The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

EFFICACY OF DOSIMETER-CONTROLLED SMALL VOLUME NEBULIZER BRONCHODILATOR THERAPY IN HOSPITALIZED ADULT PATIENTS.

Charles R Hall, Sr. BS, RRT, RPFT, R. Randall Baker, PhD, RRT, RCPT. Medical College of Georgia, Augusta, GA.

BACKGROUND: Hospitals have attempted to use self-administered MDI as the primary method for bronchodilator delivery due to decreased labor costs. However, use of an MDI to achieve bronchodilation requires proper technique, which is frequently inadequate even after instruction, or a spacer device. Often patients receive little or no follow-up instruction or fail to use a spacer device. Therefore, while hospitals may be saving money, patient treatments may be ineffective.

Methods: This study used a crossover design to examine the efficacy of bronchodilation comparing two methods of drug delivery: self-administered MDI without a spacer (saMDI) and dosimeter-controlled small volume nebulizer (dcSVN). In the dcSVN method, a computerized dosimeter controlled the delivery of precise doses of albuterol via a characterized small volume nebulizer (DeVilbiss 646, Pulmonary Data Services, Inc) driven by air at 30 psig. Twelve patients with a current physician order for albuterol were randomly assigned to receive bronchodilator therapy with either saMDI or dcSVN on Day 1 of the study. Subjects received the alternate method on Day 2 within two hours of the treatment time from Day 1. No therapy was given if subjects received a bronchodilator treatment within six hours of study treatment. Baseline spirometry was performed prior to treatment on Day 1 and Day 2. Subjects initially received 180 mg of albuterol via either dcSVN or saMDI. Spirometry was performed 15 minutes later to assess bronchodilator response. Then, a second 180 mg dose was given and spirometry was performed after 15 minutes. No adverse sequelae were noted in any treatment method.

Results: Eight of the 12 subjects (67%) responded to the bronchodilator as determined by post-bronchodilator increases of both ³ 10% and ³ 0.20 L in either FVC or FEV1. Spirometry data from the responder group were analyzed using a multivariate analysis of covariance. There was no statistical difference in baseline FVC and FEV1 values between Day 1 and Day 2. Differences in percent change from baseline in FVC (DFVCinit) and FEV1 (DFEV1init), absolute volume change in FVC (DFVC[L]) and FEV1 (DFEV1[L]), and percentage change from predicted FEV1 (DFEV1pred) were evaluated as outcomes for bronchodilation in saMDI and dcSVN. Bronchodilator response was significantly greater (p < 0.05) for dcSVN when compared to saMDI in each of the spirometric outcome measures.

(n=8) DFVCinit DFVC[L] DFEV1init DFEV1[L] DFEV1pred
saMDI 180 mg 1.6 ± 2.4 0.07 ± 0.07 4.7 ± 3.2 0.06 ± 0.06 1.7 ± 1.7
360 mg 2.7 ± 3.2 0.09 ± 0.09 4.9 ± 3.4 0.08 ± 0.07 1.8 ± 2.0
dcSVN 180 mg 11.6 ± 4.4 0.29 ± 0.02 12.3 ± 2.8 0.19 ± 0.03 5.2 ± 1.0
360 mg 15.9 ± 4.4 0.40 ± 0.13 14.6 ± 1.4 0.25 ± 0.03 7.1 ± 0.9
n, number of responders; Values expressed as [mean] ± SE

Conclusions: This study demonstrates that dcSVN therapy resulted in greater bronchodilation than saMDI using comparable doses of albuterol. Thus, dosimeter-controlled SVN therapy may improve patient care by providing more effective bronchodilator therapy than self-administered MDI without spacer.

OF-99-037

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