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Research ArticleOriginal Research

β Agonist Delivery by High-Flow Nasal Cannula During COPD Exacerbation

Clément Beuvon, Rémi Coudroy, Justine Bardin, Nicolas Marjanovic, Christophe Rault, Vanessa Bironneau, Xavier Drouot, René Robert, Arnaud W Thille and Jean-Pierre Frat
Respiratory Care January 2022, 67 (1) 9-15; DOI: https://doi.org/10.4187/respcare.09242
Clément Beuvon
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.
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Rémi Coudroy
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.
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Justine Bardin
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.
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Nicolas Marjanovic
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Service d’accueil des Urgences, CHU de Poitiers, Poitiers, France.
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Christophe Rault
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Service de Neurophysiologie, CHU de Poitiers, Poitiers, France.
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Vanessa Bironneau
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and Service de Pneumologie, CHU de Poitiers, Poitiers, France.
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Xavier Drouot
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Service de Neurophysiologie, CHU de Poitiers, Poitiers, France.
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René Robert
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.
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Arnaud W Thille
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.
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Jean-Pierre Frat
INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Whereas high-flow nasal cannula (HFNC) oxygen therapy is increasingly used in patients with exacerbation of COPD, the effectiveness of β2 agonist nebulization through HFNC has been poorly assessed. We hypothesized that salbutamol vibrating-mesh nebulization through HFNC improves pulmonary function tests in subjects with COPD.

METHODS: We conducted a physiological crossover study including subjects admitted to the ICU for severe exacerbation of COPD. After subject improvement allowing a 3-h washout period without bronchodilator, pulmonary function tests were performed while breathing through HFNC alone and after salbutamol vibrating-mesh nebulization through HFNC. The primary end point consisted in the changes in FEV1 before and after salbutamol nebulization. Secondary end points included the changes in FVC, peak expiratory flow (PEF), airway resistance, and clinical parameters.

RESULTS: Among the 15 subjects included, mean (SD) FEV1 significantly increased after salbutamol nebulization from 931 mL (383) to 1,019 (432), mean difference +87 mL (95% CI 30–145) (P = .006). Similarly, FVC and PEF significantly increased, +174 mL (95% CI 66–282) (P = .004) and +0.3 L/min (95% CI 0–0.6) (P = .037), respectively. Airway resistances and breathing frequency did not significantly differ, whereas heart rate significantly increased after nebulization.

CONCLUSIONS: In subjects with severe exacerbation of COPD, salbutamol vibrating-mesh nebulization through HFNC induced a significant bronchodilator effect with volume and flow improvement.

  • COPD
  • high-flow nasal cannula oxygen
  • nebulization
  • aerosol
  • respiratory function tests

Footnotes

  • Correspondence: Jean-Pierre Frat MD PhD, Médecine Intensive Réanimation, Centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex. E-mail: jean-pierre.frat{at}chu-poitiers.fr
  • See the Related Editorial on Page 149

  • The study was performed at intensive care of Poitiers University Hospital: CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.

  • The study received a grant from Le nouveau souffle.

  • The study was registered on ClinicalTrial.gov: NCT03449056.

  • Dr Frat discloses relationships with the French Ministry of Health, Fisher & Paykel Healthcare, and SOS Oxygène. Dr Thille discloses relationships with the French Ministry of Health, Fisher & Paykel Healthcare, Maquet Getinge, GE Healthcare, and Covidien. Dr Marjanovic discloses a relationship with Fisher & Paykel. The remaining authors have no conflicts to disclose.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (1)
Respiratory Care
Vol. 67, Issue 1
1 Jan 2022
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β Agonist Delivery by High-Flow Nasal Cannula During COPD Exacerbation
Clément Beuvon, Rémi Coudroy, Justine Bardin, Nicolas Marjanovic, Christophe Rault, Vanessa Bironneau, Xavier Drouot, René Robert, Arnaud W Thille, Jean-Pierre Frat
Respiratory Care Jan 2022, 67 (1) 9-15; DOI: 10.4187/respcare.09242

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β Agonist Delivery by High-Flow Nasal Cannula During COPD Exacerbation
Clément Beuvon, Rémi Coudroy, Justine Bardin, Nicolas Marjanovic, Christophe Rault, Vanessa Bironneau, Xavier Drouot, René Robert, Arnaud W Thille, Jean-Pierre Frat
Respiratory Care Jan 2022, 67 (1) 9-15; DOI: 10.4187/respcare.09242
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Keywords

  • COPD
  • high-flow nasal cannula oxygen
  • nebulization
  • aerosol
  • respiratory function tests

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