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Monday, November 12, 2007

The latest research on Atrovent

As I wrote last night, we have a doctor here at Shoreline who loves to order Atrovent. Even if a patient needs a continuous treatment, it will be Duoneb, Duoneb, Duoneb, Duoneb and Duoneb. And then an hour later it will be Duoneb again.

I graduated from respiratory school in 1997, and was taught that Atrovent should ideally be given QID but never more frequently than Q4. I don't see what it would hurt to give the drug more often than that, but I also wasn't taught that it had any added benefit either.

But now we have Dr. Krane ordering it galore. She even orders Duoneb on pediatrics and Neonates. Umm, I was under the understanding that it was a drug for COPD patients mostly, or at least just adults. National Jewish Medical and Research Center verifies this.

However, I suppose I could be behind the times in my research. And, as I also wrote yesterday, so too are the other doctors behind on their research, because they still follow the old Atrovent routine.

There is one exception, though, and that would be Dr. Kipper on the floor. He's a new Internist who likes to order Q4 Atrovent treatments. My thinking about this is: why not just go with the inhaler.

So, do these doctors know something I don't? If you guys have any research on this, I'd really appreciate it. I've asked RT students that mosey through here and none of them have heard of anything. I figured if anyone would be up on the latest research it would be the RT teachers.

I did manage to find one article on the Internet "Evidence-Based Medicine for Student Health Services" by Dr. Robert J. Flaherty, MD, of Montana State University, which reports:
The addition of a single inhalation of anticholinergics (such as Ipratropium bromide) to a beta2-agonist regimen may improve lung function in children and adults with acute exacerbations of asthma treated in the emergency department. Multiple-dose anticholinergics improve lung function and may avoid hospitalisation in severe exacerbations.
Dr. Flaherty also lists some studies.

I found a second website which states the same: "(Anticholonergic) can be useful adjunct to beta-agonist in exacerbations for both adults and children-- NHLBI guidelines recommend considering in severe exacerbations." He lists several studies.

Another study from the University of Michigan that states Atrovent works on acute asthma exacerbations in children.

So, based on these reports, the excessive use of Atrovent may benefit Asthma patients, but this still doesn't get to the bottom of every treatment including Atrovent as Dr. Krane does.

Now I have absolutely no problem with giving Duoneb more often than Q4. But, if Atrovent is something that will benefit every person in need of a neb, then I want the other docs to know about this too.

Either way, if these studies are credible, then Atrovent should be given to Asthmatics, and multiple Duoneb treatments do work. If this is true, Dr. Krane appears to be up to date on her research.

If you guys know something I don't, let me know. Sometimes we can be behind the times here at Shoreline, and it's my job to catch us up.

3 comments:

Glenna said...

I'm with you. I think the Atro is overkill too in most cases. Our protocols, unless it's severe COPD, is Q6 Duoneb or Q4 Albuterol with Q8 Atrovent.

Although I will say as a pretty severe Asthmatic that I can live with out my long acting beta before I can live without my Spiriva. When I asked my pulmo if I was crazy :-) he said that I'm just one of those rare asthmatics who responds incredibly well to anticholinergics. To me, that says that in general most people don't. We always scratch our heads and ask for a pulmo consult if the regular docs start ordering Atro with not beta agonist and the patient doesn't seem to be doing well enough. Gee, and the first thing the pulmos do is add the beta and pull back on the Atro times. So....we can't be too far off base, right?

Anonymous said...

I'm a recent graduate from an advanced respiratory school, but the hospital where i am i have a doctor ordering Atrovent QID for a pneumonia pt, and xopenex as needed. I have never heard of this being done before. I don't know maybe im still too wet behind the ears to know anything about this. anyone have any thoughts on this?

Freadom said...

You are right to question any order for just Atrovent -- I do. If someone needs atrovent, they can get it via an inhaler with only one exception: if they can't coordinate an inhaler.