title: Randomised controlled crossover trial of the effect on PtCO2 of oxygen-driven versus air-driven nebulisers in severe chronic obstructive pulmonary disease.
abstract: 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).
  
  
  CONCLUSIONS
  Nebulisers driven with oxygen result in significantly higher levels of PtCO(2) than those driven with air in patients with severe COPD.
  
  
  BACKGROUND
  The study was registered on the Australian New Zealand Clinical Trials Registry (ACTRN12610000080022).
authors.affiliation: Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand.
authors.forename: Llifon
authors.initials: L
authors.lastname: Edwards
authors.forename: Kyle
authors.initials: K
authors.lastname: Perrin
authors.forename: Mathew
authors.initials: M
authors.lastname: Williams
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.forename: Richard
authors.initials: R
authors.lastname: Beasley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D001785:Blood Gas Monitoring, Transcutaneous / Q000379:methods; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers / Q000592:standards*; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000188:drug therapy*
chemical_list: D001993:Bronchodilator Agents; D010100:Oxygen