Comparative efficacy of metered dose inhaler with spacer and nebulized bronchodilator in the treatment of COPD acute exacerbation in the emergency department, Chiangrai Prachanukroh Hospital.
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Abstract
Background Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a common cause of the emergency department (ED) visiting with dyspnea. Before COVID – 19 pandemic, nebulized bronchodilator was a standard treatment. After that, MDI with spacer are advised to prevent spread of the virus. The efficacy of two treatment methods remains unclear.
Objective To compare the efficacy of metered dose inhaler with spacer and nebulized bronchodilator in the treatment of COPD acute exacerbation on the admission rate, intubation rate, length of stay and revisit probability within 48 hours.
Methods A historical cohort study in COPD acute exacerbation patient who visited ED since 1stoctober 2019 to 31st March 2021. Patients were divided into two groups (Nebulized bronchodilator and MDI with spacer). A relation between two treatment methods and clinical outcomes were analyzed by using multivariable regression.
Results 645 COPD acute exacerbation patients were included and divided into 2 groups (339 patients in the MDI with spacer and 306 patients in the nebulized bronchodilator). Admission ratio was 1.11 (95% CI=0.92-1.33) p-value 0.273. Intubation ratio was 1.07 (95% CI=0.44-2.61) p-value 0.887. Revisit probability within 48 hours ratio was 0.38 (95%CI=0.16-0.95) p-value 0.038. Mean length of admission difference was -1.85 hours (95% CI=-11.18-7.47) p-value 0.697.
CONCLUSIONS AND DISCUSSIONS In patients with COPD acute exacerbation there was no difference in the efficiency of MDI with spacer compared with nebulized bronchodilator. The MDI with spacer reduced the probability of revisiting within 48 hours and can be used as a guideline for treat COPD acute exacerbation patients who come to the ED.
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References
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