Question About Albuterol Atrovent Neb. Tx

I was told by my former DON that a Pt can receive a breathing tx every hour and it not be harmful. Under what circumstances would this be true?
When you are giving albuterol 2.5mg per neb the dosing is every 4 hours. You may give every 2 hours if there is an acute exacerbation x4 doses. However, if you have to give every 1 hour, the pt needs to be evaluated in the ER.

Well we put serious wheezers who don't respond to triple nebs on continuous albuterol. If they need it for more than 24 hours we check lytes and make sure they're on a high potassium diet during treatment.

If the patient is needing it that often, or even just more often than every 4 hours, you consider having it switched to levalbuterol. Albuterol should never be scheduled, only prn. Regular albuterol contains both levalbuterol as well as it's by product. The byproduct is pro-inflammatory and can cause bronchospasm and bronchoconstriction, this is usually cancelled out by the levalbuterol unless you are taking it frequently, in which case the byproduct levels can build it up beyond that of the levalbuterol since the byproduct has a longer half-life.

Not a by-product. Racemic albuterol contains both the (L) & (S) enantiomer of albuterol. Basically, same components with a different mirror image configuration. Also, light will take a different path around each type of molecule.Let's be clear about the inflammation and constriction. The literature is in vitro based not in vivo, so take it for what it's worth. Not absolute at this point.

Quote from fnkEchknI was told by my former DON that a Pt can receive a breathing tx every hour and it not be harmful. Under what circumstances would this be true?

The albuterol treatment via nebulizer is okay every hour (if necessary), however you should not be giving the Atrovent that frequently. If you have to give more than 4 treatments in a row each hour, I would be phoning the physician.

Obviously what you should do is dependent upon the setting. In the ED, we give stacked nebs quite frequently. In an LTC setting, an increased need for nebs would be an indication to seek further evaluation.However, that was not the original question.

Quote from GilaRNNot a by-product. Racemic albuterol contains both the (L) & (S) enantiomer of albuterol. Basically, same components with a different mirror image configuration. Also, light will take a different path around each type of molecule.Let's be clear about the inflammation and constriction. The literature is in vitro based not in vivo, so take it for what it's worth. Not absolute at this point.

Quote from MunoRNYou really only need look at the well established dosages and administration intervals for levalbuterol and albuterol particularly when given in larger doses and to treat more severe symptoms; given the same amount of (R)-albtuerol, levalbuterol requires a smaller dosage for the same effect, the result of containing a component with opposing effects to levalbuterol.

Quote from ~*Stargazer*~In acute bronchospasm, albuterol can be given Q20 minutes X3 doses. We do this in the ED quite often.

Oops double post

Quote from GreyGullYou can not compare "dosages" when you now have two different chemical configurations. You can also look at other medications which also have similar differences with the isomers.L-epinephrine1:1000 and Racemic Epinephrine 2.25% are good examples.You could also take a look at the albuterol dosage in DuoNeb (or the generic) and the single unit dose.Duoneb contains 3.0 mg (0.1%) of albuterol sulfate, the equivalent to 2.5 mg (0.083% of albuterol base).