Chronic Obstructive Pulmonary Disease Exacerbation Chronic Obstructive Pulmonary Disease Exacerbation Nebulized High-Dose Inhaled Corticosteroid Emergency department ICS Nebulization
Conditions
Interventions
Budesonide 2000 mcg (1000 mcg/2 ml, 2 respules) and 1.25 mg fenoterol and 0.5 mg ipratropium bromide q 20 minutes x 3 doses,Normal saline 4 ml and 1.25 mg of fenoterol and 0.5 mg of ipratropium bromid
Experimental Drug,Placebo Comparator Drug
Sponsors
Thai College of Emergency Physicians (TCEP)
Eligibility
Sex/Gender
All
Age
40 Years to No maximum
Inclusion criteria
Inclusion criteria: 1.Volunteers aged 40 years or older who have been diagnosed with chronic obstructive pulmonary disease (COPD), as evidenced in medical records or the hospital's database system. 2. Having symptoms and signs of exacerbation of chronic obstructive pulmonary disease (COPD), including shortness of breath, rapid breathing, breathing difficulties, chest tightness, coughing, and wheezing.
Exclusion criteria
Exclusion criteria: 1. Presence of respiratory failure with indications for endotracheal intubation in any of the following cases: - Altered of consciousness or restlessness - Air hunger - Cyanosis - Cardiopulmonary arrest 2. Indications for the use of non-invasive ventilation (NIV) in any of the following cases: - Respiratory acidosis, defined as PaCO2 is greater than or equal to 45 mmHg and pH is less than or equal to 7.35 - Severe fatigue with signs of respiratory muscle exhaustion, such as the use of respiratory accessory muscles, respiratory paradox, or intercostal retraction - Persistent hypoxemia despite oxygen therapy 3. Indications for the use of high-flow nasal cannula (HFNC) from the initial presentation when any of the following criteria are met: - Pulse oximetry (SpO2) less than 92% when breathing room air - PaO2/FiO2 (PF) ratio of less than 300 mmHg on any mode of oxygen support - SpO2/FiO2 ratio of less than 315 on any mode of oxygen support 4. History of an allergy to corticosteroids** 5. Suspected or diagnosed infection meeting the criteria for investigation of the 2019 coronavirus disease (COVID-19) 6. Suspected or diagnosed disseminated pulmonary tuberculosis infection 7. Inability to cooperate in pulmonary function testing (e.g., spirometry or peak expiratory flow) 8. Presence of other emergency conditions, such as heart failure, acute myocardial infarction, or shock 9. Use of systemic steroids or an increase in the dosage of inhaled corticosteroids (ICS) within the past 7 days 10. Volunteers diagnosed with asthma-COPD overlap syndrome or bronchiectasis, as documented in medical records
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Length of hospital stays On the day of hospital discharge Number of days | — |
Secondary
| Measure | Time frame |
|---|---|
| Pulmonary function test (%predicted PEF) At the initial presentation and 1 hour after nebulization for total of 4 hours Spirometry ,Brog dyspnea score At the initial presentation and 1 hour after nebulization for total of 4 hours Brog dyspnea scale | — |
Countries
Thailand
Contacts
Public ContactKumpol Kornthatchapong
Department of Emergency medicine, Faculty of medicine, Thammasat university
Outcome results
None listed