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

Vandenbergh et al in 1967 noted that COPD patients with low weight had higher morbidity and mortality, and the question of the mechanism of this weight loss remains unanswered. A relatively recent finding of interest is that a number of such patients have a raised REE whether this is compared with values given by prediction equations or compared with control subjects matched for height and weight. Although there must be an imbalance of energy intake to energy expenditure for weight loss to occur, it is by no means certain that a raised REE is always the underlying cause; not all patients who are losing weight have an elevated REE. Elevation of REE, however, would exacerbate the problem as it would become increasingly difficult to match food intake to expenditure due to increasing weakness and inability to take in adequate calories leading to further weight loss. Gaining, or even maintaining, weight in these patients is a major clinical problem. Weight loss cannot be explained simply by a decreased energy intake, since the physiologic response to starvation is for REE to fall. One hypothesis is that the raised REE is due to an increase in the work of breathing. Canadian neighborhood pharmacy further If this were the case, one might expect that more effective bronchodilation might lead to a fall in REE and we did not observe this. However, change in PEF rate over time was small in each group and not enough to expect an effect on lowering work of breathing (mean change in PEF rate MDI group, 11 Us; mean change nebulizer group, 18 Us; p=not significant [NS]; Cl, -24 to 38 Us).
Our study aimed to answer the following question: does the regular use of high-dose nebulized β2-agonists cause or contribute to the raised REE seen in some patients with chronic airflow obstruction? We found no evidence for this. We also found no changes in weight, body composition, and HGS. We conclude that the clinical use of regular high-dose &beta2-agonists by nebulizer is not likely to contribute to the weight loss seen in patients with COPD.