title: Randomized controlled trial of a breath-activated nebulizer in patients with exacerbation of COPD.
abstract: BACKGROUND
  Exacerbations of COPD (ECOPD) are characterized by increased dyspnea due to dynamic pulmonary hyperinflation. This study sought to determine whether the AeroEclipse II breath-activated nebulizer (BAN) would produce greater bronchodilator responses than a continuous flow  small-volume nebulizer (SVN) in patients with ECOPD.
  
  
  METHODS
  Prospective randomized controlled trial. Forty patients with ECOPD were recruited to participate in the trial. The primary study outcomes were inspiratory capacity (IC) and dyspnea via the Borg scale. Subjects were randomized to  receive bronchodilator from either a BAN or a continuous flow SVN. Subjects in both groups received 2.5 mg albuterol sulfate and 0.5 mg ipratropium bromide by nebulizer every 4 hours, and 2.5 mg albuterol every 2 hours as needed. Approximately 2 hours after the subject's 6th scheduled nebulizer  treatment, IC, dyspnea, and respiratory frequency measurements were repeated.
  
  
  RESULTS
  Both groups received an equal number of nebulizer treatments over the study period (BAN 6.25 ± 0.55, control 6.2 ± 0.7, P = .80). Following completion of the study protocol the BAN group  had a higher IC than the SVN group (1.83 ± 0.65 L vs 1.42 ± 0.49 L, P = .03, respectively). The change in IC was higher in the BAN group (0.33 ± 0.31 L than in the SVN group (0.15 ± 0.19 L, P = .03). The BAN group also had a lower respiratory rate  (19 ± 3.3 breaths/min vs 22 ± 5.3 breaths/min, P = .03, respectively). There was no difference in resting dyspnea as measured with the Borg scale (BAN 3.3 ± 2.1, SVN 3.5 ± 2.4, P = .69) or stay (BAN 4.6 ± 2.6 d, SVN 5.7 ± 2.8 d, P  = .21).
  
  
  CONCLUSIONS
  In this cohort of patients with ECOPD, a BAN was more effective in reducing lung hyperinflation and respiratory frequency than a continuous-flow SVN.
authors.affiliation: Department of Respiratory Therapy, St Joseph Hospital, Nashua, New Hampshire 03060, USA. jhaynes@sjhnh.org
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Haynes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000494:pharmacology* / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000494:pharmacology* / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D007320:Inspiratory Capacity / Q000187:drug effects; D009241:Ipratropium / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D056152:Respiratory Rate / Q000187:drug effects
chemical_list: D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol