Metered Dose Inhalers in Asthma Lower Hospitalization Rates

Changing to bronchodilator treatment through use of a metered dose inhaler in patients with mild to moderate asthma resulted in lower hospitalization rates, shorter lengths of stay, and a decrease in continuous use of albuterol, according to a study recently published in the Journal of Asthma.

This study included 7635 individuals who were eligible before changing pathways with12,673 individuals who were seen in the following 1.5 years. Participants had been discharged with a diagnosis of asthma and a nonemergent assessment on the Emergency Severity Index triage. The rate of <3-hour discharge increased by 10% (39% to 49%), with a 33-minute median reduction in length of stay, by switching to a metered dose inhaler. Continuous albuterol use decreased from 43% to 25% via special cause variation. The revisitation rate did not change for patients with higher acuity, nor did length of stay; however, there was a 8% reduction in asthma admissions with an 18-month period of sustained results.

Researchers developed a protocol to increase the use of metered dose inhalers to replace continuous albuterol through recommending metered dose inhalers for those with emergency severity index scores of 3/4 and through urging respiratory clinicians to continue administering the treatment until a mild assessment was reached. The goal of the study was a 10% increase in patients discharged in ≤3 hours relative to baseline. Revisitation rates and admission were used as balancing measures.

The researchers concluded that “[i]mplementation of the changes resulted in a decrease in continuous albuterol use which was associated with an increase in the proportion of patients discharged within 3 hours and a reduction in overall admission rate for asthma. These changes were sustained for over 18 months after the implementation and have continued to be sustained beyond the period of the intervention. Future work should explore similar interventions in other populations and further assess impact on hospitalization and other outcomes.”

Reference

Abaya R, Delgado EM, Scarfone RJ, et al. Improving efficiency of pediatric emergency asthma treatment by using metered dose inhaler [published online September 12, 2018]. J Asthma. doi:10.1080/02770903.2018.1514629