GUIDELINES FOR THE USE OF NEBULIZERS IN THE HOME AND AT DOMICILIARY SITES - REPORT OF A CONSENSUS CONFERENCE

Guidelines for the use of nebulizers outside of the hospital were deve loped at the request of the Health Care Financing Administration (HCFA ) to assist in the preparation of Medicare criteria for reimbursement. The National Association for Medical Direction of Respiratory Care (N AMDRC) convened a consensus conference in Leesburg, Va, with physician representatives from the major medical organizations involved in adul t and pediatric respiratory care. Members of the health-care industry also were invited to participate, After review of the pertinent refere nces, members of the faculty were preassigned topics for presentations during the first day of the meeting. Three workshops were organized t o address segments of the consensus statement and to develop written r eports. Each report was reviewed by the entire group and then finalize d. The Consensus Conference recommends that a metered-dose inhaler (MD I) with reservoir chamber is the preferred mode of aerosol therapy for patients outside of the hospital. The circumstances under which a sma ll-volume nebulizer (SVN) may be appropriate are described. The medica tions that may be administered by SVN are identified with recommendati ons as to the usual doses to be prescribed. A cost analysis of the var ious modes of aerosol therapy is presented, These guidelines should be of value to physicians who are prescribing aerosol therapy in the hom e and also to policy makers who are developing guidelines for reimburs ement.