Out of curiousity why do you stress not to use the same dose at home?
After all I regularly send patients home with nebulizers - 1 SVN q 4-6
hours during acute attack, why not 6-8 puffs with a spacer q 4-6 hours?
At 11:24 AM 9/8/99 -0400, Jeanne Lenzer wrote:
>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
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