A randomized, placebo-controlled trial of bronchodilators for bronchoscopy in patients with COPD.
BACKGROUND
In contrast to asthma, the indication for bronchodilators prior to bronchoscopy in patients with COPD has not been properly investigated. We therefore performed a randomized, double-blind, placebo-controlled trial to determine whether use of a short-acting bronchodilator provides a protective effect in patients with COPD undergoing bronchoscopy.


METHODS
One hundred twenty patients undergoing bronchoscopy were included. Patients with COPD were randomized to receive either 200 mug of salbutamol (n = 40) or placebo (n = 40) before bronchoscopy. Control patients (n = 40) did not receive any inhaled medication. Spirometry was performed before and 2 h after bronchoscopy in all patients. Sedative drug requirements and hemodynamic parameters were recorded.


RESULTS
Hemodynamic findings before, during, and after bronchoscopy were similar in patients with COPD randomized to either salbutamol or placebo (p = not significant for all). Compared to prebronchoscopy values, postbronchoscopy percentage of predicted FEV(1) decreased significantly in all three groups: salbutamol (median, - 4.7%; interquartile range [IQR], - 13.3 to 6.6); placebo (median, - 4.8%; IQR, - 19.9 to 8.4); and control subjects (median, - 10.0%; IQR, - 20.2 to - 3.3) [p = 0.023]. The decrease in FEV(1) was similar in all three patient groups (p = 0.432). The relative change in FEV(1) was inversely correlated to the increasing severity of COPD as expressed by Global Initiative for Chronic Obstructive Lung Disease stages (p = 0.01).


CONCLUSIONS
Premedication with an inhaled short-acting beta-agonist cannot be recommended in patients with COPD undergoing bronchoscopy.
Stolz
Daiana
D
The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland. Electronic address: stolzd@ummhc.org.
Pollak
Vincent
V
The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland.
Chhajed
Prashant N
PN
The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland.
Gysin
Christian
C
The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland.
Pflimlin
Eric
E
The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland.
Tamm
Michael
M
The Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland.
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D001999:Bronchoscopy; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy; D013223:Statistics as Topic; D014797:Vital Capacity / Q000187:drug effects
D001993:Bronchodilator Agents; D000420:Albuterol