1. It may cause harm!

Weak evidence exists that in mild pulmonary edema 1, albuterol may cause fluid to shift back into the vasculature, however, in severe left heart failure, it could cause harm. Dilation of the pulmonary vasculature may cause more blood to enter the left heart further shifting it off of the Starling curve. 

2. It delays the appropriate treatment.

Some doctors use albuterol to determine if a patient is suffering from a COPD exacerbation or a CHF exacerbation. We have better, faster diagnostic tools. Delay in treatment of CHF causes people to die 2. Do not waste time with albuterol if it is pulmonary edema. 

3. It wastes one of your most valuable resources, your Respiratory Therapist. 

Many Emergency Departments only have one RT on at a time. Some departments share their RT with other sections of the Hospital. When you urgently need an RT at the bedside, you do not want them busy doing an unnecessary breathing treatment. 

4. We have better diagnostic tools. 

Point of care ultrasound has changed the diagnosis of respiratory distress. The scan for pulmonary edema is one of the easiest to perform and interpret. You can know within minutes of patient arrival if the patient is in pulmonary edema. 

Jacob Avila does a great job discussing Pulmonary Ultrasound HERE

 

REFERENCES

1. Taylor et al. Effect of β2-adrenergic receptor stimulation on lung fluid in stable heart failure patients. J Heart Lung Transplant, 2017 Apr;36(4):418-426

2. Matsue Y et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. JACC 2017. PMID: 28641794