Q&A: With supplies of respiratory drug low, hospitals look for alternatives

Landon Flannery, 2, at Mpls. Children's Hospital
Tim Flannery, right, reads a Curious George story to his two-year-old son Landon on Friday at Children's Hospital in Minneapolis. Landon Flannery was having trouble breathing and is now receiving continuous respiratory assistance.
Jennifer Simonson/MPR News

Some children's hospitals in the Twin Cities are running low on a drug that helps ease labored breathing.

Related: Respiratory drug in short supply at pediatric hospitals battling virus

The shortage follows the outbreak of an unusual virus that has been causing severe respiratory illnesses in children across the Midwest. Enterovirus D68 causes cold-like symptoms that can range from mild illnesses to very serious respiratory conditions.

There is still no official confirmation that this virus is circulating in Minnesota. But some children's hospitals in the Twin Cities metro area have been swamped this week with a surge in patients who are suffering from respiratory illnesses.

MPR News reporter Lorna Benson spoke to hospital officials about the shortage and reports on efforts to treat children with breathing problems.

What is the drug that is in short supply?

It's called albuterol and it's the drug of choice for helping these kids with their breathing problems. So far, the shortage only applies to the concentrated form of the drug that would be used in a hospital.

Children's Hospitals and Clinics of Minnesota has been using a lot of concentrated albuterol this week to give some children "continuous nebulizer" treatments of vaporized medication blown through a mask. The treatment course may be needed for a few days.

Children's officials say the two hospital campuses in St. Paul and Minneapolis only have about a two-and-a-half day supply of albuterol left. Doctors and pharmacists are searching for alternate medications. Hospital administrators have asked a pharmaceutical company if they can obtain more of the drug.

Many people with asthma use albuterol as a rescue breathing medication. Will this shortage affect them?

Officials say the shortage doesn't apply to rescue inhalers, or even those small liquid tubes of albuterol that parents use to nebulize young children at home. Apparently the shortage is limited to concentrated albuterol used in hospitals.

It appears that Children's two hospitals in the Twin Cities metro area have had a very busy week. Have they been able to handle all of the patients seeking care?

Children's officials say inpatient units have been operating at full capacity all week. On Monday, doctors sent six patients to the University of Minnesota Children's Hospital. But that has been the only time they diverted patients, so far.

How sick have their patients been?

Children's has been seeing around 70 to 80 extra patients per day who have severe respiratory symptoms. Many of those children have been treated in the emergency department and sent home, but some were sick enough to be admitted to the intensive care unit.

Today, the two hospitals have about 10 children between them who are on ventilators. That is very unusual, as the intensive care units often can go for weeks without admitting a single child with asthma or breathing problems.

Roxanne Fernandes, chief nursing officer at Children's Hospitals and Clinics of Minnesota, said today that the situation reminds her of the 2009 flu pandemic because the hospitals are so busy and the situation is unpredictable. The viral illnesses may fade away quickly or last for weeks.

But Fernadnes said it is important for parents not to panic about the illness because there likely are many mild cases of disease.

"Use your instincts, watch your child. This is not something to be afraid of," she said. "Most likely you and your pediatrician together are going to be able to handle this and do this well. Come to the emergency rooms when you need to, if your child really can't breathe."

What about other pediatric hospitals in the Twin Cities metro area or around the state?

The University of Minnesota Children's Hospital also has experienced a large surge in patients with respiratory problems. Hospital officials say they are still able to treat the most critically ill patients and have not had to change any care routines. But the hospital is developing a plan to increase its patient capacity.

Essentia Health officials say their hospitals and clinics in Brainerd and Fargo have so far not seen any signs of this virus among pediatric patients. Essentia's hospital in Duluth has reported a slight increase in respiratory illnesses this week.

Officials at the Mayo Clinic in Rochester say doctors there have been treating a surge in children with acute respiratory illness, involving wheezing and difficulty breathing, since mid-August. But they say the hospital has been able to treat all patients.

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