A Prospectively Designed Chart Review Comparison of Vibrating Mesh Nebulizer Versus Standard Jet Nebulizer to Deliver Bronchodilators in Asthma and COPD Patients in the Emergency Department

Abstract

Background: Patients admitted to emergency departments (ED) with breathlessness are often ordered on bronchodilator therapy. Due to limited clinical response, dosing of these short acting bronchodilators has necessitated the use of hour-long aerosol therapy with jet nebulizers (JN) to accommodate the required high dosages for asthma and COPD patients admitted to our ED. Our aim was to determine whether treatment with vibrating mesh nebulizer (VMN) compared to (JN) would result in less total amount of albuterol (mg) required for adult asthma and COPD patients. Methods: We designed a prospective, single center, non-randomized chart review study of adult asthma and COPD patients in the ED with breathlessness requiring bronchodilator therapy (at the treating physician’s discretion). They were treated according to current standards with JN during period 1 or VMN during period 2 (sample size calculation, 80% power). At the end of the two treatment periods, demographic and endpoint data were extracted from the electronic medical record (EMR) for patients meeting inclusion and exclusion criteria. This study was IRB approved. Results: A total of 199 patients (118 JN, 81 VMN) were extracted from the EMR between December 10, 2018 and April 5, 2019. The total mean amount of albuterol (mg) required was significantly less in asthma patients treated with VMN compared to JN (7.9 ± 5.4 vs. 13.8 ± 9.6. respectively) (P = .0003) but it was not significant in the COPD patients (7.6 ± 4.4 vs. 8.8 ± 6.5. respectively) (P = .84). Patients treated for asthma and COPD combined with VMN required significantly fewer treatments compared to JN (2.1 ± 1.6 vs. 2.7 ± 1.6. respectively) (P = .009). Total treatment time (minutes) for asthma patients treated with the VMN was significantly less than the JN (40.7 ± 24.9 vs. 63.1 ± 40.4. respectively) (P = .002) but for COPD it was not significant (40.4 ± 23.1 vs. 42.6 ± 26.3. respectively) (P = .99). In asthma patients, 1 in 42 (2.4%) VMN required an hour-long treatment compared to 30 in 63 (47.6%) in the JN group (P < .001). In COPD patients 0 of the 39 VMN required hour-long treatments compared to 9 in 55 (16.4%) in the JN group (P < .001). Conclusions: Asthma patients treated with the VMN required significantly less total albuterol and shorter treatment times. Combined COPD and asthma patients treated with VMN required significantly fewer treatments. Both diagnoses required significantly fewer hour-long treatments with VMN vs JN.