a BAN or a continuous flow SVN. Subjects in both groups received 2.5 mg albuterol sulfate and 0.5 mg ipratropium bromide by nebulizer every 4 hours, and 2.5 mg albuterol every 2 hours as needed. Approximately 2 hours after the subject's 6th scheduled nebulizer treatment, IC, dyspnea, and respiratory frequency measurements were repeated. RESULTS Both groups received an equal number of nebulizer treatments over the study period (BAN 6.25 ± 0.55, control 6.2 ± 0.7, P = .80). Following completion of the study protocol the BAN group had a higher IC than the SVN group (1.83 ± 0.65 L vs 1.42 ± 0.49 L, P = .03, respectively). The change in IC was higher in the BAN group (0.33 ± 0.31 L than in the SVN group (0.15 ± 0.19 L, P = .03). The BAN group also had a lower respiratory rate (19 ± 3.3 breaths/min vs 22 ± 5.3 breaths/min, P = .03, respectively). There was no difference in resting dyspnea as measured with the Borg scale (BAN 3.3 ± 2.1, SVN 3.5 ± 2.4, P = .69) or stay (BAN 4.6 ± 2.6 d, SVN 5.7 ± 2.8 d, P = .21). CONCLUSIONS In this cohort of patients with ECOPD, a BAN was more effective in reducing lung hyperinflation and respiratory frequency than a continuous-flow SVN.