Should I use 2.5mg or 5mg Nebulised Salbutamol in Acute Exacerbations of COPD?
Date First Published:
April 4, 2009
Last Updated:
October 21, 2010
Report by:
Sandeep Rahul Kusre, Senior House Officer (Royal Free Hospital)
Search checked by:
Jonathan Costello, Royal Free Hospital
Three-Part Question:
In [patients admitted with acute exacerbations of COPD] is [5mg nebulised salbutamol superior to 2.5mg nebulised salbutamol] at [improving lung function and reducing length of hospital stay]
Clinical Scenario:
While working a busy nightshift in A&E, you see a patient with an acute exacerbation of COPD. They require bronchodilators & the nurse asks you if you want 2.5mg or 5mg of nebulised salbutamol. You usually administer 5mg however wondered if 2.5mg salbutamol would have the same effect?
Search Strategy:
Medline OVID 1950–June week 3 2010.
Search Details:
(exp Adrenergic β-Agonists OR exp albuterol OR salbutamol.mp OR b2 agonist.mp OR b agonist.mp OR β agonist.mp OR β 2 agonist.mp) AND (exp Administration, Inhalation OR exp ‘Nebulisers and Vaporizers’ OR (nebulised or nebuliser or nebulised or nebuliser).mp) AND (exp Dose-Response Relationship, Drug OR dose OR dosage) AND (exp Pulmonary Disease, Chronic Obstructive OR copd.mp OR coad.mp).
The Cochrane Database of Systematic Reviews (CDSR) June 2010
The Cochrane Database of Systematic Reviews (CDSR) June 2010
Outcome:
62 papers found of which only 1 was relevant
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| A Randomised Controlled Trial to Assess the Optimal Dose and Effect Of Nebulised Albuterol in Acute Exacerbations of COPD. Nair S. 2005, UK | 86 patients admitted with acute exacerbation of COPD randomised to either 2.5mg or 5mg nebulised salbutamol | Double-blind RCT | No significant difference in recovery of PEFR | p=0.684 | Small number of patients. Uncertain randomisation methodology. Extensive exclusion criteria. |
| No significant difference in length of hospital stay | p=0.084 |
Author Commentary:
Treatment of exacerbations of COPD with 5 mg nebulised salbutamol is commonplace; however, the best available evidence suggests no change in patient outcome when administering 2.5 mg including recovery of lung function and length of hospital stay. Of note, using 5 mg nebulised salbutamol causes no significant increase in reported side effects. Encouraging the use of 2.5 mg nebulised salbutamol would also have an associated financial benefit (1 mg/ml: 20×2.5 ml (2.5 mg) @ £1.99 and 2 mg/ml: 20×2.5 ml (5 mg) @ £3.98).
Bottom Line:
Patients admitted with acute exacerbations of COPD requiring nebulised therapy should be considered for 2.5 mg nebulised salbutamol in place of 5 mg.
References:
- Nair S.. A Randomised Controlled Trial to Assess the Optimal Dose and Effect Of Nebulised Albuterol in Acute Exacerbations of COPD.