A Novel Common Canister Protocol for Albuterol Sulfate Metered Dose Inhalers: Conservation Strategy and Clinical Outcomes Amid COVID-19 Pandemic

The COVID-19 pandemic led to unprecedented shortages of albuterol sulfate metered dose inhalers (MDIs) utilized in the supportive management of respiratory symptoms in patients with SARS-CoV-2 infections. The risk of generating infective aerosols in nebulized treatments increased the demand for metered dose delivery, leading to a worldwide shortage of albuterol sulfate MDIs. Previous common canister protocols involve the recycling and cleaning of canisters for multiple patient use, however have not undergone quality control studies on viral cross-contamination. Torrance Memorial Medical Center utilized an off-label method of common canister administration through spacer devices, forgoing the need for sterilization while conserving albuterol sulfate during a public health emergency. A retrospective review of this emergency department protocol was conducted on 329 patients receiving this novel albuterol sulfate common canister method over a 10-month period between 3/23/2020 to 1/23/2021. Results showed 265 patients (80.5%) had improved aeration determined by breath sounds evaluation by the respiratory therapist and patient interview. Purchasing records reviewed since 3/1/2020 show purchases were sufficient to sustain albuterol sulfate MDI supply so that no treatments were delayed omitted during the 10-month evaluation period. This novel approach to common canister delivery offers a promising measure to conserve a vital inhaled medication during a public health emergency and could serve as a basis for future development of conservation and quality control studies.