Albuterol-Metered Dose Inhalers: Evaluation of A Free Medication Program

Purpose: Albuterol is a commonly prescribed medication for respiratory conditions. Guidelines exist that outline albuterol usage criteria for chronic pulmonary conditions, but current guidelines do not support albuterol use for most acute pulmonary conditions. This evaluation was conducted to determine appropriateness of albuterol metered-dose inhaler use dispensed as part of a free medication program in the family health center setting and overuse per national guidelines.

Methods: Albuterol metered-dose inhalers are inventoried and hard copy prescriptions should be generated for medications dispensed from the free medication program at three UPMC Family Health Centers. An evaluation was done for two years (1/09-12/11) of albuterol inhaler usage. Prescriptions for each inhaler were matched to the inventory record to determine if current documentation practice is sufficient. From these records, patient electronic health records were utilized to determine reason for prescribing, appropriate usage of medication per current guidelines, and multiplicity of medication per monthly period indicating possible inadequate disease control.

Results: Out of 485 total albuterol prescriptions dispensed through the free medication program, there were 258 hard copies obtainable. Of the 258 hard copy prescriptions, 199 of those were prescribed for appropriate reasons including asthma, COPD, and wheezing. The inappropriate reasons allergic rhinitis, bronchitis, cough, pneumonia, respiratory abnormalities/reactive airway disease, shortness of breath, upper respiratory infection, refill known medication, and unknown accounted for 59 of the prescriptions. Overuse of more than one inhaler in a calendar month was discovered in 43 out of the 167 patients.

Conclusion: In the majority of cases, albuterol is being prescribed according to guidelines. Also, in the majority of cases, albuterol is not being overprescribed. However, there is room for educational intervention on use of albuterol in non-chronic conditions, prescribing process to limit lost orders, and patient education to ensure medication safety and economic stewardship of the free medication program.