Effectiveness and acceptability of a domiciliary multidrug inhalation treatment in elderly patients with chronic airflow obstruction: Metered dose inhaler versus jet nebulizer

The aim of this study was to compare the immediate and long-term bronchodil ator effect as well as the patient acceptability of a 2-week, multidrug, in halation treatment delivered by a metered dose inhaler (MDI) versus a jet n ebulizer in a group of elderly patients with chronic obstructive pulmonary disease (COPD) or asthma and an at least partially reversible airflow obstr uction. Twenty elderly outpatients (17 men; mean +/- SD age, 67 +/- 2 years ; mean +/- SD baseline forced expiratory volume in 1 second [FEV1], 46.5 +/ - 14% of predicted value) with COPD or asthma participated in the study, wh ich was of an open, randomized, crossover design. After a 1-day baseline ev aluation, including patient history, clinical examination, and spirometry, participants were randomly assigned to receive a multidrug inhalation treat ment (a combination of salbutamol, ipratropium, and flunisolide) with eithe r an MDI or a jet nebulizer. Two weeks later, they were shifted to treatmen t with the alternative system for a further 2 weeks. FEV1 was measured on t he first and fourteenth days of each treatment period, on each occasion bot h before and 30 minutes after the morning inhalation. At the end of the stu dy, patients were asked to express a personal preference for one of the two inhalation treatments with regard to effectiveness and acceptability by fi lling out a simple questionnaire. Both the MDI and jet nebulizer had a sign ificant immediate bronchodilator effect on the first and fourteenth days of treatment, with no differences between treatments. No long-term bronchodil ator effect was seen with either aerosol delivery system. Patient preferenc es were clearly in favor of the jet nebulizer with regard to effectiveness and in favor of the MDI with regard to acceptability. In conclusion, in eld erly patients with COPD or asthma and partially reversible airflow obstruct ion, a maintenance multidrug bronchodilator/anti-inflammatory inhalation tr eatment produced a statistically significant and clinically relevant bronch odilator effect without substantial differences between the two delivery sy stems. Most patients considered the MDI to be more acceptable and the jet n ebulizer to be more effective. These preferences should be taken into consi deration when prescribing a maintenance aerosol inhalation treatment.