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Three Part Question

In [patients admitted with acute exacerbations of COPD] is [5mg nebulised salbutamol superior to 2.5mg nebulised salbutamol] at [improving lung function and reducing length of hospital stay]

Clinical Scenario

While working a busy nightshift in A&E, you see a patient with an acute exacerbation of COPD. They require bronchodilators & the nurse asks you if you want 2.5mg or 5mg of nebulised salbutamol. You usually administer 5mg however wondered if 2.5mg salbutamol would have the same effect?

Search Strategy

Medline OVID 1950–June week 3 2010.


(exp Adrenergic β-Agonists OR exp albuterol OR salbutamol.mp OR b2 agonist.mp OR b agonist.mp OR β agonist.mp OR β 2 agonist.mp) AND (exp Administration, Inhalation OR exp ‘Nebulisers and Vaporizers’ OR (nebulised or nebuliser or nebulised or nebuliser).mp) AND (exp Dose-Response Relationship, Drug OR dose OR dosage) AND (exp Pulmonary Disease, Chronic Obstructive OR copd.mp OR coad.mp).

The Cochrane Database of Systematic Reviews (CDSR) June 2010

Search Outcome

62 papers found of which only 1 was relevant

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Nair et al, 2005, UK	86 patients admitted with acute exacerbation of COPD randomised to either 2.5mg or 5mg nebulised salbutamol	Double-blind RCT	No significant difference in recovery of PEFR	p=0.684	Small number of patients. Uncertain randomisation methodology. Extensive exclusion criteria.
			No significant difference in length of hospital stay	p=0.084

Comment(s)

Treatment of exacerbations of COPD with 5 mg nebulised salbutamol is commonplace; however, the best available evidence suggests no change in patient outcome when administering 2.5 mg including recovery of lung function and length of hospital stay. Of note, using 5 mg nebulised salbutamol causes no significant increase in reported side effects. Encouraging the use of 2.5 mg nebulised salbutamol would also have an associated financial benefit (1 mg/ml: 20×2.5 ml (2.5 mg) @ £1.99 and 2 mg/ml: 20×2.5 ml (5 mg) @ £3.98).

Clinical Bottom Line

Patients admitted with acute exacerbations of COPD requiring nebulised therapy should be considered for 2.5 mg nebulised salbutamol in place of 5 mg.

References

1. Nair S. A Randomised Controlled Trial to Assess the Optimal Dose and Effect Of Nebulised Albuterol in Acute Exacerbations of COPD. Chest 2005;128;48-54.