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Albuterol is the world's most abused medicine. Listed here are some of the medical conditions it is so often prescribed for in the hospital setting. This is followed by a pithy explanation of why it does or does not work for that particular diagnosis. Asthma . Bronchial airways are chronically inflamed and hypersensitive (twitchy) to asthma triggers. Exposure to which causes an abnormal immune response that causes worsening airway inflammation. This irritates bronchial smooth muscles that spasm and constrict (bronchial constriction). This is responsive to bronchial dilators (beta adrenergic medicines) like Albuterol. This is because they are lined with beta 2 adrenergic receptors. Albuterol attaches to them and causes bronchial smooth muscles to relax, thereby opening airways and relieving asthma symptoms. This same type of bronchial constriction occurs with cystic fibrosis and in patients with chronic bronchitis, so it works for them too. Pulmonary Edema . Heart failure. It causes...

I would like to define "Best Practice Medicine" and then analyze it's usefulness as far as it pertains to the respiratory therapy community. My "theory" is that it is not used properly. Best Practice . According to The University of Iowa  College of Nursing , it means: "The use of care concepts, interventions and techniques that are grounded in research and known to promote higher quality of care and living for... people." Best Practice Medicine . It is using the "best practices" available based on the medical research, particularly respiratory therapy research. and in real life practice. Now, let's examine another term: Evidence Based Medicine . According to Sackett, et al, 1996, it "is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available externa...

About 90% of breathing treatments ordered in the emergency room are for patients ultimately diagnosed with heart failure. This is according to a non-scientific poll of respiratory therapists This certainly bodes well for job security, but such injudicious use of Ventolin has also been implicated in respiratory therapy apathy syndrome . It also results in a needless hospital expense, as bronchodilators do not suck fluid out of lungs and do not benefit patients with pulmonary edema and heart failure. I always thought it would be nice if there was a test to determine who was actually experiencing bronchospasm and who was not. Apparently, researchers have been experimenting with using ultrasounds to find the true cause of respiratory distress, or to differentiate between COPD and cardiogenic pulmonary edema. Rather than just using a stethoscope, which has its limits as a diagnostic tool, researchers developed a ultrasound protocol that takes less than three minutes to perform. In fact, it ...

I like the idea of  best practice medicine . These are the recommendations or guidelines by which we live with when treating patients.  The problem with these is that many of the guidelines are based on consensus and not science.  This results in healthcare providers offering profligate or surreptitious treatment to our patients, and often with the side effect of frustration, burnout, and apathy. If you know that what you are ordered to do is a complete waste of time and money, and you have no choice but to do as you are told in order to keep your job, chances are that you are well aware that medicine is not based on science but consensus.  As John described a while back, a consensus is not science .  If it comes to a vote, it's not science, it's a consensus. If it's believed because it's popular, it's not science. Science is infiltrated with consensus.  So how do you know if it's science or consensus?  When you go to school, teachers must teach you th...

Fresh out of respiratory therapy school 20 years ago the medical profession seemed so right.  Doctors always properly diagnosed patients and everything they ordered was always necessary. Then, after studying charts and assessing patients before and after every procedure I did, unexpected revelations occurred. Most of what we do is a waste of time or delays time No diagnosis can be trusted Look, what I am about to say does not reflect, in any way, my respect for physicians and the institutions they work for.  In fact, I in no way expect any person to be perfect, and therefore it's not possible for every thing they order to be necessary, nor every diagnosis to be accurate.   What is my evidence?  Why is this true? Yes, I will get to the answers.  I've written enough about useless breathing treatments on this blog to choke a cow, so I don't want to get into that too much here.  But any respiratory therapist is taught to assess a patient before and after every ...

So one of my respiratory therapist friends, of whom I will not name here even though he said I could, sent me an email a while back explaining why it is that respiratory therapist driven protocols will never result in a decrease in treatment loads. There will always be the belief that if the patient is short of breath we must do something People sitting in leather chairs in Washington decided that in order to meet criteria for admission a patient must have needed at least 3 treatments in ER.  It eludes them that hospitals would have physicians order them just so the hospital can be reimbursed .  People sitting in leather chairs in Washington decided that in order for a patient's stay to be reimbursed for certain respiratory conditions (pneumonia, CHF, COPD) the patient must have breathing treatments ordered.  This is under the fake belief that if treatments aren't needed why keep the patient.  It eludes them that there may be other reasons for keeping the patient, no...

Today's version is Ventolin Taking note of the fact that the long-held conventional wisdom that aerosols like albuterol help with secretion clearance and mobilization have been overturned, we can now offer up the eight stages of how a medical hoax, faux theory, or scam is overturned and proven false. 1.  The theory is proposed by scientists on a nonscientific mission. (Example: the study of 4 COPD patients to which the hypoxic drive theory was devised.) 2.  It is believed because it plausibly explains an observation.  It taps into large anxieties about not being able to help those with chronic diseases we actually don't know much about, and make us feel like we are actually doing something good. For example, albuterol mobilizes secretions and enhances clearance, or under oxygenating COPD patients will prevent their hypoxic drive from being blunted.  The solution taps into the hearts of physicians and nurses: it sounds like a good idea; it makes them feel like they...