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LEVALBUTEROL 1 ML (0.42 MG) Q8H DOSING USING THE AEROECLIPSE BREATH-ACTUATED NEBULIZER IN A COPD INPATIENT POPULATION

Crouse Hospital, Syracuse, NY

PURPOSE: In order to maximize therapist time, an auto-conversion from Levalbuterol (Lev) 1.5 ml (0.63 mg) Q8h to Lev 1 ml (0.42 mg) Q8h using the AeroEclipse Breath Actuated Nebulizer (BAN) in a predominantly COPD in-patient population was evaluated.

METHODS: All patients with orders for Lev assessed by Respiratory Therapists with the ability to perform aerosol treatments by mouthpiece were converted to 1 ml Lev using the BAN. Lev was poured from a standard 3 ml unit dose vial to the 1 ml line in the BAN and administered. All protocol treatments, including breakthrough treatments, delivered during the two-month pilot were recorded. The breakthrough data for Racemic Albuterol (Alb) Q4h and Lev 0.63 mg Q8h was from our previous studies.

RESULTS: Clinical: Lev 1 ml (0.42 mg) Q8h had similar daily breakthrough rates per 100 treatments as did Lev 1.5 ml (0.63 mg) Q8h and significantly lower breakthroughs rates than Alb 2.5 mg Q4h (6.0, 4.9, 13.7 respectively, both compared to Alb p<0.05). Economic: Time to deliver 1 ml by BAN was 2.67 minutes as compared with 8.33 minutes using a standard small volume nebulizer (SVN). The time saved per treatment multiplied by the number of treatments and the hourly Therapist cost annualized to a personnel cost savings of $54,693. The increased cost of BAN vs. SVN annualized to $10,851. Net savings $43,842 per year. Pharmacy costs did not change.

CONCLUSION: The conversion from 1.5 ml (0.63 mg) to 1 ml (0.42 mg) Lev using the BAN had similar clinical performance in breakthrough requirements. The savings in personnel cost more than offset the increase in device cost. Lev 1 ml delivered by the BAN is a very cost effective delivery method. Smaller doses in the BAN lead to shorter administration times.

CLINICAL IMPLICATIONS: When utilizing the BAN, the 1 ml Lev dose showed similar clinical efficacy and economic advantages when compared to our prior use of the 1.5 ml Lev dose, Alb, and a standard SVN.

DISCLOSURE: Robert Pikarsky, None.