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Friday, November 21, 2014

Albuterol is the current big con

Whenever a physician, nurse, patient, or even another respiratory therapist, tries to explain to me why a patient needs a bronchodilator breathing treatment when they don't, I can't help but to think of the 1973 movie "The Sting.

The movie stars Robert Redford as Johnny Hooker and Paul Newman as Henry Gondorff. Hooker is a young con man who is being groomed by the more seasoned con Gondorff. In explaining how to be a successful con, Gondorff says, "You have to keep this con even after you take his money. He can't know you took him."

This was one of those movies where most of the audience was shocked when the final sting occurred because they had been conned for so long.  Yet for the few who figured out the truth long before the final sting it wasn't as much of a surprise. 

You see, most people, other than the trained respiratory therapist, have been duped into believing that albuterol is the saving grace of dyspnea. They also believe that nebulizers work better than inhalers, even though nearly every study I've ever seen proves they work equally well, even in emergent situations.

"So, who did the conning?" some ask.

"Pharmaceutical and hospital administrators who got rich during the 3rd period of respiratory.  therapy, that's who," I say.  

Look, there is no evidence that albuterol works for anything other than bronchospasm.  Once bronchospasm is ruled out, albuterol will only have a placebo effect

Evidence of the big albuterol con comes when the only argument for giving it is "It can't hurt." And boy do I hear that puerile argument a lot.  

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