The basic summary I get is nothing has proven that Xoponex works better, it has a slower onset and longer duration and is very expensive thus making it less effective/efficient as a front line drug in the field?
Disclaimer:
It works very well for some and not for others. Some swear by it and some see no difference.
It's like Aleve, Advil, Tylenol... One medication may actually be better than the others for certain aches and pains but for some it is personal preference and what some feel works better.
My favorite trick I used to play on people (mostly residents or student doctors) was to offer them the same drug but under a different name and see if "it worked better" from their observation.
The thing to remember is that if the underlying is severe or if the patient has not been compliant with their maintenance meds, one neb, whether it is Xopenex or Albuterol, is just a drop in the bucket with a whole lot of catching up to do to get back to baseline. The neb will only treat some symptoms and not the cause. The patient probably already tried a boxful of ampules or a canister prior to calling you. If the bronchospasm or airway constriction was easily reversed by an inhaler you probably would not have been called.
Look for the underlying: fever, persistent productive cough, environment, lung sounds, crackles?, sinus infection, flu, colds, change in prescription meds especially beta blockers, recent dental work/infection etc.
