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BREAKTHROUGH TREATMENTS RATES DURING A CONVERSION TO LEVALBUTEROL, TIOTROPIUM AND BREATH ACTUATED NEBULIZERS

Crouse Hospital, Syracuse, NY

PURPOSE: In order to maximize therapist time, an auto-conversion to Levalbuterol (Lev) Q8h, Tiotropium (Tio) QD and AeroEclipse Breath Actuated Nebulizer (BAN) usage in mouthpiece (MP) mode was evaluated.

METHODS: All patients assessed by Respiratory Therapists with the ability to perform aerosol treatments by mouthpiece were converted to Lev 0.63 mg Q8h by BAN MP. If ordered, Ipratropium (Ipra) 0.5 mg was converted to Tio 18 mcg QD. If unable to perform the MP treatment patients were converted to Lev 1.25 mg Q8h delivered by mask. If ordered, Ipra 0.5 mg was converted to Ipra 0.25 mg Q8h. All protocol treatments, including breakthrough treatments delivered between 10/04 and 4/05 were recorded. Treatment refusals and omitted treatments were recorded. The breakthrough data for Racemic Albuterol (Alb)was from our previous studies.

RESULTS: The table shows the number of treatments(tx), the number of prn breakthrough treatments and the per-treatment and daily rates of breakthroughs per 100 treatments. Lev 0.63 mg Q8h MP had significantly lower breakthroughs rates than the Alb 2.5 mg Q4h, both in per-treatment and daily rates (p<0.05)* Alb/Ipra Q4h had significantly lower per-treatment rates when compared with Lev/Tio Q8h and Lev/Ipra Q8h (p<0.01)**; the daily breakthrough rates were not significantly different. Omitted treatments decreased from 2.28% to 1.95%. Patients refused 3.81% of scheduled treatments.

CONCLUSION: The conversion from Alb Q4h to Lev Q8h allowed for a decreased frequency of daily medication administrations and a decrease in breakthrough requirements. Ipratropium showed a significant benefit in breakthrough reduction for the Alb group. Lev 0.63 mg MP performed as well as Lev 1.25 mg via mask.

CLINICAL IMPLICATIONS: The efficiencies gained by decreasing the daily frequency of aerosol administration can have a significant impact on resource utilization. The conversion to Lev allows for decreased respiratory therapy time or the re-allocating of workforce needs while maintaining, or improving, quality of aerosol administration, as evidenced by the decrease in breakthrough requirements. Smaller doses in the BAN lead to shorter administration times.

Order Count Break-throughs Break-throughs per 100 tx Treatment per day Daily Break-throughs per 100 tx Lev 0.63 mg Q8h (MP) 3541 58 *1.64 3 *4.91 Lev 0.63 mg Q8h/Tio 18 mcg Qday (MP) 1130 22 **1.95 3 5.84 Lev 1.25 mg Q8h (Mask) 3092 74 2.39 3 7.18

DISCLOSURE: Robert Pikarsky, None.