Nebulized Long-Acting Bronchodilators to Treat Acute Respiratory Failure in an Older Adult: A Case Report

This report describes the case of a 79-year-old man admitted to the intensive care unit (ICU) for acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and treated with long-acting nebulized bronchodilators, arformoterol and revefenacin. This article aimed to assess the use of long-acting nebulized bronchodilators in an older adult with acute respiratory failure. The institutional setting was a 500-bed academic medical center in the southern US. Arformoterol is a long-acting beta agonist (LABA) and revefenacin is a long-acting muscarinic antagonist (LAMA), both approved to treat stable chronic obstructive pulmonary disease (COPD). Neither medication is US Food and Drug Administration approved for acute respiratory failure. In this case, both medications were used for their rapid-onset and long-duration bronchodilator activity to treat acute respiratory failure secondary to COVID-19. This older adult clinically improved within three days of nebulized long-acting bronchodilator use.