# Nebulized Long-Acting Bronchodilators to Treat Acute Respiratory Failure in an Older Adult: A Case Report

## TL;DR

A 79-year-old man with severe COVID-19-induced respiratory failure improved after being treated with long-acting nebulized bronchodilators not typically approved for this condition.

## Contribution

This case report explores the off-label use of long-acting nebulized bronchodilators for acute respiratory failure in an older adult.

## Key findings

- The patient showed clinical improvement within three days of treatment with arformoterol and revefenacin.
- Long-acting bronchodilators demonstrated rapid-onset and long-duration effects in acute respiratory failure.
- The treatment was used in a non-approved context for acute respiratory failure secondary to COVID-19.

## Abstract

This report describes the case of a 79-year-old man admitted to the intensive care unit (ICU) for acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and treated with long-acting nebulized bronchodilators, arformoterol and revefenacin. This article aimed to assess the use of long-acting nebulized bronchodilators in an older adult with acute respiratory failure. The institutional setting was a 500-bed academic medical center in the southern US. Arformoterol is a long-acting beta agonist (LABA) and revefenacin is a long-acting muscarinic antagonist (LAMA), both approved to treat stable chronic obstructive pulmonary disease (COPD). Neither medication is US Food and Drug Administration approved for acute respiratory failure. In this case, both medications were used for their rapid-onset and long-duration bronchodilator activity to treat acute respiratory failure secondary to COVID-19. This older adult clinically improved within three days of nebulized long-acting bronchodilator use.