title: Nebulisers or spacers for the administration of bronchodilators to those with asthma attending emergency departments?
abstract: BACKGROUND
  Systematic reviews and national guidelines conclude that the nebulised route of administration of bronchodilators has no advantage over the use of a spacer in moderately severe exacerbations of asthma. Whether this recommendation is implemented and whether it might affect use of staff time is unknown.
  
  
  OBJECTIVE
  To determine the current method of administration of bronchodilators to those with non-life-threatening asthma attending emergency departments (ED) in London, UK and to monitor the implementation of a new policy to administer bronchodilators by spacers in one ED with a special reference to the time taken by nurses to administer the therapy by two different routes.
  
  
  METHODS
  Thirty-five EDs in Greater London were surveyed regarding their current practice. A time and motion study was then undertaken in one department observing nurses administering bronchodilators in the 3 weeks before and 3 weeks after a departmental policy change to favour the use of spacer devices rather than nebulisers.
  
  
  RESULTS
  The majority of EDs (94.3%) in Greater London were using the nebulised route of administering bronchodilators to the majority of their adult patients. Spacers were more commonly used for the treatment of children (60.3% of departments using spacers and nebulisers or spacers alone). Over half of the hospitals surveyed (51.4%) were unaware that the British Guidelines on Asthma Management suggested that outcomes were the same and that there were potential advantages in the use of a spacer for both adults and children. Time and motion studies showed that the use of a spacer took no more nursing time than administration of the bronchodilator via a nebuliser; in fact treatment and set-up time were considerably lower for spacers.
  
  
  CONCLUSIONS
  Spacer administration of bronchodilators to those with asthma attending EDs utilises less treatment time than use of a nebuliser. A survey of EDs in Greater London has shown that despite guideline conclusions there appears to be little evidence of reduction in use of nebulisers; a fear that use of alternatives might take nurses longer is not supported by this study.
authors.affiliation: NHLI Division, Faculty of Medicine, Imperial College London, Charing Cross Campus, London W6 8RP, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Mason
authors.forename: Nicola
authors.initials: N
authors.lastname: Roberts
authors.forename: Nick
authors.initials: N
authors.lastname: Yard
authors.forename: Martyn R
authors.initials: MR
authors.lastname: Partridge
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000191:economics; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D003362:Cost-Benefit Analysis; D016503:Drug Delivery Systems / Q000191:economics / Q000379:methods; D004636:Emergency Service, Hospital / Q000191:economics; D019317:Evidence-Based Medicine / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D036503:Inhalation Spacers; D008131:London; D008297:Male; D009330:Nebulizers and Vaporizers; D017410:Practice Guidelines as Topic; D013997:Time Factors
chemical_list: D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents