ALBUTEROL IN ACUTE BRONCHIOLITIS - CONTINUED THERAPY DESPITE POOR RESPONSE

To determine whether clinicians continue to treat acute bronchiolitis with nebulized albuterol despite lack of clinical improvement after su ch treatment, we reviewed the medical records of 90 randomly selected infants and children with the primary diagnosis of that disorder who w ere treated in this 232-bed tertiary care children's hospital. Clinica l improvement and no clinical improvement were defined as improvement and lack of improvement, respectively, in air movement, wheezing, retr actions, oxygen saturation, work of breathing, and respiratory rate af ter administration of nebulized albuterol. Response to nebulized albut erol was determined from explicit written documentation in the medical records. Of 68 children who received nebulized albuterol in the emerg ency department, 52% had written documentation indicating no clinical improvement; however, 94% had admission orders to continue the therapy . Within 12 hours after admission, 61% were again noted to have no cli nical improvement with nebulized albuterol. Eighty-seven percent of no nresponders continued to receive albuterol throughout hospitalization, and 54% continued to receive it after discharge. Continuing therapy d espite lack of response resulted in unnecessary medical expenses.