The Science Journal of the American Association for Respiratory Care
OBJECTIVE: Manufacturer's guidelines and recommendations have cautioned the use of high dose bronchodilators via Metered Dose Inhaler (MDI). At UCSD Medical Center, the Patient Driven Protocol for Bronchodilator Administration incorporates the titration of MDI dose with a range of 2-20 puffs based on the severity of the patients illness and response to therapy. This dosing regimen permits a larger number of high dose therapies. Our objective was to determine if there was a significant increase heart rate with high dose bronchodilator administration. METHOD: We collected Data on 43 adult patients who received 16-20 puff of Albuterol or Combivent from 10/98 to 2/99. There was no exclusion of patients due to diagnosis or severity in disease process. Bronchodilator dose and pre/post heart rate was tracked as well as any adverse reaction. Significant increase heart rate was defined as a change of 20 BPM or greater.
Results: The total number of MDI treatments administered was 333 with an average dose of 17.34 puffs per treatment. Only 1 patient demonstrated a heart rate increase of 20 or greater. This patient received a total of 47 treatments with 20 puffs. Treatment number 27 and 28 had an increase heart rate of 20 BPM and 29 BPM prospectively. Of the 333 treatments the mean heart rate before treatment was 100.16 with a mean of 102.67 after treatment. The mean change in heart rate before and after treatment was 2.4 BPM. CONCLUSION: Our data indicates that high bronchodilator doses of 16-20 puffs have no significant side effect on patient heart rate.