Safety, Efficacy, and Feasibility of Nebulized Long-Acting Bronchodilators vs Short-Acting Bronchodilators in Hospitalized Patients With Acute Exacerbations of COPD: A Phase IV, Randomized, Parallel-Group Clinical Trial

Abstract

BackgroundLong-acting bronchodilators are preferred over short-acting bronchodilators in patients with stable COPD, but prospective studies are needed to determine the safety and efficacy of nebulized long-acting bronchodilators in hospitalized patients with exacerbations of COPD (ECOPD). MethodsWe conducted a prospective, randomized, parallel-group study comparing a nebulized formoterol/revefenacin combination with an albuterol/ipratropium combination among n = 60 hospitalized patients (n = 30 in each group) with ECOPD who tested negative for COVID-19. Treatments were administered q12 to 24 hrs (formoterol/revefenacin), or q6 hrs (albuterol/ipratropium) by jet nebulizers for up to 7 days. Safety and efficacy assessments were recorded on days 1, 3, and 7, or at hospital discharge. Assessment of dyspnea by the Modified Borg dyspnea scale was the primary outcome. Data were analyzed with parametric or non-parametric statistical tests, and generalized estimating equations with an identity link function were used to analyze differences in the two groups. Statistical significance was assumed at an unadjusted two-sided alpha value of 0.05. ResultsParticipants’ mean age was 63.2 (SD 9.30) years, and 39 (65.0%) were current smokers. Patients' age, sex, race, smoking history, body mass index, Charlson Comorbidity Index, supplemental oxygen requirements, and length of hospital stay were similar in the two groups (p>0.05 for all). Patients receiving formoterol/revefenacin had similar Modified Borg dyspnea scores (p = 0.95) and required fewer total drug doses (P<0.001), but there was a non-significant trend for more frequent rescue treatments (p=0.08) compared to those receiving albuterol/ipratropium. There were no serious adverse events or treatment failures in either group. ConclusionIn non-ventilated hospitalized patients with ECOPD, the institution of nebulized formoterol/revefenacin in combination within 24 to 36 hours of hospital admission provided convenient dosing and required fewer drug doses to achieve comparable efficacy and safety with the standard short-acting nebulized albuterol/ipratropium combination.