The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts


Bob Langenderfer, MEd, RRT, Asst. Prof and R.C. Clinical Coordinator, Northern Kentucky Univ. Highland Heights, KY.

Background: As the active component of racemic albuterol, levalbuterol provides a longer duration of bronchodilation than does racemic albuterol. Levalbuterol lacks the (S)-isomer that triggers bronchoconstrictive and proinflammatory effects. The higher dose of active ingredient allows Q8 or Q6 levalbuterol to provide bronchodilation as effective as Q4 racemic albuterol.

Hypothesis: Xopenex given Q8 (or Q6 if necessary) and PRN can provide bronchodilator coverage equivalent to albuterol given Q4 and PRN. Despite a higher drug cost per dose, the reduction in total HHN treatments and associated labor through a Xopenex protocol could lead to significant cost savings.

Methods: At St. Elizabeth Medical Center, Edgewood, Ky., a Xopenex Substitution Protocol allowed RTs to give1.25 mg levalbuterol by HHN Q8+PRN (or Q6+PRN if necessay) in place of the standard 2.5 mg albuterol Q4+PRN. During a 60 day trial, all COPD and asthma patients admitted by a staff pulmonologist or hospitalist went under the Xopenex protocol. If Atrovent was ordered, it was given on the Xopenex schedule.

Results: During the 60 day trial, 228 patients were treated with Xopenex and 528 with albuterol for an overall average of 12 HHNs per patient hospitalization. In the same time period of the previous year, 530 patients were all treated with racemic albuterol at an average rate of 15 treatments per admission. Compared with the HHN/Pt rate of the previous year, the protocol avoided 1912 treatments during the trial. With a labor cost of $5.46 per tx, the protocol led to a labor savings of $10,440 over the 60 day trial period. Savings with hospital wide use of the Xopenex protocol is projected to be $53736.

Conclusions: Providing bronchodilator therapy for acute asthma and COPD with 1.25 mg Xopenex on a Q8+PRN (or Q6+PRN if necessary) schedule yields significant cost savings when compared to the standard regimen of Q4+PRN albuterol.

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