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.

No significant effect of order (group 1 vs 2) on the changes (before vs one hour after) in the FEVj and Borg scores was found. In addition, no significant interactions between the effects of order and the type of treatment were present. While there was no significant direct effect of order on changes in the FVC, there was a significant interaction between the effects of order and the type of treatment (p = 0.024) for the percent change in the FVC. The MDI-spacer system was much less effective when active drug was given via this system in the second treatment block (group 2). Click Here
The heart rate and systolic and diastolic blood pressure at either five minutes or 1 h after therapy were not different from values before treatment. This result was not affected by the type of treatment or order (interactions not significant). The mean increases in heart rate five minutes after MDI-spacer treatment (2.7 ±9.0 beats per minute) and nebulizer treatment (2.9 ±7.4 beats per minute) were not statistically different, nor did the mean decreases in systolic/ diastolic blood pressure five minutes after MDI-spacer treatment (2.7 ± 11.8/2.5 ± 12.5 mm Hg) and nebulizer treatment (0.8 ± 15.2/3.7 ± 13.2 mm Hg) differ significantly.

Figure 2. Percent change in FEV, following MDI-spacer and nebulizer treatments (or each subject. Large amount of variability in response to the two methods of treatment were noted.

Figure 2. Percent change in FEV, following MDI-spacer and nebulizer treatments (or each subject. Large amount of variability in response to the two methods of treatment were noted.