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Saturday, December 5, 2009

Ahhhhh.... Sometimes you gotta wonder

So, I've been using a bronchodilator of some sort for 30 years at least every 4-6 hours (so how many puffs does that come to???) I have been a respiratory therapist for 14 years, and given at least ten treatments every day I've worked, which comes to about 36 hours per week.

Okay, let's do a little math here. This should come to about 65,071 bronchodilator meds inhaled, and 18,071 bronchodilators given. And those numbers are very conservative, because there have been many days I've used my inhaler way more than every 4 hours. I bet it's more like 100,000+ and 25,000 +.

Let's think this through further. There was a 25 years stretch I used an inhaler or more a week plus took breathing treatments in between. Assuming about 200 puffs per inhaler, that comes to....250,000 puffs. Plus there were days I used up one inhaler in a day, plus took nebulizers in between each puff.

So, you can see, it's really hard to estimate how many much Ventolin or Alupent I've inhaled in my life. But you can see I've taken in lots of bronchodilator juice, either in inhaler or nebulizer form.

Regardless, I started becoming curious and studying this wonderful medicine when I was 15 in 1985 and have never stopped learning about it ever since. I write about it. I blog about it. I live it. I am a bronchodilator in my sleep. I have bronchodilators chasing me when I dream. I've taken in so much of this medicine either first or second hand that it could replace my blood supply a thousand times over.

Yet still, as I go down to the ER to do a bronchodilator breathing treatment, I get educated by one of our most excellent nurses that my treatment will help with pneumonia.

The patient was curious about the medicine because a week ago he was diagnosed with pneumonia and was sent home with an MDI to take every four hours. He said he wasn't getting any relief, so he came to the hospital today.

I said, "So do you have asthma?"

"No," he said.

"Do you smoke or have COPD?"


You did the right thing by coming in," I assured him. "But Albuterol usually doesn't do much for pneumonia."

The nurse cut me off. "It dilates the bronchioles and can help him bring up that junk."

Well, not exactly. I wanted to say it, but I held my tongue. Like I said, in the medical field, as in any other I suppose, we have to be political. Still, political-ness can often lead to poorly educated people. It leads to us being enablers. In this case, it leads to ignorant nurses like this one. And it leads to needless medical waste in the form of bronchodilator abuse.

So am I wrong to be honest with my patient? Perhaps. Yet it's times like this when I wonder why we spend so much time educating ourselves. And it reminds me of an old saying; It's easier to remain ignorant than it is to take the time to educate ourselves.

Just for the record, pneumonia is an inflammatory disease of the alveoli, and Albuterol is not an anti-inflammatory medicine. Likewise, you cannot dilate bronchioles that are not constricted due to bronchial muscle spasms. And, moreover, Albuterol particles are 0.5 microns, too large to even get to the 0.1-0.2 micron alveolar sacs. Plus there are no beta receptor cells in the alveoli.

And while I may have taken puffs of my inhaler, or extra breathing treatments due to anxiety, I never once used it for any other reason than simple asthma. So you can see why I hate to see it abused in this way.

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