Comparison of Outpatient Nebulized vs Metered Dose Inhaler Terbutaline in Chronic Airflow Obstruction

Mestitz, Hugh; Copland, Janet M; McDonald, Christine F

doi:10.1378/chest.96.6.1237

Cited by 66 publications

(14 citation statements)

References 10 publications

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“…Because the two treatment regimes consisted of two components, steroids and bronchodilators, only conclusions on treatment as a whole can be drawn, disregarding which specific variable played a significant role in the observed changes. However, meta-analysis by TURNER et al [9] and numerous other trials have shown that the different modes of administration of bronchodilators in the treatment of stable [10][11][12] and acute [9] COPD in in-and outpatient settings are associated with comparable therapeutic outcomes. To date, no trials have sufficiently evaluated the dose-response relationship to short-acting b 2 -agonists in COPD exacerbations, or the comparison of salbutamol versus fenoterol as agents for bronchodilation.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis by TURNER et al [9] and numerous other trials have shown the two devices to be equally effective in the treatment of stable [1][2][3][4][5][6][7][8][9][10][11][12] and acute [9] COPD in inand outpatient settings. No difference was reported in the effect of bronchodilation, in pulmonary function tests (PFTs), exercise performance, symptom scores or extra b 2 -agonist use.…”

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confidence: 99%

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What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations?

Willaert¹,

Daenen²,

Bomans³

et al. 2002

Eur Respir J

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What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations? W. Willaert, M. Daenen, P. Bomans, G. Verleden, M. Decramer. #ERS Journals Ltd 2002. ABSTRACT: The present study aims to determine whether treating chronic obstructive pulmonary disease (COPD) exacerbations with intravenous steroids and aerosol bronchodilators (group I) is superior to oral steroids and multiple dose inhaler (MDI) bronchodilators with a spacer (group II).Group I received 40 mg methylprednisolone?day -1 intravenously with a decrease to 20 mg after 10 days and a further decrease of 4 mg?4 days -1 . Aerosol therapy consisted of 10 mg salbutamol and 1 mg ipratropiumbromide?day -1 . Group II received 32 mg methylprednisolone orally for 1 week followed by 24 mg?day -1 for 4 days and a subsequent decrease of 4 mg?week -1 . Duovent1 MDI with a spacer was given at a dose of 1.6 mg fenoterol and 640 mg ipratropiumbromide?day -1 . In group I (n=19) forced expiratory volume in one second (FEV1) rose from 0.82¡0.46 to 0.91¡0.47 L and average dyspnoea decreased from 6.0¡1.9 to 4.1¡2.6 within 10 days. The Chronic Respiratory Disease Index Questionnaire (CRQ) score increased from 78¡24 to 90¡24 points after 4 weeks. In group II (n=18) FEV1 increased from 0.70¡0.27 to 0.90¡0.29 L, dyspnoea regressed from 6.2¡2.4 to 2.7¡2.6 and CRQ from 67¡17 to 86¡20. Both groups showed similar results in dropout rate, length of hospital stay and patient satisfaction.In conclusion, the two treatment strategies appear equally effective in treating chronic obstructive pulmonary disease exacerbations, although oral steroids and metered dose inhaler bronchodilators appear associated with a higher risk of hospital re-admission. [8]. Notwithstanding the increase in the number of trials in the last decade evaluating the effect of steroids in COPD, little research has been done to compare orally to intravenously administered steroids when treating an exacerbation in casualty or in patients admitted to hospital.More attention has been given to comparing wet nebulizers to metered dose inhaler (MDI) as a device for bronchodilator delivery in COPD. A meta-analysis by TURNER et al. [9] and numerous other trials have shown the two devices to be equally effective in the treatment of stable [1][2][3][4][5][6][7][8][9][10][11][12] and acute [9] COPD in inand outpatient settings. No difference was reported in the effect of bronchodilation, in pulmonary function tests (PFTs), exercise performance, symptom scores or extra b 2 -agonist use. The degree of bronchodilation was considered to be a reflection of the administered dose rather than the mode of administration.There is no consensus on the optimal route of administration for steroids and the device for bronchodilators. Therefore, a prospective, randomized, controlled trial was conducted to investigate the hypothesis that treatment of COPD exacerbations with oral corticosteroids and MDI bronchodilators, compared to intravenous corticosteroids and aerosol bronchodilators, would not result in different ...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations?

Willaert¹,

Daenen²,

Bomans³

et al. 2002

Eur Respir J

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“…However, several studies have demonstrated similar efficacy for inhaled bronchodilators using pMDIs with spacers (pMDIs alone are not as effective), compared with nebulisers in emergency rooms in patients with non-life-threatening asthma and in patients with COPD with non-severe exacerbations [103][104][105][106][107][108]. To more closely match the dose administered by nebulisation, the number of puffs from the pMDI should be increased to between four and 10 puffs in the emergency room setting [104].…”

Section: Choice Of Drug-device Combinations To Use In the Emergency Rmentioning

confidence: 99%

What the pulmonary specialist should know about the new inhalation therapies

et al. 2011

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A collaboration of multidisciplinary experts on the delivery of pharmaceutical aerosols was facilitated by the European Respiratory Society (ERS) and the International Society for Aerosols in Medicine (ISAM), in order to draw up a consensus statement with clear, up-to-date recommendations that enable the pulmonary physician to choose the type of aerosol delivery device that is most suitable for their patient. The focus of the consensus statement is the patientuse aspect of the aerosol delivery devices that are currently available.The subject was divided into different topics, which were in turn assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. To achieve consensus, draft reports and recommendations were reviewed and voted on by the entire panel.Specific recommendations for use of the devices can be found throughout the statement. Healthcare providers should ensure that their patients can and will use these devices correctly. This requires that the clinician: is aware of the devices that are currently available to deliver the prescribed drugs; knows the various techniques that are appropriate for each device; is able to evaluate the patient's inhalation technique to be sure they are using the devices properly; and ensures that the inhalation method is appropriate for each patient.

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“…An NEB system may require a much larger dose of medication to produce equivalent bronchodilation compared with other formulations [5]. Some pharmacodynamic and clinical studies have been undertaken to determine the comparative efficacy of an MDI with or without a large-volume spacer, DPI and NEB [6, 7, 8, 9, 10, 11, 12, 13], but there are few well-controlled studies simultaneously comparing the effects of these three devices using salbutamol.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Bronchodilator Effects of Salbutamol Delivered via a Metered-Dose Inhaler with Spacer, a Dry-Powder Inhaler, and a Jet Nebulizer in Patients with Chronic Obstructive Pulmonary Disease

Ikeda

Nishimura²,

Koyama³

et al. 1999

Respiration

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The aim of this study was to compare the bronchodilator effects of salbutamol delivered via three different devices: a dry-powder inhaler (DPI), a metered-dose inhaler (MDI) with a large-volume spacer and a jet nebulizer (NEB) in patients with stable chronic obstructive pulmonary disease (COPD). Ten male patients with stable COPD [age: 67.2 ± 3.8 years, forced expiratory volume in 1 s (FEV₁): 1.56 ± 0.32 liters] were studied in a randomized, double-blind and crossover manner. Each patient received 200 or 1,000 µg salbutamol via an MDI with an InspirEase^TM spacer, a Rotahaler^TM, or a DeVilbiss 646^TM nebulizer (NEB), or matching placebo on 7 separate days. Spirometry was performed before and 15, 30, 60, 90, 120, and 240 min after inhalation. With the 200-µg dose, only DPI produced a small but greater response in maximum FEV₁ and in area under the time-response curve (AUC-FEV₁) compared with placebo. With the 1,000-µg dose, DPI and MDI produced equally greater improvements in both maximum FEV₁ and AUC–FEV₁ than NEB. An equal bronchodilating effect can be obtained using either DPI or MDI with a spacer device, whereas the NEB was less effective when the same dose was administered.

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Comparison of Outpatient Nebulized vs Metered Dose Inhaler Terbutaline in Chronic Airflow Obstruction

Cited by 66 publications

References 10 publications

What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations?

What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations?

What the pulmonary specialist should know about the new inhalation therapies

Comparison of the Bronchodilator Effects of Salbutamol Delivered via a Metered-Dose Inhaler with Spacer, a Dry-Powder Inhaler, and a Jet Nebulizer in Patients with Chronic Obstructive Pulmonary Disease

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