o2 flowrate for Albuterol

[Tigger]

I would suggest that you try to use a spacer that has an attached mask or place a silicone connector onto the mouthpiece of a spacer so you can attach a cushion style BVM mask. People often say that they can't use a puffer because they can't inhale...which makes me wonder how the nebulized meds make it down...

By the way, they make spacers for horses since they are prone to exercise induced asthma.

Many of them have just come off the field or ice and feel that they can't take a deep enough inhale to use it properly. After a minute or two on the neb they apparently open up enough to start "properly" using the neb.

I don't really have much of an idea of which one is more appropriate I will admit. My Athletic Trainer bosses usually give me the "it works when we do it this way, so we do it" type explanation. I'm trawling for knowledge here.

 

[ThadeusJ]

For athletes, by far the best approach is to have them take the medications long before they hit the ice/field. I don't dispute the fact that cold, damp air of arenas contributes to exercise induced bronchoconstriction. The monograph for Ventolin states that a "measurable improvement" can be found within 5-15 minutes, but peak effect is in 60-90 minutes, lasting 3-6 hours. These are the results of pulmonary function studies repeated many times. Ipratropium is longer than that but has a synergistic effect when given with albuterol.

Personally my feeling is that the vast majority of bronchodilator "success" is anecdotal, subjective and far over-relied upon. Unfortunately this has led to forum threads and social website pages dedicated to the fact that these classification of drugs are prescribed for almost every illness. Will it change our practice? Probably not.

 

[Tigger]

Problem cases are given nebulizer treatments prior to competition or practices that the athlete believes will likely can cause an issue. We use mostly albuterol but some athletes receive levalbuterol under the request of a team physician.

If an athlete has to stop competition because of bronchoconstriction that is not responsive to an MDI (for whatever reason, I can't make them use it properly though I do try), they are held out for at least 20 minutes to give the medication a bit more time to work.

I've dealt with an athlete with fairly severe exercised induced asthma and Thalassemia. For me he can be a fairly worrying case during an asthma exacerbation. He looks like crap, becomes quite lethargic, sometimes has blue lips and often has a pulse oximetry reading in the low 80s. He usually responds quite well to a nebulizer treatment and perks up in only a few minutes.

 

[mycrofft]

I am enjoying the low degree of armchair quarterbacking here.

I was treating a population of people with issues relating to drug abuse (including albuteral), crack and crank smokers, the offspring of crank and crack smokers, tobacco smokers (but we were a nonsmoking facility, ha), ER-as-primary care, medication sharers/self-prescibers, and some really bad asthmatics as well.

1. Most had some of the MDI routine right, but many had bad timing (or rhythm). "Blipping" the canister and squirting it four or five time in full-auto was not enthusing. One old guy did it 13 times; when I asked him how many times, he said two.

2. Non-asthmatics using them as a pre-basketball performance enhancer. Not saying it worked, and some folks I think had bad effects from this, but they used it for that.

3. We had the $20 Transformers-like folding spacers. but found proper technique and one segment of blue respiratory tubing did as well for adults. Poor technique left powder inside the tube and we could point to it as a teaching tool for better technique.

4. Did you know you can spray albuteral or its older cousins on cigarettes and get a buzz?

5. When I started teaching and administering inhalers (1987) you had to hold your mouth off the mouthpiece. Now most if not all inhalers have an air gap between the canister and the handpiece wall allowing enough air to pass with your mouth closed on it IF you have pretty decent inspiratory effort.

BTW, we had personalized inhalers in a big wall organizer, and wasted out dozens of seemingly full ones each month; checking the books, those pt's stopped asking for them after the first or second time because we would not give it if not needed, and we would not let them machine-gun doses as they were used to. They did just fine. Stopping smoking of everything helped, but we wasted hundreds of dollars and man-hours each month.

 

[MSDeltaFlt]

Here's the deal regarding optimal flow for nebs. You do get the best results at 6-8L/min. Some have been known to give st 10 L/min. However, at that rate the medication is baffled more in to smaller particles and sometimes the smaller particles can actually irritate he distal bronchioles exacerbating the wheeze. So 6-8. No more.

 

[Clare]

As others have said, 6-8 lpm here and if the patient has mild to moderate asthma and an MDI that is clean and usable then preference should be given to using their own medicines. although in theory if they have called an ambulance then their own medicine is not working ...

 

[NomadicMedic]

I've removed the off topic posts. Let's try to keep the discussions focused on the topic.

 

[TomB]

It's almost like being in kindergarten! Thanks, n7lxi.