Cost comparison of bronchodilator delivery methods in Emergency Department treatment of asthma

Various methods of bronchodilator delivery are used in the Emergency Department, with similar efficacy. Our goal was to compare the costs of intermittent updraft nebulization, continuous nebulization, and metered-dose inhaler with spacer. Comparison was made for an average 1-h treatment. Material costs to the hospital were ascertained, and labor costs were estimated from salary and time studies in our urban community hospital. In this setting, the total cost for intermittent updraft nebulization was $11.66 for 1 h (three treatments). Cost for continuous nebulization was $9.66. Metered-dose inhaler with spacer had a cost of $15.45 for 1 h (three treatments). For the Emergency Department treatment of asthma, continuous nebulization may be a less costly method of bronchodilator delivery.     

超声雾化药物吸入治疗急慢性咽炎152例

目的观察超声雾化药物吸入治疗急性慢性咽喉炎疗效。方法用超声雾化药物吸入治疗急慢性咽喉炎152例。结果其中急性咽炎68例，治愈显效率92．82％；慢性咽炎急性发作59例，治愈显效率81．36％；慢性咽炎25例，治愈显效率72％。与对照组相比，有显著差别。结论此法能使药物直接作用于病灶，是治疗急慢性咽炎的有效方法。     

Barriers to Metered-dose Inhaler/spacer Use in Canadian Pediatric Emergency Departments: A National Survey

Background Metered-dose inhalers and spacers (MDI+S) are at least as effective as nebulizers for treating children with mild to moderate asthma exacerbations. Despite advantages in terms of efficacy, side effects, and ease of use, MDI+S are not used in many North American pediatric emergency departments (PEDs).
Objectives To survey emergency physicians, emergency nurses, and respirologists in Canadian pediatric teaching hospitals regarding their practices, beliefs, and barriers to change with respect to bronchodilator delivery.
Methods This was a cross-sectional, mailed survey of all emergency physicians, all respirologists, and a random sample of emergency nurses at ten Canadian PEDs.
Results A total of 291 of 349 health care professionals (83%) responded. Twenty-one percent of emergency physicians use MDI+S in the PED (largely concentrated at two "user sites"). A majority at nonuser sites, and virtually all professionals at user sites, responded that MDI+S are at least as effective as nebulizers, switching to MDI+S is justified by existing research, patient outcomes would be equal or better, and they have the required knowledge and skills to use MDI+S in the emergency department. The largest perceived barriers to MDI+S implementation include concerns regarding safety and costs, related to feasibility of providing and sterilizing spacers, and parental expectations for nebulizers. Other barriers included staff beliefs regarding the effectiveness of MDI+S, changes in nursing workload, and lack of a physician champion for change.
Conclusions MDI+S are infrequently used to treat patients with acute asthma in Canadian PEDs, despite the fact that most emergency staff believe they are effective. Important barriers to using MDI+S have been identified in this study and should be used to guide future implementation strategies.     

肺内吸入给药治疗哮喘和慢性阻塞性肺病研究进展

哮喘和慢性阻塞性肺疾病(COPD)是最常见的呼吸道疾病之一,全球分别有3 亿和2.1 亿患者。肺部吸入给药是治疗和管理哮喘、COPD 等呼吸道疾病的首选给药方式,而患者的依从性与该类制剂的疗效优劣有密切关系。综述现在已经上市的肺部吸入给药治疗哮喘和慢性阻塞性肺疾病的主要剂型和药品,以及雾化吸入剂、定量吸入剂和干粉吸入剂对患者依从性的影响,并认为提高患者依从性需要反复提供给患者个性化用药和正确使用给药装置的指导。