Nebulized Bronchodilator Use in the United States and England: Results of an Audit in Three Institutions

Abstract

Although nebulization of bronchodilator drugs is a common method of treating pulmonary diseases, we believe that much confusion exists concerning the proper dosing and administration of these drugs. METHOD: Orders for nebulized bronchodilators were monitored in three hospitals (two in England and one in the United States) over 2-8 weeks for the drug, dose, diluent, and dosing interval prescribed. RESULTS: The audits revealed that the drugs of choice in the English institutions studied were salbutamol and ipratropium and in the U.S. institution metaproterenol and atropine. The majority of orders were for a single agent, but a significant number were for irrational combinations of two sympathomimetics. The majority of orders were by volume of drug as opposed to dose by weight, a potentially dangerous situation. The diluent and/or volume prescribed varied greatly in England. In the U.S., the dose and volume administered often differed from that ordered due to use of unit-dose packaging. The most frequent dosing interval was every 4 hours. CONCLUSION: Although generalizations should not be made from such a small sample, we believe that the problems observed are not unique to the institutions studied. A better understanding of the proper choice of bronchodilator, dose, type, and volume of diluent is needed. We provide an example of guidelines for standardized procedures of administration of bronchodilators. (Respir Care 1988;33:852-857.)