Yes, we are using MDI/Spacer Salbutamol for mild/moderate asthma
exacerbations. We are aiming to reduce nebuliser usage as much as possible
in the light of the recent papers. We are also trying to convert patients
with more serious exacerbations on to spacer multidosing as soon as
possible. "Every nebuliser is a missed opportunity to teach the parents how
to multidose !"
How many puffs? We have no strict criteria. Roughly <2yr 4-6 puffs, 2-6yr
6-8 puffs, 6yr+ 8-10+ puffs. We tend to err on the high side on the
assumption that side effects would be greater with a nebuliser anyway.
How often? As often as the patient needs it - as often as you would give a
Practices with canisters & spacers (usually Ventolin & Volumatic - Allen &
Hanburys) vary depending on the nursing staff. Usually, a new set will be
opened & labelled for each new patient and this set will stay with the
patient throughout their stay in the hospital. The set is then given to the
patient/parent on discharge from the hospital. I'm not sure how this set up
would work in your Health Care System! Volumatics can be washed in soapy
water and left to dry.
Incidentally, we have realised the importance of checking canisters prior to
discharge and ensuring that the family have enough medication to see them
through until then they can make contact with their GP (Family
Practitioner). 8 puffs 3-4 hourly can run out a 200 dose MDI very quickly.
We try to put a lot of effort into parent/patient education and try to have
asthma plans for all parents on discharge. We stress very strongly the
correct technique for multidosing - that is, shake MDI, puff once, take 5-10
breaths then shake again before the next puff.
We are very positive when talking
to parents about Multidosing as many of them see nebulisers as magic bullets
and often want one at home - with all the problems that that brings. We feel
that if they see Multidosing working when their child is sick, they will
have the confidence to deal with the next attack at home.
Specialist Registrar in Paediatrics
Royal Hospital for Sick Children
P.S. Sorry about the UK spelling!!
----- Original Message -----
From: jay pershad <[log in to unmask]>
To: Multiple recipients of list PED-EM-L <[log in to unmask]>
Sent: Wednesday, September 08, 1999 4:25 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
> 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
> "PEM -pal"
> For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
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