{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:40:10Z","timestamp":1792647610260,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>Non\u2010invasive ventilation (NIV) and inhaled bronchodilator therapy are foundational in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, optimal drug\u2010delivery strategies during NIV remain uncertain. This study compared bronchodilator delivery via a pressurized metered\u2010dose inhaler (pMDI) interface versus standard jet nebulization during NIV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This randomized, open\u2010label trial enrolled adults with hypercapnic AECOPD requiring NIV. Participants were randomized 1:1 to receive ipratropium bromide via pMDI using a modified NIV mask, or via jet nebulizer integrated into the inspiratory limb. Serum ipratropium concentrations at 30\u2009min constituted the primary bioequivalence endpoint, analysed using geometric mean ratios (GMR) and Bayesian posterior probabilities. Secondary outcomes included changes in physiologic parameters, blood gases, ventilatory asynchrony, duration of stay and cost effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010four patients were randomized; 41 were included in the intention\u2010to\u2010treat analysis (pMDI\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920, nebulizer\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921). At 30\u2009min, geometric mean serum ipratropium levels were higher with pMDI (110.9\u2009pg\/mL) versus nebulization (51.6\u2009pg\/mL), yielding a GMR of 2.15. Bayesian analysis showed a 95.9% probability that GMR exceeded the non\u2010inferiority threshold (0.80). At 6\u2009h, differences again favoured pMDI (GMR 3.18;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022; posterior probability 99.8%). Physiologic outcomes, gas exchange, and NIV duration were similar between groups, though ICU stay was shorter in the pMDI arm. No safety concerns or device\u2010related complications were observed. Post hoc cost analysis showed markedly lower therapy cost with pMDI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>pMDI\u2010based bronchodilator delivery during NIV using a customized interface is feasible, safe, cost\u2010efficient, and achieves higher systemic drug levels than jet nebulization. Larger multicentre trials are warranted to determine clinical impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Clinical Trials Registry of India CTRI\/2023\/07\/054734<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/resp.70334","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:28:32Z","timestamp":1792646912000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bronchodilator Drug Delivery With Pressurized Meter\u2010Dose\u2010Inhaler Versus Jet Nebulizer With Noninvasive\u2010Ventilation in Acute\u2010Exacerbation of\n                    <scp>COPD<\/scp>\n                    : A Randomized Controlled Pharmacokinetic Endpoint Trial"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4101-062X","authenticated-orcid":false,"given":"Vishal","family":"Raj","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3212-9875","authenticated-orcid":false,"given":"Pawan Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rama","family":"Akondy","sequence":"additional","affiliation":[{"name":"Department of Biology, Trivedi School of Biosciences Ashoka University  Sonipat India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0307-3427","authenticated-orcid":false,"given":"Aman","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyothi Geethamohan","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6437-6275","authenticated-orcid":false,"given":"Munmun","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Biology, Trivedi School of Biosciences Ashoka University  Sonipat India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0726-4474","authenticated-orcid":false,"given":"Vineela","family":"Surapaneni","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3818-7205","authenticated-orcid":false,"given":"Samruddhi Dhanaji","family":"Chougale","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences  Rohtak India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saima","family":"Ejaz","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences  Rohtak 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