The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

Evaluation of Recovery Medication after Bronchial Provocation Testing



Franklyn Sandusky, RRT, Thomas Kallstrom, RRT, FAARC, Fairview Hospital, Cleveland, OH

Background:
Our Pulmonary Function Lab does 20 Bronchial Provocation tests per month. As per protocol, when patient has a FEV1 a 20% reduction or more (or has reached the last administrated level), the patient is given a bronchodliator to reverse the effects of the methacholine. The bronchodilator (albuterol 2.5 mg ), is administered with a small volume nebulizer. Ten minutes after administration, the patient is retested (spirometry). If the spirometry has returned to normal, (within 10% of pretesting levels) the patient is released. If the Spirometry has not returned to acceptable levels a second treatment is given with albuterol and ipratropium bromide. Ten minutes after administration, the patient is retested (spirometry). If the spirometry has returned to normal the patient is released.

Objective:
The objective of the study was to determine if using levalbuterol 1.25 mg would affect a change in the number of patients requiring a second post test bronchodilator treatment.

Method:
The first month levalbuterol 1.25 mg would be administrated after methacholine administration. The next month, albuterol 2.5 mg was administered. Bronchodilator administration was administered via a small volume nebulizer, until medication was expended (sputter). Post-test spirometry was done at 5 and 10 minutes after administration of the bronchodilator. The numbers of bronchodilator treatments recorded.

RESULTS:
Testing took place over a four-month period, N=82 patients. Levalbuterol was tracked for an additional 2-month period. The monthly average, of bronchodilator readministations was 2 patients, regardless of bronchodilator administrated.

CONCLUSION:
The patients, requiring a second bronchodilator treatment, were unaffected by choice of bronchodilator. Therefore, use of albuterol or levalbuterol did not have an impact patient reversal. Patients receiving levalbuterol responded faster then the patients receiving albuterol. Patients receiving levalbuterol , had a significant response, FEV1 was within 10% of baseline, within 5 minutes. FEV1 remained unchanged at 10 minutes. Patients receiving albuterol, had FEV1 within 10% of baseline, after 10 minutes.

The cost of the medication must be considered. Hospital cost for unit dose albuterol is significantly less than Levalbuterol. With the time saving calculated in, mean of 6.3 minute wait verses mean of 12.4 minute wait, the total cost/ mean recovery time of Levalbuterol is $0.31 less than albuterol.

    Albuterol Levalbuterol Difference  
Sample Size (Male/Female) 82(32/50) 38(10/28) 44(22/22)    
Mean Age, Years (± SD) 45 (± 20.5) 43 (±18) 48 (±22)    
Mean Number of Treatments   1.24 1.25    
Mean Time For Recovery   12.4 6.3 6.10  
Cost of medication   0.13 1.83    
Cost of therapist/min   0.32 0.32    
total cost /mean recovery time    $4.22 $3.91 $0.31 savings
           

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