RT Cave Rule #5: There is only one purpose for bronchodilators, and that is to treat shortness-of-breath due to bronchospasm
In no way do I think I am smarter than a doctor, for they have knowledge in far more areas than I will ever imagine to have. It is their job, after all, to fix patients. And, when they order therapies I disagree with, I will still do them without complaining.
I have to say, however, that this is difficult not to complain when I know a treatment is not indicated, especially considering I have been using Albuterol since it was invented in the 1980s, and before that I used Alupent, and never once used either one for anything other than SOB due to asthma. In this way, I have over 30 years of bronchodilator experience.
Likewise, I have given many breathing treatments to patient in the hospital the past 12 years as a registered respiratory therapist, and have seen first hand for whom they have a beneficial effect and for whom they have no effect.
Plus I believe my opinion is in concordance with nearly every other RT on the planet.
If you are an RT or suffer from diseases like Asthma or COPD, you know how wonderful a drug Albuterol is. I can tell you from personal experience it's a life saver. In fact, without the drug I'd probably would have died many years ago.
And that brings up my next point. Bronchodilators of the past, such as Alupent and Bronchosol, did have some bad side effects. Alupent was proven to be a great bronchodilator, but had the side effect of making the heart thump. I remember abusing it when I was a kid and fearing that I might now wake up in the morning.
Alupent was a good drug in it's time, and was used for many years, but in 1987 a new refined bronchodilator was invented that was proven to have very little effect on the cardiac muscle, and thus rarely causes the heart to thump or increase. I'm not saying it never does, but very rarely, and usually only when it's given in huge quantities all at one time.
I can tell you from my personal experience as a "Rescue Inhaler Abuser" that I have gone through an entire inhaler in a day and still not had my heart thump like it used to when I used Alupent. Now, I wouldn't recommend using that much Albuterol outside the hospital setting, but my point is that Albuterol is that safe.
When patients come into the hospital, and you are having bronchospasm, we quite often give you an aerosol of Albuterol. If that aerosol doesn't do the job, we have been known to give as many as 10 in a row back to back to back. Again, I wouldn't recommend doing this at home, but I bet many of you chronic asthma and COPD patients have at one point or another. Hey, back me up here.
Now, understanding how quickly and magically Albuterol can get an asthmatic or COPD patient breathing easy, and considering how safe it is, many doctors choose to try it for other respiratory illnesses, even illnesses that are not bronchospasm in nature
I find that some doctors order Albuterol because a patient is short-of-breath because of pneumonia (fluid in alveoli), atelectasis (collapsed alveoli), pleural effusion (fluid in lung) and pneumothorax (collapsed lung) . All of these diseases are in the alveolar sacks, and the aerosol particle of Albuterol are too large to deposit in the alveoli, and thus have no effect there.
If, however, a patient has a bronchospasm component to their disease with any of the diseases listed in the last paragraph, then I'd recommend Albuterol. But if there is not bronchospasm, then it has no benefit to the patient.
Other diseases that Albuterol does not benefit that it is often prescribed for are: Croup, upper airway congestion or excess secretions, CHF, pulmonary edema, post-operative, obesity, cancer and many more.
Let's tackle croup. The harsh inspiratory noise kids make with this illness is because their throats become swollen. The key word here is throat. There are other medications that might help here, but not a bronchodilator. Hence, Albuterol is a bronchodilator, not a throat dilator.
Chronic Heart Failure (CHF) causes fluid to build up in the lungs called pulmonary edema. This does not occur in the bronchioles, but outside them. When this fluid overload causes the pressure inside the lungs to build up, this can cause the fluid to in effect squeeze the bronchioles and causing a wheeze. This is called a cardiac wheeze. Yes, it does cause the bronchioles to tighten, but, since the cause is outside the bronchioles and not inside, Albuterol will not work to solve this problem. This patient will need diuretics like Lasix.
Nonetheless, a cardiac wheeze is very often confused as a bronchospastic wheeze, and treated like bronchospasm.
Many times in the hospital setting I give a breathing treatment the same time a nurse is giving Lasix. The patient is severely SOB. My treatment has no effect on the patient's WOB. But, an hour later when the Lasix has worked, the patient is no longer SOB. Since the patient actually participated in taking the treatment, he or she often thinks the treatment is what eventually solved the SOB.
So, what happens the next time we get a CHF patient? The doctor orders Albuterol back to back to back to back until the Lasix works. Can you see how I can easily make comedy out of this.
Cancer will not be absorbed and broken up by a bronchodilator, nor will it absorb a pleural effusion, nor re inflate a collapsed lung (that's what a chest tube is for). Even if it did get down into the alveoli, it will not remove fluid in the alveolar sacks caused by pneumonia.
Now hopefully by you reading this you understand RT humor. Since doctors use Albuterol for all these diseases, we RTs (me in particular) have a choice between grumbling and griping about it, or making humor of it. We at Shoreline Hospital choose to make humor, and thus our list of 'olins came to be.
One of the reasons I made this post was because I've received more than one emails or comments from patients who wondered if I was being serious or funny when I wrote "Xoponex now a humidifier." I will confess: I was being facetious.
While Dr. Krane is a brilliant doctor, and while I enjoy working with her, and while I have no problem trying one Albuterol treatment with patients with croup just to see if it works, it is not a humidifier. In fact: Albuterol given via nebulizer treatment is a mist.
Just so you know, any post on this site where I'm using RT humor will be labeled on the bottom as "RT humor" or "funny."
Again, I am in no way proposing that RTs know more about the human body than doctors, but we are the experts in the hospital on the respiratory system -- that's all we do. We study respiratory, we learn respiratory, we learn the other systems as they pertain to respiratory, we keep people alive with our respiratory machines, we sleep respiratory, we breath respiratory. We give breathing treatments all day long, and we see how they work first hand. Doctors can only order them. And, when they do, we have to give them. We have no choice.
Now, if you are a medical staff at a hospital other than an RT, or if you are a patient viewing RT sites like RT Cave, it is important that you know that there really is only one true purpose for Albuterol, and that is to treat shortness-of-breath due to bronchospasm.
To determine if someone is having bronhospasm, it requires an assessment of lungsounds and/or a quick review of the patients history, which usually can be provided by the patient. Most of the time, true bronchospasm is very obvious.
In the insert inside the Albuterol inhaler or aerosol solution you will find an insert. Go ahead and pull it out if you have access to one. On that packet it says: Indication: "(Albuterol) is indicated for the treatment and prevention of bronchospasm in adults and children under 12 years of age and older with reversible obstructive airway disease." (emphasis added)
It is a a fact, proven by much research, that Albuterol is a medications that becomes a particle size of 5 microns and fits perfectly into the size 0.5 micron bronchioles of the lungs to relieve bronchospasm. Five microns is too big to go into the alveoli level (which is 0.1 to 0.2 microns wide) and too large to deposit in the throat (although some of them will deposit there).
It is not a cure for any disease. It will only resolve the symptom of bronchospasm. This is my humble personal and professional opinion. And as long as doctors continue to abuse this most wonderful drug, we will continue our effort at bronchodilator reform. And while we may never get it, we will continue our feeble effort at RT humor here at the RT Cave.
I encourage you to challenge me.