An Evaluation of Inhaled Bronchodilator Therapy in Patients Hospitalized for Non-Life-Threatening COPD Exacerbations

Objective: Chronic obstructive pulmonary disease (COPD) increasingly is a cause of morbidity and mortality in and economic burden on the US healthcare system, and COPD exacerbations continue to be among the top 10 causes of hospitalization in adults. The objective of this study was to evaluate the incidence and potential implications of missed scheduled nebulized bronchodilator therapy in the setting of acute, non-life-threatening COPD exacerbations. Materials and Methods: This study was a retrospective chart review of all of the patients with a primary diagnosis of severe, non-life-threatening COPD exacerbations admitted from January 2007 to June 2008 at a university-affiliated hospital. Each patient's inhaled bronchodilator treatment regimen, including potential for nebulization to metered-dose inhaler (MDI) with valved holding chamber (VHC) conversion, was assessed. Results: A total of 259 patients met inclusion criteria: 235 (90.7%) patients received inhaled bronchodilators by nebulization alone in the treatment of COPD exacerbations; 81.1% of these patients could have used MDI with VHC. Patients missed 24.3% of their scheduled, nebulized bronchodilator doses. Conclusions: Patient care can be improved through the initiation of MDI with VHC, especially considering the number of missed nebulizations that these patients experienced. Development of an inhaled bronchodilator treatment algorithm for COPD exacerbations should be considered to ensure an evidence-bassed medicine approach to these patients.