Saturday, March 27, 2010
A world of bronchodilator lies!!!
I hate to say it, but it's true. First of all, you've seen the surreptitious Physician's Creed I've been posting on my blog as I obtain pages from my secret sources. Yet recently one of my valued readers emailed me five online articles with the note: "It is hard not to expect doctors to use bronchodilators for pneumonia when articles like these are so easy to obtain."
The first one he sent to me was this one about bronchodilators at Yourtotalhealth about bronchodilators. The worst part about it is this article was approved by a doctor. I hate to say it, but he's either ignorant about bronchodilators, living on another planet, or he's an all out liar.
Here's what the article had to say: "Bronchodilators are medications taken to improve breathing. They help expand the airways and improve the breathing capacity of patients with bronchial asthma, chronic obstructive pulmonary disease (COPD), emphysema, pneumonia, bronchitis and other lung diseases."
So right off the bat this article lies. Bronchodilators improve breathing, but only in patients who have airway narrowing due to bronchospasm. This can be the case with bronchial asthma and chronic bronchitis, but is not true with emphysema and pneumonia.
Emphysema is a disease where the tissues in your lungs break apart. There is nothing that Ventolin does to increase lung tissue. Pneumonia, as I've written a million times on this blog, is a disease of inflammation of the alveoli. Not only are bronchodilator aerosols too large to make it to the Alveoli (Ventolin is 0.5 microns, a perfect size to fit into the bronchioles, but too large to fit into the 0.1-0.2 micron alveolar sacs).
Plus, there are no beta adrenergic receptor sites in the alveoli for the bronchodilator to attach to. And, even if there were, bronchodilators relax smooth muscles in the bronchioles. There are no smooth muscles to relax in the alveoli. Plus a bronchodilator will do nothing to treat inflamed alveoli.
Some doctors claim bronchodilators open up airways of pneumonia patients so they can cough up the junk, but this is a lie too, because pneumonia does not cause bronchospasm unless the patient is an asthma or COPD patient.
Of course the article only gets worse: "Bronchodilators also help clean mucus from the lungs to improve breathing. As air passageways are opened, mucus moves more freely because it becomes thin and can be coughed out more easily."
Where's the scientific proof to back this up? What study was ever done that proves bronchodilators clean mucus from the lungs. Of course, that is why we RTs joke that doctors think Ventolin works like scrubbing bubbles, in that it gets deep down in the lungs, suds up like soap, and gives the lungs a nice washing.
Of course, if air passages are not constricted, there is no need to open them (which is the case for most pulmonary patients). Likewise, MUCUS DOES NOT MOVE MORE FREELY BECAUSE IT BECOMES THIN AND CAN BE COUGHED OUT MORE EASILY. Who the hell thought that one up?
Ventolin is not a mucus thinner. In fact, Ventolin has absolutely nothing to do with secretions. If you want a mucus thinner, you have to go to a medicine called Mucomyst, which is a medicine made to reduce the viscosity of secretions. Ventolin does not.
The article states, "They work by relaxing the bands of muscle surrounding the airways." This is correct. By reading his own article this doctor should have realized what he said above was not true. And we wonder why Ventolin is the most abused medicine in the entire hospital.
Just reading this one article ticks me off so much I don't even want to waste my time with the rest. Here, I'll let you check them out though. Perhaps you can write the authors and ask them where they get their proof for their claims. Or is science not a part of medicine anymore?
This article from Allina Hospitals and Clinics describes Xanthines like Theophylline (Theodur) as a bronchodilator that treats pretty much any lung condition, including pneumonia. Of course we know it's a bronchodilator, meaning it dilates constricted bronchioles and that's it.
My anonymous source writes, "Then this study for antibiotic use for pneumonia suggested that more bronchodilator use may be needed especially in patients that have a prior history of bronchodilator use. I know that I don't have a medical background and probably don't truly understand this study, but how do we fight against this type of information?
Likewise, she writes, "I do agree with you about the bronchodilator fallacies, but there is a lot of literature that sure confuses the rest of us non-medical folks."
Let's consider that final study first. Here a study was performed to see if a bronchodilator breathing treatment would be as efficacious as using antibiotics to treat childhood pneumonia, which is often caused by a virus. The conclusion was this: "Treating children with non-severe pneumonia and wheeze with a placebo is not equivalent to treatment with oral amoxycillin."
First of all, antibiotics, like bronchodilators, are of no use when it comes to treating viruses. It's like pouring tap water on a wound and saying it's disinfected. Basically, this study is saying that 100 pneumonia patients were treated with a bronchodilator and they all eventually recovered. There's no scientific basis behind this study. It's poppycock.
It's studies like this that have us still using Chest Physiotherapy in hospitals. One study 50 years ago showed that 100 post operative patients were given CPT and they all recovered. So from then on it's ordered on all post operative patients. It's all based on poppycock studies, and it's given merit too.
So basically this study shows that bronchodilators are just as ineffective for childhood pneumonia as antibiotics. Although the results were interpreted otherwise.
Well, I understand how this can be confusing. Doctors, nurses and even RTs are confused about what bronchodilators do. It's not just a few, because I'd say about 80% of all bronchodilators given in the hospital are not indicated. I know, because I'm standing by the side of the bed before, during and after every single treatment a patient receives in the 12 hours I'm on duty.
Because I've been using bronchodilators for 40 years and have never once used it for anything other than for bronchospasm. And because I do my research and have studied bronchodilators ad nauseum. Something doctors don't do. And that's fine. But it would be nice if they would admit their ignorance instead of denying it and letting it go to their head. Instead of doing that, wise doctors and hospitals are going more and more to RT driven protocols so we RTs can use our experience, wisdom and education to the benefit of not just the patient, but the hospital too. Can you imagine how much money would be saved if stupid bronchodilator orders were even cut by 25%? It would be millions of dollars.
It seems to me that too often in this life we do things the opposite way we should in medicine. It seems to me that we'd be skeptical to give a medicine for a disease until it is proven to be effective. But, in medicine, we don't want to spend too much time or money on research when we can just give the medicine and CHOOSE to believe it is doing something. And then we have to deal with the consequences no matter how harsh those consequences are.
What's going in with healthcare reform is another perfect example. Here we pass all this healthcare reform while we have zero, zilch, nada evidence that it will actually work. Which is why it's sometimes better to do nothing than to do something we think is good but we don't really know. What we really should do is leave it to the experts. When it comes to bronchodilators, the people in the room assessing the patients are the true experts.
Yet that's not what happens. Those in Washington didn't vote for healthcare reform because there is proof it will work. They passed it because it makes them feel good. It makes them feel like they're helping people. It doesn't matter if there's evidence it won't work or not: it makes them feel good.
That's the case with bronchodilators. We give them for every respiratory disease, every patient who is short of breath, every irritating lung sound, and doctors and nurses and even some RTs simply feel good that we are doing something, and they CHOOSE to believe the medicine is doing something for them.
It's kind of like the lady who's given laxis and a bronchodilator because she had heart failure and was in pulmonary edema. Five hours later she says, "Wow! That breathing treatment really helped." See, this patient saw the bronchodilator so she gave it credit. The same is true for doctors and nurses. They give credit for what they CHOOSE to believe helped the patient. When the rest of us know it was not the bronchodilator that helped the patient. The bronchodilator did nothing but add more fluid into that patient's lungs. The real credit goes to the Lasix, which helped the patient pee out the excess fluid from her body and lungs.
Of course we intelligent folks know that cardiac asthma must not be confused for asthma. The patient can get them confused, but we medical workers never should -- yet there are those amongst us who do all the time.
Allow me to say here, folks, that the battle for bronchodilator reform is not going to be won over night. It's going to take no longer being enablers for doctors and nurses. We need to quit just giving the treatments, and we need to educate one doctor and nurse at a time.
Although, the only problem is we are merely humble RTs who want to keep our jobs. So quite often it's better to keep our mouths shut and do what we are asked rather than try to change ignorance we have no control over.
For more information on how doctors abuse bronchodilators, see my Physician's (Doctors) Creed in the links above, or click here. Click here to read more about bronchodilator reform. Click here to read about the benefits of RT Driven Protocols. Click here to read my apology for my tone in this post, and my apology to the websites and doctors above mentioned.