Effect of different albuterol dosing regimens in the treatment of acute exacerbation of chronic obstructive pulmonary disease

Study objective: To compare hourly administration of albuterol with more frequent administration of a higher cumulative dose in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods: Participants in this pilot study were patients older than 50 years who presented to the emergency department with an acute exacerbation of COPD. After initial assessment and spirometry, all patients received nebulized aerosols every 20 minutes. Patients were randomly assigned to receive either albuterol (2.5 mg) every 60 minutes for two doses, interspersed with saline aerosols every 20 minutes; or albuterol (2.5 mg) every 20 minutes for 2 hours. Patients were assessed with spirometry after 60 and 120 minutes. No other medications were administered during the course of this study. Results: Eighty-six patients were enrolled in the study. No statistically significant difference was found between groups in mean 1-second forced expiratory volume (FEV(1)) at study initiation, 1 hour, or 2 hours or in the interval changes in mean FEV(1). There was, however, almost twice as much improvement in FEV(1) in the higher-dose group. Group hospitalization rates were similar. There were more side effects in the higher-dose group (45% versus 24%, P<.05). Among 32 patients with a pretreatment FEV(1) less than 20% of predicted, there was a significantly greater interval improvement in FEV(1) at both 1 hour and 2 hours. Conclusion: This study failed to demonstrate a statistically significant advantage to use of a higher cumulative dose of albuterol in patients with acute exacerbation of COPD, possibly because of type II statistical error. There may be an advantage to more frequent dosing, particularly in patients with initially severe bronchospasm, although at the expense of more frequent side effects.