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A Randomized, Placebo-Controlled Trial of Bronchodilators for Bronchoscopy in Patients With COPD^*

^* From the Clinic of Respiratory Medicine and Pulmonary Cell Research University Hospital Basel, Basel, Switzerland.

Correspondence to: Daiana Stolz, MD, Department of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts Memorial Hospital, 55 Lake Ave N, Worcester, MA 01655; e-mail: stolzd{at}ummhc.org

Abstract

Background: In contrast to asthma, the indication for bronchodilators prior to bronchoscopy in patients with COPD has not been properly investigated. We therefore performed a randomized, double-blind, placebo-controlled trial to determine whether use of a short-acting bronchodilator provides a protective effect in patients with COPD undergoing bronchoscopy.

Methods: One hundred twenty patients undergoing bronchoscopy were included. Patients with COPD were randomized to receive either 200 µg of salbutamol (n = 40) or placebo (n = 40) before bronchoscopy. Control patients (n = 40) did not receive any inhaled medication. Spirometry was performed before and 2 h after bronchoscopy in all patients. Sedative drug requirements and hemodynamic parameters were recorded.

Results: Hemodynamic findings before, during, and after bronchoscopy were similar in patients with COPD randomized to either salbutamol or placebo (p = not significant for all). Compared to prebronchoscopy values, postbronchoscopy percentage of predicted FEV₁ decreased significantly in all three groups: salbutamol (median, – 4.7%; interquartile range [IQR], – 13.3 to 6.6); placebo (median, – 4.8%; IQR, – 19.9 to 8.4); and control subjects (median, – 10.0%; IQR, – 20.2 to – 3.3) [p = 0.023]. The decrease in FEV₁ was similar in all three patient groups (p = 0.432). The relative change in FEV₁ was inversely correlated to the increasing severity of COPD as expressed by Global Initiative for Chronic Obstructive Lung Disease stages (p = 0.01).

Conclusions: Premedication with an inhaled short-acting ß-agonist cannot be recommended in patients with COPD undergoing bronchoscopy.

Key Words: bronchoscopy • COPD • premedication