Pharmacy Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
J Clin Pharm Ther. 2021 Aug;46(4):1129-1138. doi: 10.1111/jcpt.13410. Epub 2021 Mar 25.
Nebulizer use has been suspended in Malaysian public health facilities due to the potential to aggravate COVID-19 nosocomial transmission. Currently, our facility uses the pressurized metered-dose inhaler (pMDI) bronchodilator with Venturi mask modified spacer (VMMS) in patients visiting the Emergency Department (ED) for mild to moderate exacerbation of asthma and chronic obstructive pulmonary disease (COPD). We sought to assess the outcomes and acceptance of pMDI-VMMS in the outpatient ED of a tertiary hospital in Malaysia.
We analysed the total visits and discharge rates during periods of using the nebulizer and current pMDI-VMMS methods. The acceptance of pMDI-VMMS by patients and assistant medical officers (AMOs) were assessed by questionnaire.
We analysed 3184 ED visits and responses from 103 patients and 32 AMOs. The direct discharge rate was similar for both nebulizer (n = 2162, 92.5%) and pMDI-VMMS method (n = 768, 90.7%) (p-value = 0.120). Twenty-eight patients (27.2%) favoured the pMDI-VMMS over the nebulizer, whereas 36 patients (35.0%) had no preference for either method. Sixty-four patients (62.1%) felt that the current pMDI-VMMS method was better or at least as effective in relieving their symptoms as a nebulizer. The current method was favoured over the nebulizer by twenty-seven AMOs (84.4%). Twenty-eight (87.5%) AMOs suggested that the current method was more effective than the nebulizer.
The bronchodilator delivered via pMDI-VMMS appeared to be comparable to nebulizer in treating mild to moderate asthma and COPD exacerbations in the outpatient ED. Most patients and AMOs accepted the use of pMDI-VMMS in the outpatient ED during the current COVID-19 pandemic. The Venturi mask modified spacer can be a cheap and effective alternative to the commercial spacer in a resource-limited situation.
由于潜在的 COVID-19 医院内传播风险，马来西亚公共卫生设施已暂停使用雾化器。目前，我们的机构在急诊部（ED）就诊的轻度至中度哮喘和慢性阻塞性肺疾病（COPD）恶化患者中使用带文丘里面罩改良储雾罐（VMMS）的压力定量吸入器（pMDI）支气管扩张剂。我们旨在评估在马来西亚一家三级医院的门诊 ED 中使用 pMDI-VMMS 的结果和接受程度。
我们分析了使用雾化器和当前 pMDI-VMMS 方法期间的总就诊次数和出院率。通过问卷调查评估患者和助理医疗官（AMO）对 pMDI-VMMS 的接受程度。
我们分析了 3184 次 ED 就诊和 103 名患者和 32 名 AMO 的回应。雾化器（n=2162，92.5%）和 pMDI-VMMS 方法（n=768，90.7%）的直接出院率相似（p 值=0.120）。28 名患者（27.2%）更喜欢 pMDI-VMMS 而不是雾化器，而 36 名患者（35.0%）对两种方法均无偏好。64 名患者（62.1%）认为目前的 pMDI-VMMS 方法在缓解症状方面与雾化器一样好或至少同样有效。27 名 AMO（84.4%）更喜欢当前方法而不是雾化器。28 名 AMO（87.5%）表示，目前的方法比雾化器更有效。
在门诊 ED 中，通过 pMDI-VMMS 输送的支气管扩张剂似乎与雾化器在治疗轻度至中度哮喘和 COPD 恶化方面相当。大多数患者和 AMO 在当前 COVID-19 大流行期间接受在门诊 ED 使用 pMDI-VMMS。在资源有限的情况下，文丘里面罩改良储雾罐可以替代商业储雾罐，是一种便宜且有效的替代方案。
