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Friday, January 15, 2010

Here's why we give unindicated nebulizers

In the past week I have seen the following written in two different books on asthma: "All that wheezes is not asthma."

Likewise, all studies I've ever seen show that an MDI with spacer works equally well as a nebulizer, and the asthma guidelines recommend using an MDI except for cases of severe breathing exacerbations.

I mentioned this to my coworker, and asked her this question: "Don't doctors read this stuff. Don't doctors get these books?"

She said, "Yes they do. But people expect when they come to the ER, or get admitted to the hospital, that we are going to do something. Giving them the breathing treatment as opposed to just an IV and a bunch of pills makes the patient feel like we are doing something."

That about explains it in a nutshell. That's 50% of the reason why we do bronchodilator breathing treatments on every person who comes in with a wheeze or any respiratory ailment. There are other reasons though. What follows are the real indications for bronchodilator breathing treatments:
  1. To make the patient feel like we're doing something. (20% of treatments)
  2. To make the doctor feel like he's doing something to help the patient (20% of treatments)
  3. To create a procedure so the respiratory therapist doesn't lose his job. (20% of treatments)
  4. To meet admission criteria (20% of treatments)
  5. Bronchospasm (20% of treatments)

There you have it. Now if you add up the percentages that I just made up, you have 20% of the breathing treatments we do are indicated, and 80% are not indicated.

In other words, most therapies we do are because of the government, big companies and doctors who don't care about wasting money.

1 comment:

dharmesh said...

That was a really good post. It helped me to make sense of some of the issues with the subject.

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