The dose of albuterol that we chose for the nebulizer is the standard recommended dose, while that chosen for the MDI-spacer system was twice the usual dose. In the study of Jenkins et al, cumulative dose-response curves were generated to establish the doses of albuterol (salbutamol) by MDI and nebulizer which produced maximum bronchodilation in stable patients with chronic airflow obstruction. Nine of 19 patients had a maximal response at 2.5 mg via nebulizer, and 17 of 19 had a maximal response at 0.4 mg by MDI. Thus, it may be argued that we biased our results toward the MDI-spacer system by using a dose more likely to produce maximal bronchodilation. However, the study of Jenkins and co-workers was performed in patients in stable condition who presumably could use the MDIs in an optimal manner. Our population was quite different. We chose the 2.5-mg dose for the nebulizer because it is a standard one, and we chose the MDI-spacer dose because we believed that a dose higher than standard would be needed in the setting of an acute exacerbation. Indeed, even if six to eight puffs per MDI-spacer system were needed for equivalent effect, this would not detract from its potential usefulness. More info Read the rest of this entry »

Nebulizer vs Spacer for Bronchodilator Delivery in Patients Hospitalized for Acute Exacerbations of COPD: MDI-spacer methodsTwo previous studies comparing nebulizer and MDI-spacer methods in acute exacerbations of COPD were also unable to demonstrate a difference in efficacy but did not employ a crossover design. Jasper et al compared delivery of metaproterenol by nebulizer (15 mg) and MDI-spacer (two puffs; 1.3 mg) in a mixed population of patients with asthma and COPD who were hospitalized for airflow obstruction. Treatment (either nebulizer or MDI-spacer) was randomized, but neither the patients nor investigators were blinded. Spirograms were read by a blinded observer. The InspirEase spacer was used in this study. The two treatments were associated with equivalent improvement in spirometric data initially and at discharge. Although the treated populations included a substantial number of asthmatic subjects, covariant analysis showed that this had no significant effect on the conclusions. other Read the rest of this entry »

Many patients have difficulty employing the proper technique for using MDIs. Spacer/reservoir systems circumvent some of these difficulties. With proper use of MDIs, a much smaller dose of drug than that administered by nebulizer is equipotent for bronchodilation. However, patients with acute exacerbations of COPD are frequently tachypneic, and this makes optimal use of MDIs difficult. For this reason, many physicians have used nebulizers to deliver sympathomimetic medication in this setting. We hypothesized that the use of a spacer might make an MDI use more practical in these tachypneic patients. This study compared the efficacy of nebulizer and MDI-spacer systems in the delivery of albuterol in acutely ill hospitalized patients with severe COPD. review Read the rest of this entry »

Nebulizer vs Spacer for Bronchodilator Delivery in Patients Hospitalized for Acute Exacerbations of COPD: Change in FEVIn addition, there was large variability in the percent change in the FEVi that individual subjects exhibited after the two treatments (Fig 2). Analysis of the effect of the order with which active medication was delivered by MDI-spacer (group 1 vs 2) showed no effect of this factor on the FEV, values or Borg scores and no significant interaction of order with the effect of treatment (before vs 1 h after). Patients randomized to receive active medication by MDI-spacer in treatment block 1 (order 1) did have higher FVC scores overall (p = 0.048). The values of FEVi and FVC on admission for group 1 were better than group 2, but this difference was not significant when analyzed by the t test for independent samples. Read the rest of this entry »

The 20 male patients participating in the study had an age range of 60 to 91 years, with a mean of 67.9 ± 7.1 years. Their spirometry on admission showed an FEVi of 0.71 ±0.26 L, an FVC of 1.77±0.52 L, and an FEVi/FVC ratio of a 0.41 ±0.11. Thus, the patients were quite elderly and had severe airflow obstruction. The arterial blood gas levels for the group were pH of 7.42±0.03, PaC02 of 40±9 mm Hg, and Pa02 of 68 ± 9 mm Hg. While of four of the 20 patients had a PaC02 greater than 45 mm Hg, all of these patients had well-compensated respiratory acidosis, and none had a pH less than 7.30. Four patients were receiving oxygen at 1 to 2 L/min by nasal cannula at the time of arterial blood gas analysis. Read the rest of this entry »

Nebulizer vs Spacer for Bronchodilator Delivery in Patients Hospitalized for Acute Exacerbations of COPD: MonitoringMonitoring
On admission, spirometry, an arterial blood gas analysis, a chest roentgenogram, and determination of the theophylline level were done. Spirometric data (Vitalograph) and a Borg dyspnea score were obtained before each treatment block and 1 h after nebulizer inhalation was begun (referred to as 1 h after treatment). The best values for FEV, and FVC of at least three attempts were selected and recorded in BTPS units. The Borg score is an interval scale that contains the numbers 0 to 10 associated with the statements, “0=nothing at all; 1 = very, very light;. . . 9=very heavy; 10=very, very heavy.” Subjects were asked to indicate their degree of dyspnea after they were presented with a poster containing the scale. Systolic and diastolic blood pressure and heart rate were measured before each treatment block, at five minutes after MDI-spacer and nebulizer treatments, and 1 h after the start of nebulizer administration. avandia online Read the rest of this entry »

Subjects
Twenty patients admitted through the emergency room to medical wards for an acute exacerbation of COPD were studied. One additional subject was recruited for the study but was excluded when he was unable to perform adequate spirometry. All patients had a long history of chronic airflow obstruction and cigarette smoking. Patients with acute respiratory acidosis (pH<7.30) were excluded. Subjects were studied within 24 h of admission to the hospital. The project was approved by our institutional review board for human studies, and informed written consent was obtained from each subject prior to initiation of the study. generic zoloft
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