Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan-Feb;44(1):40-49.
doi: 10.1097/JHQ.0000000000000326.

Practicing What We Teach: Increasing Inhaler Use for Mild Asthma in the Pediatric Emergency Department

Chisom Agbim, Shilpa J Patel, Kathleen Brown, Jaclyn Kline

Practicing What We Teach: Increasing Inhaler Use for Mild Asthma in the Pediatric Emergency Department

Chisom Agbim et al. J Healthc Qual. 2022 Jan-Feb.

Abstract

Introduction: Asthma is a leading cause of pediatric emergency department (ED) visits. A metered-dose inhaler and spacer (MDI-S) device is equivalent to and more cost effective than delivery by nebulization in the ED management of mild asthma exacerbations. We aimed to increase the use of albuterol MDI-S among patients with mild asthma exacerbations using a quality improvement framework.

Methods: We evaluated albuterol use for mild asthma exacerbations between January 2019 and March 2020 in our pediatric EDs.

Results: Our primary outcome was the proportion of albuterol delivered through an MDI-S. Our process measure was the use of a new electronic order set. Balancing measures included ED length of stay, admission rates, and the use of intravenous magnesium. Interventions included forging multidisciplinary partnerships, revising clinical practice guidelines, establishing an electronic order set, and leading educational initiatives for clinicians. We demonstrated a center line shift of MDI-S use from 34.4% to 47.7%. The average length of stay, hospital admissions, and magnesium use were not affected by our interventions.

Conclusion: Forging multidisciplinary partnerships, creating an electronic order set prioritizing albuterol MDI-S use, and educational initiatives led to a sustained increase in albuterol MDI-S use for mild asthma in our pediatric EDs.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2017 Emergency Department Summary Tables. Hyattsville, MD. National Center for Health Statistics; 2017:37. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf . Accessed June 6, 2020.
    1. Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis. 2014;18(11):1269-1278.
    1. Delgado A, Chou KJ, Silver EJ, Crain EF. Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department. Arch Pediatr Adolesc Med. 2003;157(1):76-80.
    1. Dhuper S, Chandra A, Ahmed A, et al. Efficacy and cost comparisons of bronchodilator administration between metered dose inhalers with disposable spacers and nebulizers for acute asthma treatment. J Emerg Med. 2011;40(3):247-255.
    1. Alhaider SA, Alshehri HA, Al-Eid K. Replacing nebulizers by MDI-S-spacers for bronchodilator and inhaled corticosteroid administration: Impact on the utilization of hospital resources. Int J Pediatr Adolesc Med. 2014;1(1):26-30.