Nurse-initiated albuterol metered-dose inhaler for acute exacerbations of chronic obstructive pulmonary disease in an emergency department: A randomised controlled trial

Objective: A randomised controlled trial (RCT) to assess the effectiveness of nurse-initiated use of albuterol metered-dose inhaler (MDI) to patients for relieving the signs and symptoms of acute exacerbations of chronic obstructive pulmonary disease (COPD) prior to consultation in an emergency department (ED). Design: A single-centre unblinded RCT. Methods: Known COPD Chinese patients who aged at least 18 years old, previous use of albuterol MDI, competent to blow the peak flow meter and complained of dyspnoea. The anticipated time between nurse-initiated use of albuterol MDI and consultation was over five minutes. The subjects were recruited from the ED of a hospital in Hong Kong and were allocated to the albuterol or control group by block randomisation. Six albuterol puffs were administered via a MDI to the albuterol group but not the control group. Peak flow rate, blood oxygen saturation, respiratory rate, adverse effects, ED length of stay and admission rate were assessed before nursed-initiated use of albuterol MDI and prior to consultation. Results: 110 subjects were recruited and randomly allocated into the albuterol (n=55) or control (n=55) group. The PFR increased 2.4 L/minute (p<0.001) in the albuterol group but not in the control group. The oxygen saturation and symptom of dyspnoea also improved in the albuterol group but not in the control group. Conclusions: Nurse-initiated use of albuterol MDI can improve PFR prior to consultation so that it should be recommended as a standard practice in EDs to reduce the suffering of patients with acute exacerbations of COPD.