My recall is that approx. 8 puffs of Ventolyn delivers a dose comparable to
one alb. neb tx - I use MDIs
as first line tx in the ED preferably for a variety of reasons:
1. I can whether the patient is actually able to deliver the medication
to him or herself correctly; (a number of "treatment failures" are actually
delivery failures) - actually the most recent of which was a case in which
the patient had mistakenly inserted a steroid inhaler in his beta agonist
box and was using that for emergencies!) Another cause for failure was
mentioned by an asthmatic physician in some journal noting that the end of
the cannister was not as potent (apparently the accelerant is left at the
2. The extra expense and time it take for the neb tx are simply
unnecessary in many instances
3. I assure that the patient actually has a fresh MDI in hand to go
home - (I don't save the cannister).
When I have a patient take a few puffs - I usually just watch their response
after 2-4 puffs initially and add on as many more
puffs as needed - I always caution them that they should never do this at
home - that they are in the hospital in a controlled environment where we
can deal with any side-effects or reactions - otherwise they might be too
tempted to self-tx in the same manner. I know that this issue alone
is something that puts off other providers but I still prefer it. I only
use the nebulizer when the patient is in such distress that they clearly are
not going to be able to suck in any real volume. Results have been
uniformly excellent - esp. as I can just slide from MDI to neb tx as needed.
Our spacers are disposable (re the peak flow meters) but since I'm
dispensing the MDI itself its not an issue.
From: jay pershad <[log in to unmask]>
To: Multiple recipients of list PED-EM-L <[log in to unmask]>
Date: Wednesday, September 08, 1999 8:16 AM
>In light of all the evidence confirming the successful use of MDI's for
>to moderate acute asthma exacerbations, I was wondering if anybody is using
>them as a first line mode of Beta Agonist administration (instead of "wet"
>nebulizations) in cooperative patients???
>If so, how many puffs? How often? Are you reusing the canisters for
>patients? How is the re-use of spacers handled w.r.t sterilization etc?
>Thanks for your time & input.
>Jay Pershad, MD
>For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
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