Treatment of Patients Hospitalized for Exacerbations of Chronic Obstructive Pulmonary Disease: Comparison of an Oral/Metered-Dose Inhaler Regimen and an Intravenous/Nebulizer Regimen

Abstract

OBJECTIVE: Compare the therapeutic efficacy of an oral/metered-dose inhaler (oral/MDI) regimen to an intravenous/nebulizer (I.V./neb) regimen of methylprednisolone, cefuroxime, and inhaled albuterol and ipratropium bromide in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). DESIGN: Randomized, nonblinded, therapeutic trial. SETTING: Two community hospitals in Bangor, Maine. PATIENTS: 34 individuals with severe COPD. The mean admission forced expiratory volume in the first second was 0.75 L (oral/MDI 0.78 L, I.V./neb 0.71 L). RESULTS: Baseline demographic, laboratory, comorbidity, and ventilatory values determined in 19 patients who received the oral/MDI regimen and 15 patients treated with the I.V./neb regimen indicated comparability of the two groups. Outcome variables that compared oral/MDI to I.V./neb, including mean change in forced expiratory volume in the first second (0.12 L vs 0.13 L), mean length of stay (4.3 vs 5.1 d), and treatment failures (32% vs 33%), showed no significant differences. CONCLUSION: Patients hospitalized for COPD exacerbations can be successfully (and potentially less expensively) treated with an oral/MDI treatment regimen.