IngentaConnect Pharmacodynamic effects of albuterol nebulization in hospitalized COPD-patients because of an exacerbation with blocked gastrointestinal absorption

Authors: Cromheecke, H.¹; Grouls, R.¹; Creemers, J.²; Smeenk, F.²; Verboom, L.²; Ackerman, E.¹

Abstract:

Despite major improvements in drug output of new nebulizers and differences between nebulizers [ 1], doses of albuterol nebulizing therapy of hospitalized COPD-patients has not changed in the last decades.

The objective was to determine the optimal dose in the current setting according to a standardized protocol (10 min at flow 8 l min⁻¹, MICRO MIST nebulizer, Hudson RCI).

After a washout of bronchodilators patients nebulized 5 mg (group A; n=21. FEV₁=47.4 ± 2.9% predicted; Tiffeneau=48.1 ± 2.5%) or 10 mg (group B; n=21, FEV₁=50.5 ± 3.8% predicted; Tiffeneau=49.5 ± 3.4%) albuterol (t=−10 to 0 min). Pulmonary function (PF) (FEV₁, FVC, Tiffeneau), dyspnoea (modified Borg scale) and heart-frequency (HF), blood pressure (BP), breathing-frequency (BF), serum potassium (K), fingertremor, QTc-interval, were measured at t=−30, 10, 30, 60, 120, 240 min. Charcoal was administered to prevent gastrointestinal absorption (t=−10; 10 min (5 g) and 60 min (10 g). Pharmacodynamic (PD)-effects, relative to baseline, and correlation between effects, severeness of COPD and patient characteristics were analysed.

FEV₁ and FVC increased significantly (FEV₁: (A) 10-120 min; (B) 10-240 min; Figure 1), leaving Tiffeneau unchanged. FVC at t=10 is significantly greater for group B compared to A (P=0.009). PD-parameters ( Table 1) showed significant changes.

All changes in group B had an earlier onset and were of the same or longer duration. Parameters not mentioned did not change clinically significant. FEV₁- and dyspnoeic-changes and FEV₁ and FVC changes had a significant correlation in both groups. No other correlations or differences were seen.

Group B shows no greater PF improvements, only significant and clinical relevant greater changes in some side effects. In moderate to severe COPD-patients 5 mg albuterol is the highest recommended dose, lower doses should be investigated.