BACKGROUND: The comparative safety of oxygen versus air-driven nebulised bronchodilators in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) is uncertain. A randomised controlled trial was performed to assess the effect on the arterial partial pressure of carbon dioxide of nebulised bronchodilator driven with oxygen versus air in stable severe COPD. METHODS: In an open label randomised study, 18 subjects with stable severe COPD attended on 2 days to receivenebulised bronchodilator therapy driven by air or oxygen. Subjects received 5 mg salbutamol and 0.5 mg ipratropium bromide by nebulisation over 15 min, then, after 5 min, 5 mg salbutamol nebulised over 15 min, followed by 15 min of observation. Transcutaneous carbon dioxide tension (PtCO(2)) and oxygen saturations were recorded at 5 min intervals during the study. The primary outcome was the PtCO(2) after the completion of the second bronchodilator treatment. RESULTS:PtCO(2) was higher with nebulised bronchodilator therapy delivered by oxygen, but decreased back to the level associated with air nebulisation 15 min after completion of the second nebulised dose. One subject experienced an increase in PtCO(2) of 11 mm Hg after the first bronchodilator nebulisation driven by oxygen. The mean PtCO(2) difference between the oxygen and air groups after the second nebulisation was 3.1 mm Hg (95% CI 1.6 to 4.5, p<0.001). CONCLUSION: Nebulisers driven with oxygen result in significantly higher levels of PtCO(2) than those driven with air in patients with severe COPD. CLINICAL TRIAL REGISTRATION NUMBER: The study was registered on the Australian New Zealand Clinical Trials Registry (ACTRN12610000080022).
RCT Entities:
BACKGROUND: The comparative safety of oxygen versus air-driven nebulised bronchodilators in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) is uncertain. A randomised controlled trial was performed to assess the effect on the arterial partial pressure of carbon dioxide of nebulised bronchodilator driven with oxygen versus air in stable severe COPD. METHODS: In an open label randomised study, 18 subjects with stable severe COPD attended on 2 days to receive nebulised bronchodilator therapy driven by air or oxygen. Subjects received 5 mg salbutamol and 0.5 mg ipratropium bromide by nebulisation over 15 min, then, after 5 min, 5 mg salbutamol nebulised over 15 min, followed by 15 min of observation. Transcutaneous carbon dioxide tension (PtCO(2)) and oxygen saturations were recorded at 5 min intervals during the study. The primary outcome was the PtCO(2) after the completion of the second bronchodilator treatment. RESULTS: PtCO(2) was higher with nebulised bronchodilator therapy delivered by oxygen, but decreased back to the level associated with air nebulisation 15 min after completion of the second nebulised dose. One subject experienced an increase in PtCO(2) of 11 mm Hg after the first bronchodilator nebulisation driven by oxygen. The mean PtCO(2) difference between the oxygen and air groups after the second nebulisation was 3.1 mm Hg (95% CI 1.6 to 4.5, p<0.001). CONCLUSION: Nebulisers driven with oxygen result in significantly higher levels of PtCO(2) than those driven with air in patients with severe COPD. CLINICAL TRIAL REGISTRATION NUMBER: The study was registered on the Australian New Zealand Clinical Trials Registry (ACTRN12610000080022).
Authors: Adrian Barnett; Richard Beasley; Catherine Buchan; Jimmy Chien; Claude S Farah; Gregory King; Christine F McDonald; Belinda Miller; Maitri Munsif; Alex Psirides; Lynette Reid; Mary Roberts; Natasha Smallwood; Sheree Smith Journal: Respirology Date: 2022-02-17 Impact factor: 6.175
Authors: George Bardsley; Janine Pilcher; Steven McKinstry; Philippa Shirtcliffe; James Berry; James Fingleton; Mark Weatherall; Richard Beasley Journal: BMC Pulm Med Date: 2018-10-03 Impact factor: 3.317
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