{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:16:59Z","timestamp":1777933019150,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>COPD is a common diagnosis driving in-patient admissions. A major component of in-patient COPD management involves nebulized or inhaled bronchodilators. In many hospitals, the in-patient pharmacy limits medication availability and may auto-substitute short-acting nebulized bronchodilators (SANBs) for long-acting inhalers (LAIs) to cut costs; the effect of such policy change on patient care is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a retrospective, observational study at a quaternary teaching hospital to analyze respiratory therapy utilization in subjects with COPD on home LAI, who were admitted between December 1, 2022\u2013February 28, 2023. We compared resource utilization between the following groups: SANB only, LAI\u2009+\u2009as-needed SANB, and LAI\u2009+\u2009scheduled SANB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We reviewed 302 admissions. There were 97 in SANB group, 99 in LAI\u2009+\u2009as-needed SANB group, and 106 admissions in LAI\u2009+\u2009scheduled SANB group. Subjects in LAI\u2009+\u2009as-needed SANB category utilized significantly fewer treatments overall than SANB or LAI\u2009+\u2009scheduled SANB groups (1.6\/d vs 4.2\/d vs 4.5\/d, respectively,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) and suffered fewer missed treatments (0.2\/d vs 1.7\/d vs 1.3\/d, respectively,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). There was no significant difference in the length of stay between the 3 groups. Furthermore, overall costs were lowest in LAI\u2009+\u2009as-needed SANB compared to the SANB and LAI\u2009+\u2009scheduled SANB groups ($117.62\/admission vs $219.71\/admission vs $375.35\/admission, respectively,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Within the SANB group, we found that only 36.1% of admissions included orders that complied with the auto-substitution policy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In conclusion, for patients with COPD on home LAI admitted to the hospital, substituting scheduled SANB for LAI resulted in higher costs, more frequent treatment utilization, and more missed doses than the alternative regimens. Moreover, most scheduled SANB orders were not reflective of the actual auto-substitution policy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/respcare.12385","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T15:53:21Z","timestamp":1738252401000},"page":"469-476","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["The Failure of an Auto-Substitution Protocol of Short-Acting Nebulizers for Long-Acting Inhalers to Reduce Cost of Care in a Quaternary Teaching Hospital"],"prefix":"10.1177","volume":"70","author":[{"given":"Rina W.","family":"Lee","sequence":"first","affiliation":[{"name":"Dr. Lee is affiliated with Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark W.","family":"Millard","sequence":"additional","affiliation":[{"name":"Dr. Millard is affiliated with Martha Foster Lung Care Center, Baylor University Medical Center, Dallas, Texas."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,5,5]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/00325481.2021.2018257"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S52557"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7149a3"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-023-00814-8"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-010-0017-6"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2019.09.001"},{"key":"e_1_3_3_8_2","unstructured":"Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis management and prevention of chronic obstructive pulmonary disease. Updated. 2024. https:\/\/goldcopd.org\/2024-goldreport"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.157.5.9709032"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2006.07.010"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2011.630047"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S114034"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s41030-023-00233-z"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011826.pub2"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S178040"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/02770903.2022.2047718"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201509-603OC"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/crj.13236"},{"key":"e_1_3_3_19_2","unstructured":"Pharmacy B.S.W.H. 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Missed bronchodilator medication treatments in respiratory therapy: frequency and underlying causes. Respir"},{"key":"e_1_3_3_30_1","doi-asserted-by":"crossref","unstructured":"Care. 2003; 48(2):110\u2013114.","DOI":"10.4187\/respcare.03480110"},{"key":"e_1_3_3_31_2","first-page":"11","article-title":"Missed respiratory therapy treatments: underlying causes and management strategies","volume":"13","author":"Wallace S","year":"2016","unstructured":"Wallace S, , Gardner L, , Roper C. Missed respiratory therapy treatments: underlying causes and management strategies. 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