Effect of Regular Use of High-dose Nebulized β2-Agonists on Resting Energy Expenditure, Weight, and Handgrip Strength in Patients With Chronic Airflow Limitation: Discussion

Effect of Regular Use of High-dose Nebulized β2-Agonists on Resting Energy Expenditure, Weight, and Handgrip Strength in Patients With Chronic Airflow Limitation: DiscussionThere were no changes in any of the parameters over time, either in the group receiving nebulized β2-agonists or the group receiving MDI therapy as shown in Table 2. The quality of life scores did not change significantly over time. There were no differences in the change from baseline between the two groups in any of the parameters as shown in Table 3 read more buy antibiotics online. At the second measurement, one patient had remained hypermetabolic (in the MDI group), one with a previously significantly elevated REE had become normometabolic (nebulizer group), and two who had been normometabolic previously had developed a significantly raised REE (one from each group) (Fig 1). There was no relation between the interval time between studies and change in REE.
Discussion
This study was not randomized but nebulized medication was prescribed after an independent outpatient assessment using predetermined guidelines. We believed that it would have been unethical to randomize patients after their clinical assessment and therefore deny nebulized bronchodilator treatment to symptomatic patients who had been shown to benefit from it. The initial measurements and the study were, however, prospective and the group who were eventually prescribed long-term nebulized drugs were indistinguishable in all other respects from the group who were not prescribed a nebulizer. There was a trend for the group prescribed nebulized β2-agonists to weigh less, but this did not reach statistical significance. We carried out no independent check on compliance, but the patients were questioned closely with this in mind when they returned for their repeat study and in the intervening routine clinic follow-ups. In our experience, patients at this stage of their disease, shortly after a detailed assessment, do use their nebulized drugs regularly. Therefore, we believe that there were substantial differences in the daily β2-agonist doses received by the two groups of patients.

Figure 1. Change in REE over time. Circle=nebulizer group; triangle = MDI group.Figure 1. Change in REE over time. Circle=nebulizer group; triangle = MDI group.


Table 2—Change Over Time From First Measurement to Second Measurement for Group Receiving Nebulized Salbutamol and Group Receiving Inhaled Salbutamol

Weight,kg ND HGS, kg ND MAC, cm ND TSF, mm % FFM Pred REE kJ/24 h REE, % HB REE,kj/h/kg REE,kJ/li/FFM
Neb (n=8) t=0
Mean 60.1 24 27.4 11.5 71 5,270 100 3.76 5.37
SD 14.5 7 4.3 5.1 8 949 7.1 0.46 0.79
t=8.1m
Mean 60.8 22 27.5 11.8 71 5,321 100 3.74 5.3
SD 17.4 8 4.4 5.7 8 1,100 8.8 0.46 0.84
paired t NS NS NS NS NS NS NS NS NS
MDI (n=8) t=0
Mean 72.7 27 29 13.3 69 6,199 99 3.55 5.16
SD 18.1 11 3.3 4.3 4 1,257 9 0.33 0.54
t=6.3m
Mean 74.2 29 29.8 14.4 67 6,250 99 3.41 5.21
SD 17.3 12 3.6 3.8 4 1,218 12 0.61 0.57
paired t NS NS NS NS NS NS NS NS NS
95% Cl (-1909 to 304) (—5.5 to 9.5) (-0.13 to 0.57) (-0.38 to 0.81)
unpaired t NS NS NS NS
(for baseline comparisons)

Table 3—Change From Baseline for Group Receiving Nebulized Salbutamol and Group Receiving Inhaled Salbutamol

Weight,kg ND HGS, kg ND MAC, cm ND TSF, mm FFM,kg REE,kj/min REE, kj/h/kg FFM NPRQ
Neb (n=9)
Mean 0.99 0.43 -0.18 0.37 0.79 0.02 -0.08 0.04
SD 5.02 6.27 1.13 3.15 4.11 0.38 0.60 0.09
95% Cl (-2.9 to 4.8) (-4.4 to 5.2) (-1.1 to 0.7) (-2.0 to 2.8) (-2.4 to 3.9) (-0.27 to 0.31) (-0.54 to 0.37) (-0.03 to 0.12)
MDI (n=8)
Mean 1.53 2.00 0.76 1.15 0.04 0.01 0.05 0.04
SD 3.62 3.85 1.48 2.16 2.27 0.44 0.62 0.09
95% Cl (-1.7 to 4.8) (-1.4 to 5.4) (-0.6 to 2.1) (-0.8 to 3.1) (-2.0 to 2.1) (-0.39 to 0.40) (-0.5 to 0.60) (-0.04 to 0.12)
t test NS NS NS NS NS NS NS NS
95% Cl (difference) (-5.2 to 4.1) (-7.1 to 4.0) (-2.4 to 0.5) (-3.7 to 2.1) (-2.8 to 4.3) (-0.4 to 0.4) (-0.79 to 0.51) (-0.10 to 0.10)