The Science Journal of the American Association for Respiratory Care
Background: Previous studies have demonstrated the superior performance characteristics of the CirculaireTM Nebulizer and that abbreviated and undiluted bronchodilator therapy is as safe an efficacious to a conventional small volume nebulizer. This study compared abbreviated (six minute) aerosol therapy with albuterol and ipratropium bromide using a CirculaireTM nebulizer to non-abbreviated (fifteen minute) aerosol therapy with the same drug mix using a conventional small volume nebulizer for safety and efficacy.
Methods: All patients entering our Emergency Department with an increased work of breathing requiring aerosolization of the combination albuterol and ipratropium bromide were randomized to either the abbreviated CirculaireTM treatment or the hospitals' standard nebulizer treatment. The sample was comprised of 60 patients. Variables included pre and post treatment, work of breathing, hear rate, respiratory rate, peak expiratory flow, FEV1, patient's tremulousness and relief of dyspnea. Statistical analysis using t-test compared the groups of the first treatment, and all treatments. Data was also compared using pre treatment variables. Patients response to work of breathing, relief of dyspnea, case of use, and tremulousness were ranked using a Likert 5 point scale; 1 lowest and 5 highest.
|Variable||6 min/CirculaireTM Mean||SVN Mean||P-Value|
|Work of breathing||*||2.73||2.16||0.41|
|pt. noted relief||4.13||4.25|
|pt. noted ease of use||*||3.50||4.16||.01|
|pt. noted tremulousness||2.30||2.01|
|Change in heart rate||.17||-1.70|
|Change in resp. rate||-1.40||-2.00|
|Change in PEFR l/m||22.33||34.50|
|Change in FEVI liters||0.22||0.25|
|* Statistically Significant|
Results: Both treatments were equally safe and the abbreviated consumed about 9 minutes less and was easier to use by patients. The standard fifteen minute treatment mean change in PEFR was 50% higher, but not statistically significant (P=228). This could partially be explained by significant increases in work of breathing and respiratory rate of the 6 minute group even with randomization. FEV1 were comparable between both groups.
Conclusion: Abbreviated treatments using albuterol and ipratropium bromide using a CirculaireTM Nebulizer provided comparable bronchodilation with improved efficiency and potential cost savings.