Increasing Metered Dose Inhaler Use for Acute Asthma Exacerbations in the Pediatric Emergency Department: A Quality Improvement Challenge

Pediatric asthma is the most common chronic condition in children and results in significant disease burden and healthcare costs. The mainstay of asthma treatment is inhaled albuterol, and different modalities of albuterol delivery have been shown to affect healthcare quality measures. Albuterol delivered via metered-dose inhaler with a valved holding chamber (MDI/VHC) has been shown to be at least as effective as nebulized albuterol while also reducing medication side effects, admission rates, length of stay in the emergency department (ED) and overall costs. However, a culture of nebulized albuterol still predominates in the ED. Quality Improvement methodology is well suited to address this healthcare quality problem. The goal of this article is to utilize The Model for Improvement framework to provide a review and a critique of the literature regarding the transition to MDI/VHCs from nebulizers in the acute care of children with asthma exacerbations.