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One-hundred nebulizer trials were performed in 98 adult patients with chronic airflow
limitation who had remained symptomatic despite regular use of bronchodilators by
metered dose or dry powder inhalation. Mean baseline FEV, was 0.9(sd = 0.41) 1, FVC −20 (0.74) 1 and PEFR 169 (77) l min−1. After laboratory measurements of reversibility to inhaled salbutamol (5 mg) and
ipratropium bromide (0.5 mg), patients were supplied with a compressor and a peak
flow meter to make twice daily measurements at home for 3 weeks. They nebulized normal
saline, salbutamol (5 mg) and salbutamol (5 mg) ipratropium (0.5 mg) mixture 6-hourly,
each for 1 week.A positive nebulizer trial was defined as a 15% increase in mean PEFR
over a week on an active treatment compared to the week on saline. Twenty-eight patients
had positive trials based on these criteria. Of these nine responded to both active
treatments and 16 to the salbutamol/ipratropium mixture. Although no laboratory measurements
predicted a positive domiciliary trial, the patients' subjective assessment of benefit
had a 93% sensitivity and 87% negative predictive value. We conclude that an appropriate
protocol for assessing the value of long-term nebulized bronchodilators is for patients
to measure their PEFR during a week of nebulized saline and a week of nebulized β-agonist/ipratropium
mixture. Those with an increase of 15% in mean PEFR in the week on active treatment
and who experienced subjective benefit should be supplied with a compressor. Had we
conducted our 100 trials in this way we would have started 25 of our 98 patients on
long-term home nebulized bronchodilators.
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Article info
Publication history
Accepted:
June 12,
1991
Received:
January 28,
1991
Identification
Copyright
© 1992 Baillière Tindall All rights reserved. Published by Elsevier Inc.
