Continuous Bronchodilator Therapy

doi:10.1378/chest.06-2125

Chest

Volume 131, Issue 1, January 2007, Pages 286-289

https://doi.org/10.1378/chest.06-2125 Get rights and content

Abstract

Inhaled bronchodilators are first-line treatment for acute exacerbations of asthma. Continuous bronchodilator administration is a novel option for the treatment of bronchospasm, which may be more effective than intermittent therapy for patients with severe airflow obstruction. For 2007, coding and billing changes for this modality become effective. This article reviews clinical aspects and outpatient practice management of continuous bronchodilator therapy.

Section snippets

Continuous Bronchodilator Procedure

Early clinical studies suggested a potential role for continuous bronchodilator treatment. Colacone and colleagues²in 1990 compared ED treatment of asthma by delivery of albuterol, 10 mg over 2 h, by continuous nebulization, or as 5 mg boluses 1-h apart. Heart rate increase was slightly greater after bolus treatment, but the techniques were otherwise comparable.²Olshaker et al³in 1993 compared protocols for nebulized albuterol administered to adult patients in the ED setting. Compared to bolus

Practice Management Issues

Changes occur in 2007 in the coding and billing for continuous bronchodilator therapy. Current procedural terminology (CPT) codes have been established since 1966 by the American Medical Association (AMA), to provide a common and uniform description of clinical services. CPT codes are five-digit numeric indicators of medical and surgical services and procedures, updated annually by the CPT Editorial Panel of the AMA, with input from specialty advisors. Two-digit modifiers are used to indicate

Conclusion

Continuous bronchodilator administration is a novel therapy for acute and severe bronchospasm that may be effective in mitigating the exacerbation, potentially avoiding hospitalization. Continuous administration of albuterol, or the combination of albuterol and ipratropium, may be more effective than intermittent nebulization for patients with the most severe airflow obstruction. Changes for 2007 in the CPT coding for continuous bronchodilator therapy allow more accurate capture of respiratory

Acknowledgments

The author thanks Diane Krier-Morrow, MBA, MPH, CCS-P, and Susan R. Gallo, RRT, for valuable input.

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2021, Journal of Hospital Infection
Citation Excerpt :
Although the calculated inhalation exposure to the original nebulized dose was quite low at 0.58% and 1.73%, respectively, there is considerable potential for chronic low dose exposure [32] which can lead to long term chronic respiratory illnesses in caregivers [13,16,30]. Furthermore, it is not uncommon for caregivers to administer larger nominal doses (5–15 mg/h) for extended time periods [33,34], to several patients in a ward throughout a day, week, month or year. There is also the risk of exposure to the unwanted side effects associated with different therapeutics [11,33,35], which could be toxic, over prolonged exposure and time periods.
During manual resuscitation, nebulizer therapy may be used to deliver therapeutics to patients in respiratory distress. However, the devices used to generate and deliver these medical aerosols have the potential to release these therapeutics into the local environment and expose caregivers to unwanted medical aerosols.
To quantify the levels of fugitive medical aerosol released into the environment during aerosol drug delivery using a manual resuscitation bag with and without filtration.
Time-varying fugitive aerosol concentrations were measured using an aerodynamic particle sizer placed at a position designed to mimic a caregiver. Two nebulizer types were assessed, a vibrating mesh nebulizer and a jet nebulizer. The aerosol dose delivered to the simulated patient lung was also quantified.
Filtration of the exhalation port of the manual resuscitation bag was seen to reduce fugitive medical aerosols to ambient levels for both nebulizer types. The vibrating mesh nebulizer delivered the greatest quantity of aerosol to the simulated adult patient (18.44 ± 1.03% versus 3.64 ± 0.26% with a jet nebulizer).
The results highlight the potential for exposure to fugitive medical aerosols released during the delivery of aerosol therapy with a manual resuscitation bag and also the potential for significant variation in patient lung dose depending on nebulizer type.
Models to understand contractile function in the airways
2011, Pulmonary Pharmacology and Therapeutics
Citation Excerpt :
Conversely, the contractile response of ASM in obstructive airway diseases produces a major airflow limitation that is reversible by bronchodilators. The use of bronchodilators to relax ASM is the most common and effective practice to treat airflow obstruction [10–12]. The use of corticosteroids, which is the other mainstream therapy for obstructive airway diseases, targets ASM only indirectly by acting on the airway inflammatory response and structural remodeling that characterize these diseases [13–15].
Although the role of contractile function in the airways is controversial, there is general consensus on the importance of airway smooth muscle (ASM) as a therapeutic target for diseases characterized by airway obstruction, such as asthma or chronic obstructive pulmonary disease. Indeed, the use of bronchodilators to relax ASM is the most common and effective practice to treat airflow obstruction. Excessive pathologic bronchoconstriction may originate from primary alterations of ASM mechanical function and/or from the effects exerted on ASM function by disease processes, such as inflammation and remodeling. An in depth knowledge of the potentially multiple mechanisms that distinctively regulate primary and secondary alterations in ASM contractile function would be essential for the development of new therapeutic approaches aimed at preventing the occurrence or reducing the severity of bronchoconstriction. The present review discusses studies that have addressed the mechanisms of altered ASM contractile function in models of airway hyperresponsiveness. Although not comprehensively, in the present review, animal models of intrinsic airway hyperresponsiveness, normal ontogenesis, and allergic sensitization are analyzed in the attempt to summarize the current knowledge on regulatory mechanisms of ASM contractile function in health and disease. Studies in human ASM and the need for additional models to understand contractile function in the airways are also discussed.
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2011, The Lancet
Citation Excerpt :
Aerosol deposition on the face and eyes could be reduced by use of a prototype mask that incorporates vents in the mask and has cut-outs in the eye region.3,77 In patients with acute severe asthma, short-acting bronchodilators (eg, salbutamol 5–15 mg/h) are commonly given continuously78 with large-volume nebulisers or the high-output extended aerosol respiratory therapy nebuliser, which can provide consistent drug output for 4 h70 to 8 h,79 respectively. Patients with acute asthma have some benefits from continuous bronchodilator therapy in the emergency department.80
Aerosolised drugs are prescribed for use in a range of inhaler devices and systems. Delivering drugs by inhalation requires a formulation that can be successfully aerosolised and a delivery system that produces a useful aerosol of the drug; the particles or droplets need to be of sufficient size and mass to be carried to the distal lung or deposited on proximal airways to give rise to a therapeutic effect. Patients and caregivers must use and maintain these aerosol drug delivery devices correctly. In recent years, several technical innovations have led to aerosol drug delivery devices with efficient drug delivery and with novel features that take into account factors such as dose tracking, portability, materials of manufacture, breath actuation, the interface with the patient, combination therapies, and systemic delivery. These changes have improved performance in all four categories of devices: metered dose inhalers, spacers and holding chambers, dry powder inhalers, and nebulisers. Additionally, several therapies usually given by injection are now prescribed as aerosols for use in a range of drug delivery devices. In this Review, we discuss recent developments in the design and clinical use of aerosol devices over the past 10–15 years with an emphasis on the treatment of respiratory disorders.
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Dr. Peters serves as the American College of Chest Physicians advisor to the AMA CPT Coding Panel.

The author has no conflicts of interest to disclose.

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Topics In Practice ManagementContinuous Bronchodilator Therapy

Abstract

Section snippets

Continuous Bronchodilator Procedure

Practice Management Issues

Conclusion

Acknowledgments

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Am J Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

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Topics In Practice Management
Continuous Bronchodilator Therapy