Study shows Safety and Benefits of Nebulized Bronchodilator (Brovana)
In the December 2014 issue of CHEST (volume 146; pages 1531-1542), Donohue and coauthors report that arformoterol (brand name: Brovana) used to treat patients with COPD showed a 40% lower risk of dying of failure of the lungs OR need to be hospitalized for worsening of their COPD (called an exacerbation) than those taking a placebo treatment.
Here is the reason for this study: The United States Food and Drug Administration (FDA) has required that all pharmaceutical companies that make certain types of inhaled bronchodilators called long-acting beta-agonists (abbreviated LABAs) perform long-term studies to ensure safety. In response to the FDA, Sunovion Pharmaceuticals Company sponsored a study of 841 patients evaluating nebulized bronchodilator: one-half inhaled arformoterol solution from a nebulizer twice a day, and the other half inhaled salt water from a nebulizer twice a day for one year. All subjects were able to take their other regular COPD medications.
The key findings were that:
1. more patients who received placebo (salt water) decided to stop being in the study
2. fewer patients receiving arformotrol were hospitalized for worsening of their COPD (an exacerbation)
3. lung function (breathing tests) and quality of life were better in those who received arformoterol than placebo
In summary, these findings are reassuring about the safety and benefits of arformoterol, a bronchodilator solution used in a nebulizer twice a day.
My Comment: Most patients with COPD use dry powder or aerosol (water droplets) medications that are inhaled from different devices. However, nebulized bronchodilator medications are available as an option. In my practice, I consider nebulized medications as treatment when someone with COPD:
1. is unable to use standard inhalers because of a physical problem, such as arthritis or a stroke
2. has difficulty coordinating breathing and breath holding
3. finds that it is not “easier to breathe” despite using correct technique with the inhaler
4. has a low peak inspiratory flow rate (PIFR). This means that the person does not have enough force to inhale the dry powder out of the device. Your PIFR can be measured in the doctor’s office or in a pulmonary function laboratory.
If any of these conditions fit your situation, you should discuss nebulized therapy with you doctor.
Donald A. Mahler, M.D.