Usually these are patients I've seen in the ED and also started on
steroids, arranged follow-up for. But i usually d/c on high dose albuterol
in attempt to keep them from 'bouncing' back and getting admitted in the
first 24 hours from inadequate albuterol dosing...
At 07:16 AM 9/10/99 -0400, Jeanne Lenzer wrote:
>My main reason for sticking with the low/standard (2 puffs q4h prn) dosing
>is that I
>regularly see patients in the ED with near fatal (and occ. fatal) asthma
>that they've unsuccessfully tried to manage at home
>relying solely on erratic doses of beta agonist (without any other meds).
>By telling them that they must come in if they need more than the standard
>dose, I can help them determine if they need inhaled steroids, mast-cell
>inhibitors, treatment of a sinusitis or GERD
>or whatever else before they get in serious trouble. In my very rural area,
>it is not uncommon to see locals/farmers and their children with such such
>advanced inflammatory reaction that it's very hard to bring them around in
>the ED -- and they're on nothing other than Ventolyn.
>But your point is well-taken, neb treatments probably supply more than the
>standard MDI dose which is one part of the reason that I am reticent to
>prescribe them in anyone other than the youngest of children - and I make
>sure these patients are watched closely.
>Perhaps your patients have fewer problems? Maybe they are more compliant on
>From: virgil <[log in to unmask]>
>To: Multiple recipients of list PED-EM-L <[log in to unmask]>
>Date: Thursday, September 09, 1999 10:22 PM
>Subject: Re: MDI
>>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
>>>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
>>>to him or herself correctly; (a number of "treatment failures" are
>>>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
>>>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
>>>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
>>>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
>>>>them as a first line mode of Beta Agonist administration (instead of
>>>>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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>>message: info PED-EM-L
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>>For more information, send mail to [log in to unmask] with the
>message: info PED-EM-L
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message: info PED-EM-L
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