Yet this is nothing new among a medical profession that tends to be skeptical of new ideas and dogmatic of old ones.
For many years now Duoneb has been the medicine of choice for COPD patients, even when it's not truly indicated. If someone has COPD, those patients get Duoneb every four hours (or at least QID) regardless of indication (Note: indications are rarely heeded in the hospital setting, at least when it comes to respiratory medicine).
So now we have this new medicine called Brovana. A few of the wisest doctors are ordering it, and I'm not sure even they understand it. Allow me to explain. You see orders like the following:
Brovana BID, Duoneb Q6I've observed twice a day my fellow RTs have been giving both Duoneb and Brovana. So I question them: "Do you not know what Brovana is?"
They say, "It's a long acting beta adrenergic."
I say, "It's also a rescue medicine."
They say, "No it's not. It's a LABA."
I say, "True, but it's also fast acting"
And this goes on and on, but you get the idea. So I go to the physician, and he gives me the same defiance. I go to the pharmacist, and he says, at least, "I'll look it up."
The bottom line here is that not only is Brovana a LABA, it's also fast acting, like Ventolin, like Duoneb, like Xopenex. In fact, in Korea and Europe Symbicort (which has basically the same LABA in it) is used as a rescuemedicine (look it up).
Brovana should not be given at the same time as a rescue medicine. When Brovana is given, a rescue medicine should be ordered PRN, and given only when needed, which is when rescue medicine should be used.
And this brings me to my other theory: RT Bosses fear it. In fact, even my coworkers fear it. The other day I said, to my boss, "Why isn't Brovana on the new Order Set for COPD?" My boss ignored me, and my coworker said, "What are you trying to do, get us out of a job?"
So while Duoneb is habitually ordered by doctors for years, Brovana is a much better medicine. If you give Brovana and Pulmicort BID, you should only need to give Duoneb as needed. So you can see, there's a fallacy Brovana will put us out of a job. Yet it's just another ignorant, selfish fallacy of the RT profession.
Yes, the RT Profession survived the first four stages of respiratory therapy while their demise would all result in the end of our profession. The RT profession will survive, so we don't have to fear doing what is best for the patient just so we can keep our jobs.