Sterility Practices in Bronchodilator Administration in Allergy Office Settings

Rationale: Due to the need for asthma diagnosis and surveillance, the bronchodilator reversibility test is commonly used. Yet, there are no complete, standardized guidelines for bronchodilator administration. Various methods are used to clean the Metered Dose Inhalers (MDIs), but some physicians may not even take sterility into account. We seek to determine what methods allergists use to administer bronchodilators and allergists’ opinion of bronchodilator sterility of their practice.

Methods: A questionnaire was approved and distributed by the American Academy of Allergy, Asthma, and Immunology (AAAAI) to all member allergists in North America.  Responses were tabulated after a three-week period. 

Results: Of the 487 allergists who responded, 83.98% use MDIs for bronchodilator reversibility testing, with 59.34% using MDIs with a spacer and 24.64% using MDIs without a spacer. Several allergists, or 58.52%, use a nebulizer to administer the bronchodilator.  With regards to sterility with MDI use, of 449 respondents, 9.13% wipe inhalers with a cleansing agent, 18.71% use a new inhaler between patients, and 38.75% use a new disposable attachment for a reused inhaler, respectively. Only 69.25% of allergists felt that their bronchodilator administration was sterile. Notably, 14.05% of allergists felt their bronchodilator administration was unsterile, and 16.70% of members were unsure of sterility.

Conclusions: A significant number of allergists do not use sterile techniques when administering bronchodilators. This disregard for sterility can cause negative consequences for patients, such as the spread of infection. From this survey, it is evident that there is need for guidelines for sterile bronchodilator administration in allergy practices.