title: Automatic replacement of albuterol nebulizer therapy by metered-dose inhaler and valved holding chamber.
abstract: OBJECTIVE
  Evidence supporting the delivery of bronchodilators with a metered-dose inhaler and a valved holding chamber (MDI+VHC) in place of a small-volume nebulizer (SVN) is discussed, and the steps taken to accomplish such a conversion program at one institution are described.
  
  
  CONCLUSIONS
  Double-blind, randomized studies in patients with acute exacerbations of asthma have demonstrated that higher doses of albuterol delivered by MDI+VHC (4-10 puffs per dose) are as effective as 2.5 mg of albuterol sulfate delivered by SVN. Three double-blind studies support the conclusion that the two methods are equivalent with respect to both efficacy and adverse effects in patients with chronic obstructive pulmonary disease. MDI+VHC offers practical advantages over SVN, including the capacity for home use by the patient, portability, less setup time, and no need for daily disinfection. Pharmacists and respiratory therapists obtained approval through the pharmacy and therapeutics committee for respiratory therapists to convert orders for bronchodilators delivered by SVN to administration by MDI+VHC. The conversion policy allows physicians to override it, but none have exercised this option. On intensive care units (ICUs), the policy resulted in a 53% increase in the use of MDI+VHC during the six-month period after it went into effect. Respiratory therapists have been less thorough in implementing the policy for non-ICU patients.
  
  
  CONCLUSIONS
  Delivery of bronchodilators by MDI+VHC is as effective as delivery by SVN but offers several advantages. A policy to switch patients from SVN to MDI+VHC for bronchodilator administration met with limited success.
authors.affiliation: Pharmacy and Pediatrics, University of Florida (UF), Gainesville, USA. hendeles@cop.ufl.edu
authors.forename: Leslie
authors.initials: L
authors.lastname: Hendeles
authors.forename: Randy C
authors.initials: RC
authors.lastname: Hatton
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Coons
authors.forename: Leah
authors.initials: L
authors.lastname: Carlson
mesh_terms: D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D016134:Organizational Policy; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol