Question: In regards to the bronchoconstriction protocol I was recently in a discussion with a coworker disputing the 5-15 min dosing interval. The question was does this interval begin when treatment begins or once a treatment is completed. For example nebulized ventolin may take approximately 5 mins to fully nebulize could I administer a second treatment immediately or would I have to wait 5-15 mins post completion of a treatment. Clarification would be greatly appreciated.

 Thanks for the question. You are correct. When administering salbutamol via the nebulized route, it may take up to 5 min for the entire dose to be administered. The 5-15min time starts at the moment the nebulized treatment is initiated. Therefore, for a patient in extreme respiratory distress, it is conceivable that this patient (using the every 5min dosing interval rather than the 15min interval) could have "back to back" nebulized treatments.

The same rule applies to the MDI route. The time starts from the moment of the first MDI dose. Given that each puff is usually administered approximately (by the directive) every 4 breaths, it should not take 5min to administer all 8 puffs, therefore a pause should still occur between "doses" of 8 puffs using the MDI and the every 5min dosing frequency. In other words, 8x3= 24 puffs should not be administered without some form of pause between doses using the MDI.

Remember to also reassess your patient between each dose to ensure the indications for salbutamol are met.

Airway/Breathing,Bronchoconstriction

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