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Getting back to the basics: administering inhaled bronchodilators.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Colice, Gene L. |
| Copyright Year | 2009 |
| Abstract | Over the almost 3 decades I have been actively involved in pulmonary medicine, there has been a dramatic increase in the demands placed on respiratory therapists (RTs). Ventilators have become increasingly complex. In addition to the evolution in the mechanical and electronic features of ventilators, strategies for mechanical ventilation, such as low-tidal-volume ventilation for acute respiratory distress syndrome, have also become more demanding. Noninvasive ventilation has become widely accepted for hypercapnic and hypoxic respiratory failure. With the emergence of noninvasive ventilation as a readily applicable modality, RTs have seen the principles of mechanical ventilation extended from the intensive care unit to the general medical floor. Despite these remarkable changes in respiratory care, there is surprisingly little difference today, compared to my experiences in the 1970s and 1980s, in what is probably the most fundamental aspect of respiratory care: the administration of medications, particularly bronchodilators, via inhalation. In this issue of RESPIRATORY CARE, the article by Hoisington and colleagues1 on the effect a relatively simple change in nebulizers might have on respiratory care workload should remind us that there have been important advances in the basics of administering inhaled bronchodilators. The history of nebulizers is a fascinating story.2,3 Medications have been administered via inhalation for thousands of years. In India and Egypt, between 2000 and 1500 BC, herbal preparations (Datura species and henbane) that contained anticholinergics were burned and the vapors inhaled. Over the centuries, the substances burned and inhaled became more creative. Paulus Aegineta, in Greece in the 7th century AD, recommended inhaled storax, pepper, mastick parsley, scruples, bayberries, and honey for cough. More recently, the inhalation devices have also become more inventive. Ceramic inhalers were designed in the early 1800s. Atomizers (developed as an outgrowth of the perfume industry) and nebulizers were invented in the mid-1800s. Hand-bulb nebulizers were first used in the early 1900s to administer a new medication, adrenalin, developed from adrenal extract. In the early 1930s an electric pneumatic nebulizer (compressor and jet nebulizer combination) was built and sold in Germany. Although the jet nebulizer is commonly used with a compressor in the home, it is usually powered with compressed oxygen in the hospital. Ultrasonic nebulizers were introduced in 1949 but have never been as widely used as compressor nebulizers. The jet nebulizer has evolved substantially over the past 50 years. Hoisington and colleagues1 compared a newer version of the jet nebulizer, which requires only 3 min to nebulize 3 mL of a unit dose of a short-acting inhaled 2 agonist, to an older jet nebulizer model that requires 9 min to nebulize that same volume. They estimate substantial time savings for the RT and cost savings for the hospital with the new nebulizer.1 I believe those estimates are reasonable. In my hospital, in which 18% of all admitted patients receive inhaled bronchodilators and 4,5005,000 nebulizer bronchodilator treatments are administered monthly by our RTs, switching to a more time-efficient nebulizer would have important advantages. |
| File Format | PDF HTM / HTML |
| PubMed reference number | 19327178 |
| Journal | Medline |
| Volume Number | 54 |
| Issue Number | 4 |
| Journal | Respiratory care |
| Alternate Webpage(s) | http://www.rcjournal.com/contents/04.09/04.09.0455.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
