The Science Journal of the American Association for Respiratory Care

Original Contributions

February 2002 / Volume 47 / Number 2 / Page 154

Treatment of Patients Hospitalized for Exacerbations of Chronic Obstructive Pulmonary Disease: Comparison of an Oral/Metered-Dose Inhaler Regimen and an Intravenous/Nebulizer Regimen

Sean P Shortall RRT RPFT, James Blum PhD, Frederick A Oldenburg MD, Lorraine Rodgerson RN, John M Branscombe RRT and Edward M Harrow MD

OBJECTIVE: Compare the therapeutic efficacy of an oral/metered-dose inhaler (oral/MDI) regimen to an intravenous/nebulizer (I.V./neb) regimen of methylprednisolone, cefuroxime, and inhaled albuterol and ipratropium bromide in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). DESIGN: Randomized, nonblinded, therapeutic trial. SETTING: Two community hospitals in Bangor, Maine. PATIENTS: 34 individuals with severe COPD. The mean admission forced expiratory volume in the first second was 0.75 L (oral/MDI 0.78 L, I.V./neb 0.71 L). RESULTS: Baseline demographic, laboratory, comorbidity, and ventilatory values determined in 19 patients who received the oral/MDI regimen and 15 patients treated with the I.V./neb regimen indicated comparability of the two groups. Outcome variables that compared oral/MDI to I.V./neb, including mean change in forced expiratory volume in the first second (0.12 L vs 0.13 L), mean length of stay (4.3 vs 5.1 d), and treatment failures (32% vs 33%), showed no significant differences. CONCLUSION: Patients hospitalized for COPD exacerbations can be successfully (and potentially less expensively) treated with an oral/MDI treatment regimen.
Key words: metered-dose inhaler, MDI, nebulizer, chronic obstructive pulmonary disease, COPD, exacerbation, intravenous, inhaled, methylprednisolone, cefuroxime, albuterol, ipratropium bromide.
[Respir Care 2002;47(2):154–158]

Introduction

Chronic obstructive pulmonary disease (COPD), a disorder characterized by airflow obstruction and/or mucus hypersecretion, is a major cause of morbidity and the fourth leading cause of mortality in the United States. Periodic exacerbations are common, and patients are often hospitalized when they develop increasing dyspnea, progressive gas exchange impairment, or fail to respond to an outpatient therapeutic regimen. Annual related health care costs in the United States are $15 billion, and hospitalization is the major component of those expenditures.

Standard therapy for COPD exacerbations is well known and includes inhaled beta2 sympathomimetics and cholinergic agents, corticosteroids, xanthines, and antibiotics. Demands on nursing and respiratory care services often exceed availability. Despite the magnitude of this problem, there have been relatively few clinical trials that clearly prove the efficacy of the dosing regimens or route by which they should be administered. The present study was conducted to determine if comparable therapeutic results could be achieved among patients hospitalized for COPD exacerbations using a less resource-intensive regimen (oral medications and metered-dose inhaler [oral/MDI]) than conventional therapy (intravenous drugs and nebulizer [I.V./neb]).

The entire text of this article is available in the printed version of the February 2002 RESPIRATORY CARE.

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