A single-site, prospective, randomized, comparative design study was conducted in the ED between March 2010 and February 2011. Fifty-four subjects presenting with dyspnea and wheezing and an Emergency Severity Index of 3 or 4 were enrolled and randomly assigned to 1 of 2 groups (BAN or HHN). Subjects were administered 1 to 3 nebulizer treatments (#1 ipratropium bromide and albuterol sulfate, #2 ipratropium bromide and albuterol sulfate, #3 albuterol sulfate), which was consistent with the ED Advanced Nursing Guideline for Wheezing. Nebulizer treatments were discontinued if a patient鈥檚 dyspnea or wheezing resolved. IRB approval was obtained prior to study commencement.
There was no significant difference found between the HHN and BAN in respect to number of treatments, respiratory rate, peak flow measurements, and Modified Borg scores in the 54 subjects. There was a difference of 7 points in pulse rate between the pre- and post-second BAN treatment (n = 51, P = 0.01). Subjects in the BAN group who completed all 3 treatments (n = 18) had a total treatment time that was on average of 10 minutes longer than those in the HHN group.
This study demonstrated no clinical difference between the BAN and HHN in terms of respiratory rate, peak flow, perception of dyspnea, and number of treatments. It is possible that the longer treatment times account for the elevated pulse rate. The data suggests that the higher cost and the longer treatment time do not justify the use of the BAN in this setting. We recommend that these devices be tested with a larger sample size to further test the differences between these 2 devices.