Chest

Chest

Volume 131, Issue 3, March 2007, Pages 765-772
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Original Research: Interventional Pulmonology
A Randomized, Placebo-Controlled Trial of Bronchodilators for Bronchoscopy in Patients With COPD

https://doi.org/10.1378/chest.06-2308Get rights and content

Abstract

Background:In contrast to asthma, the indication for bronchodilators prior to bronchoscopy in patients with COPD has not been properly investigated. We therefore performed a randomized, double-blind, placebo-controlled trial to determine whether use of a short-acting bronchodilator provides a protective effect in patients with COPD undergoing bronchoscopy.

Methods:One hundred twenty patients undergoing bronchoscopy were included. Patients with COPD were randomized to receive either 200 μg of salbutamol (n = 40) or placebo (n = 40) before bronchoscopy. Control patients (n = 40) did not receive any inhaled medication. Spirometry was performed before and 2 h after bronchoscopy in all patients. Sedative drug requirements and hemodynamic parameters were recorded.

Results:Hemodynamic findings before, during, and after bronchoscopy were similar in patients with COPD randomized to either salbutamol or placebo (p = not significant for all). Compared to prebronchoscopy values, postbronchoscopy percentage of predicted FEV1decreased significantly in all three groups: salbutamol (median, − 4.7%; interquartile range [IQR], − 13.3 to 6.6); placebo (median, − 4.8%; IQR, − 19.9 to 8.4); and control subjects (median, − 10.0%; IQR, − 20.2 to − 3.3) [p = 0.023]. The decrease in FEV1was similar in all three patient groups (p = 0.432). The relative change in FEV1was inversely correlated to the increasing severity of COPD as expressed by Global Initiative for Chronic Obstructive Lung Disease stages (p = 0.01).

Conclusions:Premedication with an inhaled short-acting β-agonist cannot be recommended in patients with COPD undergoing bronchoscopy.

Section snippets

Materials and Methods

A total of 120 patients undergoing diagnostic flexible bronchoscopy at the University Hospital Basel (Basel, Switzerland) between June and October 2005 were recruited for this study. This study was approved by the Ethic Committee of the University Hospital Basel.

Results

Demographic and lung function parameters are presented inTable 1. Patients with COPD randomized to salbutamol and placebo groups were similar in regard to age, gender distribution, and spirometric findings. The majority of the patients with COPD had moderate (43%) or severe (32.5%) disease, according to the GOLD stage classification.19Historical data from the lung function laboratory were available for 66 of the subjects (82.5%) with COPD. Lung function testing was performed at a median

Discussion

This study demonstrates that there is no benefit of inhaled short-acting β-agonists prior to bronchoscopy in patients with COPD. The inhalation of salbutamol neither improved safety nor prevented decrease in FEV1. Thus, routine inhalation of a short-acting β-agonist cannot be recommended as a premedication for bronchoscopy in COPD patients.

Most of the literature regarding the investigative use of bronchoscopy relates to its use in asthma.11There is a more pronounced postbronchoscopic fall in FEV

Acknowledgments

We are deeply grateful to the endoscopy staff (Esther Gysin, Dusan Jovic, Bjorn Fehrke, Monika Kohler, Sylvie Groelly, Michael Ortmann, Beatrice Lehner, Brigitte Koch, Margot Brenneisen) for their collaboration; to Anja Meyer, RN, for her enthusiastic cooperation in data collection; and to Andy Schoetzau for statistical assistance.

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    This work was funded by the Clinic of Respiratory Medicine, University Hospital Basel. The authors have no conflicts of interest to disclose.

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    Copyright © 2007 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.