Jillyan Iwinski, MBA, RRT, RCP
A COPD exacerbation can present a challenge to the Emergency Department (ED) associated with a high risk of deterioration, the potential to require escalation of care resulting in admission to the hospital floors or ICU. The average length of stay of a COPD admission is 4-5 days resulting in average cost to the hospital ranging from $7,242 to $44,909.1,2 A high performance vibrating mesh nebulizer can result in faster, more efficient delivery of aerosol potentially avoiding escalation of care, reducing the risk of admission and the associated costs.3,4,5
A 60 year old woman presented in the ED with shortness of breath, oxygen saturation 92%, respiratory rate of 36 and an acute COPD exacerbation due to a lung infection. The patient was unresponsive to traditional small volume jet nebulizer treatments (SVN) resulting in a plan to intubate and admit the patient directly to the intensive care unit (ICU).
Prior to escalation of care and admission to ICU, the patient’s aerosol delivery device was changed from a standard SVN to a high performance vibrating mesh device (Aerogen Solo with Ultra). The patient received 2.5mg of albuterol Q2 hours with the vibrating mesh device and immediately responded as demonstrated by a SpO2 increase to 96% and respiratory rate decrease to 24, which were deemed baseline for this COPD patient. The patient verbally acknowledged feeling better and a discharge plan was initiated. Within four (4) hours the patient was discharged directly from the ED, and the escalation of care and associated costs were avoided.
The average inpatient length of stay for a COPD exacerbations is 4-5 days.1,2 This patient had frequent previous admissions for COPD exacerbations and was pending intubation on arrival to the ED and inpatient admission. The patient showed improvement within 4 hours and avoided inpatient admission.
This patient demonstrated a rapid clinical response to treatment with a high performance aerosol delivery device. The change from pending intubation to discharge was dramatic. It was the consensus of the team that the de-escalation of care for this patient was attributed to the use of the vibrating mesh aerosol delivery device.
- Dalal AA1, Shah M, D’Souza AO, Rane P., Costs of COPD exacerbations in the emergency department and inpatient setting. Respir Med.2011 Mar;105(3):454-60. doi: 10.1016/j.rmed.2010.09.003.
- JinjuvadiaC, Jinjuvadia R, Mandapakala C, et al. Trends in outcomes, financial burden, and mortality for acute exacerbation of chronic obstructive pulmonary disease (COPD) in the United States from 2002 to 2010. COPD. Published July 15, 2016; doi:10.1080/15412555.2016.1199669 [Epub ahead of print]
- Hickin S, Mac Loughlin R, Sweeney L, Tatham A, Gidwani S. Comparison of mesh nebuliser versus jet nebuliser in simulated adults with chronic obstructive pulmonary disease. Poster at the College of Emergency Medicine Clinical Excellence Conference. 2014
- Dugernier J, Hesse M, Vanbever R, Depoortere V, Roeseler J, Michotte JB, Laterre PF, Jamar F and Reychler G. SPECT-CT Comparison of Lung Deposition using a System combining a Vibrating-mesh Nebulizer with a Valved Holding Chamber and a Conventional Jet Nebulizer: a Randomized Cross-over Study. Pharmaceutical research. 2017;34:290-300
- Compared to a SVN : Dunne R et al. Aerosol dose matters in the Emergency Department: A comparison of impact of bronchodilator administration with two nebulizer systems. Poster at the American Association for Respiratory Care. 2016
Jillyan Iwinski is the Respiratory Therapy Director of a health system in Chicago, IL which cares for more than 300,000 patients each year.