Albuterol in COPD exacerbations? How does it REALLY work?

[VillageEMT]

craig,

In New York State Albuterol is an optional BLS medication for previously diagnosed asthma pts if your squad writes a SOP and gets its Medical Director to sign off and you are trained to administer it. In the Susquehanna Region there is a local BLS protocol for it for COPD. https://www.srems.com/default.htm

[Ace844]

Steve,

Out of curiousity, do you or any of the posters here use FEV1 as a clinical measure of how effective your Albuterol or combivent RX's are??? If not what do you use? Is it strictly subjective? Also, will you have an objective/subjective clinical measure in your study, if so what method will you use? Also as you noted for COPD and BOOP I have seen dramatic improvement with BIPAP/CPAP...just curious,

that always asking ?'s and learning more EMS professional,

Ace844

[Stones]

You claim you are doing clinical trials, giving placebo meds, with a psychology proffessor?

what agencies will be involved in this clinical study, how are you obtaining consent from the patients to be a part of this study, and what regulating agency has authorized this clinical trial?

[THE_DITCH_DOCTOR]

It's in the planning stages, and the plan is to involve one of the professors from the medical school (the psychology professor (since placebo effect and psychological dependence are both psychological conditions) is simply aiding in putting together the psychological testing part of the study. As for the specifics of the study, I'm not going to get into them here due to the specifics not having been set up completely yet, but suffice to say that all standards for testing will be followed and remember that placebos are part of nearly any pharmacology study.

This is not going to be an EMS study- it will take place in an academic medical center after approval by the facility's institutional review board.

[bravofoxtrot]

http://www.priory.com/cmol/manageme.htm

http://www.postgradmed.com/issues/2005/03_05/cote.htm

Discusses management of COPD by Beta-2 agonists such as albuterol.

If COPD is a usually a result of two or three different respiratory diseases like asthmatic bronchitis, chronic bronchitis, and emphysema, I don't see how it could hurt. Wouldn't it give relief by just working the same way it works for asthma (except for treating the emphysema part)?

[THE_DITCH_DOCTOR]

I'm not saying it hurts, just wondering HOW it works- whether it is the power of suggestion or really some effect of the medication. That's all.

This questioning stems from the fact that many COPD patients have more of an emphysema component (tissue destruction and loss of elasticity leading to air trapping) than they do the bronchospastic effects of asthma. On either hand, remember the study is discussing patients who are having no overt wheezing and therefore are likely to be presenting with less bronchospasm and a greater degree of other issues.

By the way, one needs to remember that in common use, COPD is an umbrella term encompassing a myriad of diseases and it really depends upon who you ask which fall into this category. The ones I was taught in school were:

-Emphysema (your "classic" COPD patient)

-Chronic bronchitis

-Asthma

-Cystic fibrosis

-Bronchiolitis obliterans

-Bronchiectasis

Specifically speaking, in the eyes of the American Thoracic Society and the authors of the leading RT textbook (Egan's), COPD is technically emphysema combined with chronic bronchitis- airway hyperreactivity ("asthma") is a secondary, additional finding that is not present in all (or according to some- not even most) COPD cases. Technically, asthma is no longer considered to be part of "proper" COPD, but when they occur together it is referred to as "asthmatic COPD". There are also "asthmatic forms" of bronchitis. Remember, that when emphysema or bronchitis occur alone (without the other) the patient does not have COPD.

[BreathLife]

Albuterol is used in acute exacerbations of COPD due to its characteristics as a beta 2 agonist, as you yourself stated COPD is most commonly diagnosed as emphysema and a chronic obstructive/ restrictive respiratory complication. In an acute exacerbation thereof the beta 2 effect is not directed at the emphysema as much as it is directed to asthma, bronchitis, or another obstructive/ restrictive disease, thus hopefully alleviating the resulting bronchconstriction and improving FEV1, peak flow, and VT. It should also be considered that diminished BS does not only mean emphysema as it is commonly seen in status asthmaticus where the bronchioles have constricted to a point where there is little to no airflow, in cases such as these bronchodilators are much more than just a placebo, they are immediately necessary.

[AZCEP]

Thank you Breath,

In the words of Nancy Caroline,"Beware of the silent chest."

A lack of wheezing doesn't necessarily mean that the patient has another disease process. More often it reflects a lack of air movement altogether. For this group of patients, if they can't move the breathing treatment into the distal bronchioles/alveoli, there is no way for the medication, regardless of type, to have a significant effect.

Add to this the dehydration, and electrolyte abnormalities that go with repeated bronchodilator use, and we can guess that no amount of psychological placebo will work either.

Of course the fact that most meds that are prescribed will add to the problem with increased heart and respiratory rates, and the problem gets even bigger.

[NCFD18]

Speaking of Placebo Effect ever had a emphysema patient who freaked out when they think there not on 02. I've seen them have ^Resp. and look like there struggling to breath because they didn't think you still had them on 02 you have to tell them somtimes there on it. They get mentally dependant on it I think.

[Dustdevil]

No doubt about it. I've seen them panic themselves into distress if they couldn't find their inhaler, even if they weren't having any problems before.