• Clément Beuvon, Rémi Coudroy, Justine Bardin, Nicolas Marjanovic, Christophe Rault, Vanessa Bironneau, Xavier Drouot, René Robert, Arnaud W Thille, and Jean-Pierre Frat.
• INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.
• Respir Care. 2022 Jan 1; 67 (1): 9159-15.

BackgroundWhereas high-flow nasal cannula (HFNC) oxygen therapy is increasingly used in patients with exacerbation of COPD, the effectiveness of β 2 agonist nebulization through HFNC has been poorly assessed. We hypothesized that salbutamol vibrating-mesh nebulization through HFNC improves pulmonary function tests in subjects with COPD.MethodsWe conducted a physiological crossover study including subjects admitted to the ICU for severe exacerbation of COPD. After subject improvement allowing a 3-h washout period without bronchodilator, pulmonary function tests were performed while breathing through HFNC alone and after salbutamol vibrating-mesh nebulization through HFNC. The primary end point consisted in the changes in FEV1 before and after salbutamol nebulization. Secondary end points included the changes in FVC, peak expiratory flow (PEF), airway resistance, and clinical parameters.ResultsAmong the 15 subjects included, mean (SD) FEV1 significantly increased after salbutamol nebulization from 931 mL (383) to 1,019 (432), mean difference +87 mL (95% CI 30-145) (P = .006). Similarly, FVC and PEF significantly increased, +174 mL (95% CI 66-282) (P = .004) and +0.3 L/min (95% CI 0-0.6) (P = .037), respectively. Airway resistances and breathing frequency did not significantly differ, whereas heart rate significantly increased after nebulization.ConclusionsIn subjects with severe exacerbation of COPD, salbutamol vibrating-mesh nebulization through HFNC induced a significant bronchodilator effect with volume and flow improvement.Copyright © 2022 by Daedalus Enterprises.

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