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

Abstract

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.

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

“…In contrast to other trials patients who had already received systemic steroids prior to hospital admission were not excluded. Nevertheless the degree of spirometric improvement registered in both of the treatment groups, ¡30% early improvement, is consistent with that found in other trials [9][10]. PFTs improved in both treatment groups, particularly in the first few days after onset of treatment.…”

“…PFTs improved in both treatment groups, particularly in the first few days after onset of treatment. A similar evolution as seen in the trial conducted by NIEWOEHNER et al [10] and SEEMUNGAL et al [21] was noted, since the improvement gradually declined and no significant improvement was seen when comparing the PFTs on discharge with those gathered at the 4-week follow-up visit.…”

“…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.…”

“…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 ADMIT series — Issues in Inhalation Therapy. 4) How to choose inhaler devices for the treatment of COPD

“…48 Only two studies 49,50 were identified which compared in stable COPD patients the delivery of any short-acting bronchodilator using a pMDI, with or without spacer, to that of any other (at that time available) hand-held inhaler device, namely the DPIs Rotahaler ®49 or Turbuhaler ® . 50 No evidence of clinical difference in β-agonist delivery was found.…”