Cost comparison of bronchodilator delivery methods in emergency department treatment of asthma

A Randomized, Controlled Double-blind Trial of Usual-dose versus High-dose Albuterol via Continuous Nebulization in Patients with Acute Bronchospasm

“…1 Additionally, and probably in large part due to the decreased utilization of respiratory therapists' time, continuous nebulization of albuterol may be a less costly method of bronchodilator delivery in the ED. 2 Frei found that the total cost to the hospital to deliver continuous nebulization was $9.66 compared with $15.45 per patient for intermittent dosing. 2 In addition, although several studies have shown no significant difference in outcomes between continuous dosing and intermittent dosing of albuterol, [3][4][5][6] the studies by Lin et al and Rudnisky et al showed greater clinical improvement with continuous nebulization compared with intermittent albuterol for the subgroup with the most severe asthma.…”

“…2 Frei found that the total cost to the hospital to deliver continuous nebulization was $9.66 compared with $15.45 per patient for intermittent dosing. 2 In addition, although several studies have shown no significant difference in outcomes between continuous dosing and intermittent dosing of albuterol, [3][4][5][6] the studies by Lin et al and Rudnisky et al showed greater clinical improvement with continuous nebulization compared with intermittent albuterol for the subgroup with the most severe asthma. 4,5 Subsequent to these studies, Shrestha et al conducted a randomized trial of continuous vs. intermittent albuterol in severe asthmatic patients with predicted forced expiratory volume in 1 second (FEV 1 ) less than 40% of predicted.…”

“…It seems as though an increasing number of EDs are moving toward treating acute bronchospasm with continuous nebulization because of substantial time and cost savings. 1,2 Several recent studies have shown no significant difference between continuous and intermittent administra-tions of albuterol in the treatment of bronchospasm. [3][4][5][6] However, subgroup analysis in two of the studies showed that severe asthmatic patients may benefit significantly from the continuous mode when compared with the intermittent form.…”

Recent advances predict a bright future for nebulizers

“…Although traditionally considered more expensive delivery devices, nebulizers may be a less costly device for bronchodilator delivery in some instances [16]. In contrast to the recurrent monthly costs of hand-held device replacement, the cost of nebulization consists of recurrent costs of medication only.…”

Adjunct Therapies for Refractory Status Asthmaticus in Children

“…In children, this continuous delivery appears to be more effective than intermittent delivery 7,8 and also provides a more efficient use of respiratory therapist and nursing resources. 9 The NIH asthma guidelines 1 recommend a continuous inhaled albuterol dosage of 0.5 mg/kg/h up to a maximum 15 mg/h; however, 20 mg/h of continuous albuterol is commonly utilized by providers for children of all ages. A few studies have evaluated the use of high-dose continuous albuterol, with doses as high as 75-150 mg/h, [10][11][12] with no clear evidence of benefit over standard dosing.…”