Indications for albuterol tx.

[juliekrn]

Does anyone know of a scoring system or resource that describes indications for albuterol use in children with respiratory distress? Last winter, I spent a lot of time arguing with our respiratory therapists that wheezing was not the only indicator for albuterol tx. Also, how do you deliver oxygen to infants and children and is it always humidified? Thanks.

[anonomous RT Guy]

First, I know my name is spelled wrong...it was an inside joke and I just realized that you can't change it. Jokes on me, yeah?

There is NO debate. The drug has one function. To dilate the bronchioles by relaxing the smooth muscle around them. That's it. Nothing else. That's all it does. That is the chemical composition of the mediation.

I think the whole albuterol thing gets blown WAY out of proportion. It always get into too much of an "ego issue" than anything. People always end up arguing symptoms over signs and whether or not THEY point to bronchoconstriction. However, I will state that it does not and has not EVER "broken up secretions." Mucomyst was once thought to break down the poly-peptide cores in "mucus/sputum" and it even has been shown to be not effective as a mucolytic. Albuterol is a bronchodilator, beta2-adrenergic for you pharm-heads. That's it. That's what it does.

Do I think its abused? Yes. It's used way too much. Some day, just like with antibiotics, these medications will have little use to us because of how often they're inappropriately prescribed and they will be used more specifically.

As for "cough" being the indication for use. A person with bronchospasm may cough...however, they typically have wheezes (because they're moving air to cough...simple physics...if you can't move air..you can't cough...that's why you don't give the heimlich to someone that is coughing).

I like PFTs for ASTHMA and COPD over a history of shortness of breath and EVEN WHEEZING (there are more kinds of wheeze than just asthma). I would much prefer documentation.

OVERALL, I would say that it's more than likely NOT going to hurt the patient...so I try it once or twice. Just try the treatment...if it doesn't work then it's not the source of the sign/symptom. However, someone calling me repeatedly with known CHF/anxiety/hypoxemia that is not responsive to albuterol or Atrovent is rather irritating and just doesn't make sense. The treatment they need is better found elsewhere than the lungs, which is where the symptom seems to be coming from.

PS: rninme - you guys still use isoetherine???? I didn't even know that anyone used it anymore.

[gauge14iv, MSN, APRN, NP]

I so love spirometry!

[rninme]

yup----still use bronkosol for refractory wheeze....oldie but a goodie. Still have the elevated HR issue with it tho....that hasn't changed. Albuterol is definately overused....if it's not working, try something else.

LOL....I have a very special name for mucomyst....hate that stuff!! Once it gets on your hands...you smell it for the rest of the night:rolleyes: .

Isuprel also works....but I am not sure if it is even made for inhalation anymore???

Yes...you are right..peaks, spirometry and PFT's!

[camixander]

Hi All,

We have an excellent asthma guideline at my children's hospital. They are in phase I, II, or III. Phases are classifications based upon the nursing and respiratory assessment of : Respiratory rate (based on age), Oxygen sats on Room air and O2 use, breath sounds, retractions, and dyspnea. Their are 3 options to choose from in each of those categories. Each option has a number attached (1-3).The computerized form actually does the calculation and it places them in the Phase that they meet. For example Phase I is a score of 12-15, Phase II is a score of 8-11, etc...This sounds complicated but it is REALLY easy and it is a great standard to use. Of course, not everyone qualifies for the guidelines, such as delayed, CP, and some SEVERE asthmatics, but overall it works.

Phase I receives Q2h albuterol, Phase II receives Q4h, and Phase III receives Q6h and are on their way home!