PURPOSE: Widespread prescription and use of home nebulizers in asthma may have the unintended consequence of contributing to over-reliance on bronchodilators and inadequate use of inhaled steroids with subsequent delay in seeking medical care during an acute exacerbation and poor management of chronic asthma. This may lead to poor outcome and even death. National Asthma Education and Prevention Program (NAEPP) guidelines include the use of a daily peak flow monitor and asthma action plan in individuals over five years of age who are prescribed a nebulizer. We retrospectively analyzed the use of home nebulizers in individuals dying from asthma.
METHODS: All asthma deaths in the age group of 2 to 34 years from 2002 to 2004 were identified in Michigan. Medical records for the year before death and an interview with next of kin was obtained and reviewed by an expert panel.
RESULTS: Eighty-six deaths, 38 children (37 > 5 years) and 48 adults occurred. Fifty-two patients had a home nebulizer and 30 used it regularly (Frequency of use ranging from once every week to six times a day). Thirty-eight had a peak flow meter, 8 used it daily. Twenty-nine had both and 8 used both of them regularly. Nineteen used a home nebulizer prior to the fatal event, 9 of the 19 (47%) also used their peak flow meter. Nine (17%) individuals with nebulizers had written asthma action plans but none used it to monitor their disease. Among 30 individuals using a nebulizer regularly, 20 (67%) were prescribed inhaled or oral steroids on a chronic basis but only 11 (37%) used them as prescribed.
CONCLUSION: Home nebulizers were not used in accordance with NAEPP guidelines either on a chronic basis or for an acute exacerbation and their misuse may have contributed to some patient’s deaths.
CLINICAL IMPLICATIONS: Possible interventions include dispensing peak flow meters and written asthma management plans with nebulizers, pharmacy notification to physicians for refills on bronchodilators and emphasis on home asthma management education.
DISCLOSURE: Amit Gupta, None.