title: Comparison of dry powder versus nebulized beta-agonist in patients with COPD who have suboptimal peak inspiratory flow rate.
abstract: BACKGROUND
  A peak inspiratory flow rate (PIFR) of <60 L/min against the internal resistance (resist) of a dry powder inhaler (DPI) may limit the ability of a patient with chronic obstructive pulmonary disease (COPD) to achieve bronchodilation. The hypothesis was that lung function would be higher with a beta-agonist inhaled via nebulization compared with dry powder in patients with COPD who exhibit a PIFRresist of <60 L/min against the Diskus(®).
  
  
  METHODS
  This study was randomized, single-blind, and crossover with spirometry and inspiratory capacity (IC) measured at 15, 30, and 120 min post treatment. The efficacy of arformoterol aerosol solution (15 μg/2 mL) via nebulizer was compared with salmeterol dry powder (50 μg) via Diskus. The primary outcome was the change in lung function from baseline at 2 hr as these two inhaled beta-agonists have the similar peak bronchodilator effect as measured by forced expiratory volume in 1 sec (FEV1).
  
  
  RESULTS
  Twenty patients (15 females/5 males) with postalbuterol FEV1 of 0.83±0.31 L (38±12% predicted) and PIFRresist of 53±5 L/min completed the study. At 15 min, improvements in FEV1, forced vital capacity (FVC), and IC were significantly higher with arformoterol than with salmeterol. At 2 hr, changes in FVC and IC, but not FEV1, were significantly higher with arformoterol. At visit 3, patient preference was similar for salmeterol Diskus (n=8) and arformoterol solution (n=7), whereas five patients reported no preference.
  
  
  CONCLUSIONS
  At peak effect (2 hr), volume responses were greater with arfomoterol via nebulizer compared with dry powder salmeterol in patients with COPD who had a PIFRresist of <60 L/min. Bronchodilator therapy via nebulization should be considered in patients with COPD who have a suboptimal PIFRresist against a particular DPI.
authors.affiliation: Geisel School of Medicine at Dartmouth , Hanover, NH; and Section of Pulmonary & Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Mahler
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Waterman
authors.forename: Joseph
authors.initials: J
authors.lastname: Ward
authors.forename: Alex H
authors.initials: AH
authors.lastname: Gifford
mesh_terms: D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000336:Aerosols; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D005541:Forced Expiratory Volume; D000068759:Formoterol Fumarate; D006801:Humans; D001239:Inhalation / Q000187:drug effects*; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D009513:New Hampshire; D057240:Patient Preference; D011208:Powders; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D000068299:Salmeterol Xinafoate; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D000336:Aerosols; D001993:Bronchodilator Agents; D004983:Ethanolamines; D011208:Powders; D000068299:Salmeterol Xinafoate; D000420:Albuterol; D000068759:Formoterol Fumarate