Better airway resistance reduction profile in intubated COPD patients by personalized bronchodilator dosing: A pilot...

The optimal dose of inhaled metered-dose bronchodilators for intubated patients with chronic obstructive pulmonary disease (COPD) is unknown. In this study, we proposed a bronchodilator dosing schedule based on an individual's airway resistance (R_aw) and tested its efficacy in reducing R_aw.

A total of 51 newly admitted patients with invasively ventilated COPD were randomly assigned to receive personalized or fixed bronchodilator dosing. Personal target R_aw was defined by measuring each individual's R_aw after maximal pharmacologic bronchodilatation. Thereafter, R_aw was measured every 8 h until the 28th day. Patients in the fixed-dosing group received only predetermined doses. Additional doses of bronchodilators were given to patients in the personalized-dosing group when the measured R_aw exceeded their target R_aw.

The median daily doses of salmeterol/fluticasone were 9.2 (personalized-dosing) vs 7.6 (fixed-dosing) puffs (P < 0.001). The relative deviation of R_aw from the personal target was expressed as (measured R_aw - target R_aw)/target R_aw. The experimental group showed a smaller relative R_aw deviation than the control group (0.09 ± 0.10 vs 0.44 ± 0.11, P = 0.02). There were no differences between the two groups in terms of ventilator-free days from day 1 to day 28, number of episodes of nosocomial pneumonia, total number of puffs of rescue bronchodilator, number of drug-related adverse effects or mortality rate at day 180.

Personalized dosing of inhaled bronchodilator administered to invasively ventilated COPD patients can produce a better reduction in R_aw. Further studies with larger sample size are required to verify the conclusion of this pilot study.