New Service Begins for Children with Asthma on Continuous Albuterol

Beginning January 3, 2012, patients with asthma who need continuous albuterol treatment will benefit from a new service developed by St. Louis Children’s Hospital physicians, nurses and respiratory therapists with expertise in caring for this patient population.

“Previously, these children were admitted to our pediatric intensive care unit (PICU) and remained there until they could go on intermittent albuterol treatments,” says Albert Faro, MD, attending physician in the division of allergy, immunology and pulmonary medicine and co-leader of the 7 East Unit-Based Joint Practice Team. “Our goal was to develop a program that provided optimized treatment for these critical-status patients in an environment as safe as the PICU but in a quieter and more comfortable setting on 7 East.”

Under the new program’s guidelines, effective January 3, patients on continuous albuterol may be moved from the PICU to 7 East when:

• They are diagnosed as status asthmaticus.
• They are age 2 years or older.
• They are stable for at least two hours on continuous albuterol 20 mg/hour or less and mask delivery is tolerated.
• They are stable without Bi-pap or any mechanical ventilation.
• Their supplemental oxygen is 50 percent or less.
• Their vital signs are stable.
• They are not receiving terbutaline or aminophylline.
• They are alert.

“It is important to note that all of these patients will have spent a minimum of two hours in the PICU prior to transfer to 7 East in order to ascertain the trajectory of their disease course,” says Dr. Faro. “Transfers take place only when it is fairly clear that patients are responding to the continuous albuterol nebulizations.”

Once on 7 East, patients will be placed under the care of an allergy, immunology and pulmonary medicine attending physician. A two-to-one patient/nurse ratio will be maintained, and a dedicated respiratory therapist will be assigned to the patients. A maximum of four patients on continuous albuterol may be cared for on the floor at one time. Once patients are stable on intermittent albuterol nebulizations, they will no longer classified as critical status, and their primary care provider will then determine the attending service.

“Another advantage of this new program is that it allows us to begin much earlier the process of educating and preparing families for taking care of their child’s asthma once discharge occurs,” says Anne Borgmeyer, RN, CPNP, and co-leader of the 7 East Unit-Based Joint Practice Team. “We want to ensure our patients go home on the medications that best keep their asthma under control, work with primary care providers on developing an appropriate asthma action plan, and then educate families about the plan so they know what they need to do on a day-to-day basis to keep their child from becoming so sick again.”

In preparation for implementing the new program, 7 East staff members received in-depth training on continuous albuterol administration and its rare adverse effects.

“A major benefit to patients is that they receive care from a team experienced in the entire spectrum of pulmonary diseases, from bronchiolitis and asthma to cystic fibrosis and respiratory failure,” says Dr. Faro. “Many other well-known pediatric institutions care for children on continuous albuterol outside of their critical care units. We are confident this new approach will have significant advantages for our patients in regard to their comfort and care.”