The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

TREATMENT OF BRONCHIOLITIS WITH \beta_{2}-AGONISTS IN A CHILDREN'S HOSPITAL.

Ralph A. Lugo, PharmD, John W. Salyer. BS. RRT, J. Michael Dean, MD. Primary Children's Medical Center, Salt Lake City, Utah.

INTRODUCTION: The therapeutic role of \beta_{2}-agonists in the treatment of bronchiolitis is controversial. Studies suggest little to no improvement following their use. There is a clinical impression that a subpopulation of patients may respond, thus justifying a trial of albuterol. Accordingly, discontinuation of albuterol is warranted if no improvement is noted; however, this practice is infrequently implemented since albuterol is perceived as a benign and inexpensive drug. While the cost of albuterol is nominal, aggregate labor and material costs associated with nebulizer treatments may be significant. The objective of this retrospective study was to determine patient charges associated with the administration of \beta_{2}- agonists to children with bronchiolitis. In addition, we evaluated the utilization and response to \beta_{2}-agonists in a subset of patients and determined the frequency of continued \beta_{2}-agonist therapy, despite documentation of no clinical response. Methods:Hospital transaction data for all patients discharged from 1992 through 1994 with the principal diagnosis of bronchiolitis were analyzed for all billed procedures. The medical records of 80 noncritically ill children, aged two years or less, were randomly selected from this database for analysis of albuterol utilization. The following data were obtained: 1) patient demographics; 2) administration and response to nebulized albuterol administered in the emergency department (ED); 3) administration and response to nebulized albuterol after admission to the floor, and 4) discharge with a prescription for oral albuterol. Results: 1156 patients were admitted with the principal diagnosis of bronchiolitis in the 3-year period. Administration of bronchodilators was the third most costly intervention in this patient population. Ninety-two percent of patients utilized this intervention during their admission for a total of $190,997 over the three-year period. Sixty-four of the 80 randomly chosen patients were treated with albuterol in theED prior to admission. Twenty-three patients (36%) were documented nonresponders to therapy and 22 of these patients (96%) continued to receive albuterol after admission. Seventy- one of the 80 patients received nebulized albuterol following admission to the hospital, including both direct admissions and those admitted through the Ed. Thirty-one patients (43.7%) had no response to therapy, and in 27 of these nonresponders (87.1%) albuterol therapy was continued. Fifty-two percent of the documented nonresponders were discharged home on albuterol. CONCLUSION: The cumulative cost of administering nebulized \beta_{2}-agonists to children with bronchiolitis may be significant. Children with bronchiolitis often do not respond to nebuterol; nevertheless, therapy is often continued. The cost of treating children with bronchiolitis may be reduced by discontinuing \beta_{2}-agonists in cases where children do not respond.

Reference: OF-96-155

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