The year 2020 will no doubtably be one of those lifetime remembrances joining the ranks of the Challenger and 9/11. Where were you? What were you doing? How did it impact your life? The pandemic has had many effects on healthcare: some good, some bad. There are some practices and adaptations that are valuable and worth retaining, like video conferencing to allow for flexibility in meetings. There are some that need to be evaluated, like metered dose inhaler (MDI) usage.

Metered dose inhalers, or MDIs, are commonly used when medications need to be delivered directly to the lungs. They are portable devices that patients can take anywhere and are the mainstay of ambulatory care for those needing respiratory support. Typically, each MDI includes a month’s worth of doses and does not require any additional equipment. In the acute setting, hospitals typically utilize nebulizer treatments. Many hospitals use auto substitution policies and protocols to not only streamline respiratory care, but also manage formulary and to keep tighter control over inventory. 

In the early days of the pandemic, healthcare professionals were urged to use MDIs due to the highly contagious nature of COVID-19. The shift towards MDIs not only mitigated the spread of the virus, but minimized staffing exposure to aerosolized particles and freed limited staff to do other things. In response, hospitals modified or suspended their auto substitution policies/protocols from MDIs to nebulizer treatments. MDIs are typically more expensive than unit dose nebulizer treatments. One dose of albuterol/ipratropium is roughly $0.29. One albuterol/ipratropium MDI is more than $350. The MDI does contain about a month’s worth of doses, but the patient may or may not be admitted long enough to consume all of the doses. While it is true that a patient would likely use more than one nebulizer treatment dose while hospitalized, even if they had 4 treatments a day for 2 weeks, it would still be considerably less at ~$16-17 compared to one MDI. 

Fast forward 30 months as we emerge from the pandemic, we know more about how the virus is spread and how to treat it. It is time to evaluate which practices need to become permanent changes and which practices can revert to their pre-pandemic state. Reinstating auto-substitution respiratory policies/protocols and/or limiting MDI usage can help hospitals optimize spend, streamline operations and inventory.