A Randomized, Placebo-Controlled Trial of Bronchodilators for Bronchoscopy in Patients With COPD

Background:In contrast to asthma, the indication for bronchodilators prior to bronchoscopy in patients with COPD has not been properly investigated. We therefore performed a randomized, double-blind, placebo-controlled trial to determine whether use of a short-acting bronchodilator provides a protective effect in patients with COPD undergoing bronchoscopy.Methods:One hundred twenty patients undergoing bronchoscopy were included. Patients with COPD were randomized to receive either 200 μg of salbutamol (n = 40) or placebo (n = 40) before bronchoscopy. Control patients (n = 40) did not receive any inhaled medication. Spirometry was performed before and 2 h after bronchoscopy in all patients. Sedative drug requirements and hemodynamic parameters were recorded.Results:Hemodynamic findings before, during, and after bronchoscopy were similar in patients with COPD randomized to either salbutamol or placebo (p = not significant for all). Compared to prebronchoscopy values, postbronchoscopy percentage of predicted FEV1decreased significantly in all three groups: salbutamol (median, − 4.7%; interquartile range [IQR], − 13.3 to 6.6); placebo (median, − 4.8%; IQR, − 19.9 to 8.4); and control subjects (median, − 10.0%; IQR, − 20.2 to − 3.3) [p = 0.023]. The decrease in FEV1was similar in all three patient groups (p = 0.432). The relative change in FEV1was inversely correlated to the increasing severity of COPD as expressed by Global Initiative for Chronic Obstructive Lung Disease stages (p = 0.01).Conclusions:Premedication with an inhaled short-acting β-agonist cannot be recommended in patients with COPD undergoing bronchoscopy.