Quick Albuterol Nebulizer Cuts ER Time, Costs

0 Comments | Family Practice News, April 15, 2000 | by Mitchel L. Zoler

NEW ORLEANS -- A new nebulizer that cuts the time for administering inhaled albuterol for acute asthma was as safe and effective as a conventional nebulizer in a controlled study of 104 children.

By dropping the time needed for treatment by about 40 minutes, the Circulaire nebulizer reduced the patients' average length of stay in the emergency department by 52 minutes and cut the average total cost of care by about 16%, Dr. Kathy Monroe reported at the Southern regional meeting of the Society for Pediatric Research.

The Circulaire nebulizer "is a timesaving, cost-effective treatment," concluded Dr. Monroe, a pediatric emergency physician at the University of Alabama in Birmingham. The study did not receive support from the device's manufacturer, Dr. Monroe said.

The nebulizer has a novel baffle design that more effectively blocks large-size droplets of drug from reaching the patient's mouth. Larger droplets deposit in the mouth instead of being inhaled, and then go down the throat and are absorbed systemically. Because this is prevented with the new nebulizer, undiluted albuterol can be used, which means quicker treatment.

The study enrolled 108 children, 5-18 years old, who were experiencing a mild to moderate asthma episode. Their mean age was 10 years.

Forty-nine patients were randomized to treatment with a conventional, Hudson nebulizer. They received a standard dose of 0.09 cc albuterol/kg, which was diluted with saline to a total volume of 12 cc. The nebulizer flow rate was set to 8 L/min; it took 45 minutes to deliver the medication.

Fifty-five patients were randomized to the Circulaire group. They received 2 cc of undiluted albuterol during the first treatment and 1 cc during subsequent treatments, when needed, with a maximum of three treatments per episode. With a nebulizer flow rate of 8 L/min, the dose was delivered in 4 minutes.

Four patients were excluded from the analysis because they had seen a physician during the 48 hours prior to the study Dr. Monroe said.

Following treatment, the patients in the two groups had comparable average, final asthma scores and similar average changes in their peak flow rate. The incidence and types of adverse effects from albuterol in the two groups were also similar.

The average length of stay in the emergency department for patients treated with the Hudson nebulizer was 133 minutes, and their average, total emergency department charges were $665. Patients in the Circulaire group spent an average of 81 minutes in the emergency department, and their average total charges were $556.

The Circulaire nebulizer is made by Westmed in Lakewood, Colo.

Asthma Test for Children

The Kids' Asthma Check is a 21-question self-test designed for children aged 8-14 who have breathing problems. The self-test assesses asthma risk and, for those with asthma, gauges control of the disease.

Available beginning in May, the free test will also have a version that is designed to be completed by a parent for children up to age 7. The test was developed with funding from AstraZeneca, according to the American College of Allergy, Asthma, and Immunology, 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005-4425, 847-427-1200.

An online version of the test and a listing of free nationwide asthma screening sites will be posted at http://allergy mcg.edu.