Albuterol in COPD exacerbations? How does it REALLY work?

[THE_DITCH_DOCTOR]

I am putting together a clinical study (with the assistance of a psychology professor at my school) to assess the possibility of the placebo effect playing a major role in the relief experienced following treatment with bronchodilators (most notably albuterol). My theory is that it's most often due to a placebo effect because there is often not audible wheezing in these patients, rather the breath sounds are just diminished to varying degrees and no change is seen in peak flow measurements done in conjunction with the nebs. Basically it's my theory that the people feel better simply because we are doing something, not because we are actually doing anything that changes something from a physiologic standpoint.

What does everyone think?

[Summit]

Will basics be able to administer the new placebo nebs?

[THE_DITCH_DOCTOR]

Sorry, it will remain an ALS level skill

[1EMT-P]

You may be on to something there about ned treatments, but what about Sub Q Brethine?

[THE_DITCH_DOCTOR]

The potential issue isn't the lack of potency of the albuterol, but rather the pathophysiology of COPD- the problem isn't always bronchospasm. Often it is just simply a problem with air trapping due to a loss of the elastic recoil of the lungs and a loss of surface area due to alveolar destruction, or that the tenuous balance is upset by an infection or something else going wrong- not a bronchospastic event. Basically you can give them all the bronchodilators in the world and it won't make one bit of difference in a lot of cases.

You see subjective improvements in many stable COPD'ers following treatments (they tell you they feel better or even great after the treatment), but you often don't see objective evidence (increased peak flows or significant changes in breath sounds for example) to support that.

[craig]

Guys are you saying that salbutamol (albatross) id an ALS only drug?

here in australia it is BLS. heck even the trainee can give it.

it is a pretty safe drug to give. so it may cause tachycardia in cases where it is OD

btu relative safe drug for all to give

stay safe

[craig]

Guys are you saying that salbutamol (albatross) id an ALS only drug?

here in australia it is BLS. heck even the trainee can give it.

it is a pretty safe drug to give. so it may cause tachycardia in cases where it is OD

btu relative safe drug for all to give

stay safe

bloody spell check

albuterol and but

stay safe

[Ridryder 911]

I too believe we sometimes assume most of our COPD patients are constrictive instead of true chronic lungers with poor compliance. Many medics miss pulmonary congestion vs. pulmonary obstruction.

There are very few EMT's that are taught the difference in "pink puffer & blue bloaters" any more.

I was wondering Steven, what medication(s) do you prefer for "air entrapment syndrome".. ?

Be safe,

Ridryder 911

[THE_DITCH_DOCTOR]

I think a lot of it is psychological combined with air trapping (almost like a supped up version of hyperventilation). I've seen excellent results from using CPAP in patients with severe exacerbations, but the idea we are working on is that a lot of "attacks" are simply panic attacks- ever notice how some COPD'ers freak out over very minor things (such as if you try to take their inhaler from them).

Like I said it's just a personal theory that I would like to see tested, but I think they feel better simply because we are doing something that they have been told will make them better.

[Medic192575]

We've got Solu-medrol if we have a pt whose SOB seems to be more congested than bronchospasm. It takes awhile but it does work. Most of us also give the albuterol along with the solu-medrol