Effects of Combined Long-Acting Beta 2-Agonists and Inhaled Corticosteroids Therapy on Lung Mechanics and Airway Secretion in Prolonged Mechanical Ventilation Patients with Chronic Obstructive Pulmonary Disease

Background: To investigate the effect of combined long-acting β2 agonists (LABA)/ inhaled corticosteroids (ICS) on the lung mechanics and airway secretion in prolonged mechanical ventilation (PMV) patients with chronic obstructive pulmonary disease (COPD). Methods: Data from PMV patients receiving LABA/ICS in the respiratory care ward of Taichung Veterans General Hospital-Chiayi Branch from October 1 to December 31, 2011 were reviewed. The demographic data, nutrient parameters, and airway dynamic parameters were recorded. The weekly checked data during the 6-week period of use of LABA/LCS (4 puffs twice a day) were analyzed, including secretion quantitative grading scores, airway resistance, incidence of pneumonia, and weaning status. Results: Nineteen male patients with a mean age of 81.1±7.6 years and duration of ventilator use of 198.7±254.9 days were enrolled. They were in a chronic wasting status with low albumin (2.8±0.5 g/dL) and body mass index (19.8±3.8) despite adequate caloric intake (1821.0±199.0 kcal). Airway secretion clearance and dynamic parameters showed impaired airway secretion clearance and increased airway resistance. After the use of LABA/ ICS, airway resistance decreased by 16.3±15.2% temporally. Airway secretion quantitative scores decreased gradually and the frequency of ventilator-associated pneumonia (VAP) also significantly decreased from 0.82±0.75 to 0.56±0.55 times/month. Three patients were weaned from ventilator support for a cumulative weaning rate of 18.5%. Conclusions: A reduction of airway resistance, airway secretion, and incidence of VAP and ventilator-dependent conditions with combined use of LABA/ICS in PMV patients with COPD was observed. However, more prospective studies are needed to validate further utilization of LABA/ICS for those patients weaning from ventilation.