Resp Care
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Patient education is a critical factor in the use and misuse of medication inhalers. Inhalers represent advanced technology that is considered so easy to use that many patients and clinicians do not receive adequate training in their use. ⋯ Reimbursement and teaching strategies to improve patient education could substantially reduce these wasted resources. Problems with inhaler use, the cost of inhalers, and myths associated with inhalers are reviewed, with recommendations for strategies and techniques to better educate patients in inhaler use.
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Review Comparative Study
Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler.
Topically inhaled bronchodilators and corticosteroids are the mainstay of treatment for asthma and chronic obstructive pulmonary disease. These medications are delivered via jet or ultrasonic nebulizer, metered-dose inhaler (MDI), or dry powder inhaler (DPI). While the number of devices may be confusing to patients and clinicians, each device has distinct advantages and disadvantages. ⋯ There is a high rate of errors in device use with all these devices, especially the MDI. In choosing a drug/device combination for a patient, the clinician must take into account several factors, including the cognitive and physical ability of the patient, ease of use, convenience, costs, and patient preferences. Clinicians should also have a rudimentary understanding of aerosol principles in order to be able to teach appropriate use of aerosol devices to their patients.
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Pressurized metered-dose inhalers (pMDIs) are commonly employed for administering bronchodilator aerosols to mechanically ventilated patients. Although it is feasible to employ dry powder inhalers in ventilator circuits, the presence of humidity in the ventilator circuit could reduce their efficiency. ⋯ Significant bronchodilator effects are observed with as few as 4 puffs from a pMDI and cylindrical spacer. In mechanically ventilated patients, pMDIs are a cost-effective, convenient, and safe method for delivering bronchodilator aerosols.
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Inhaled drug delivery is an important part of the armamentarium of clinicians caring for patients with pulmonary disease. An increasing variety of metered-dose inhalers and dry powder inhalers are becoming available. This has been driven by the development of new formulations and the impending ban on chlorofluorocarbon propellants. ⋯ One of the important take-home messages of this conference is the importance of clinicians knowledgeable in the use of aerosol delivery devices and clinicians' ability to teach patients how to use these devices correctly. Respiratory therapists are uniquely positioned to provide this service, and there is evidence that respiratory therapists may do this better than others. The proceedings of this conference provide the current state of the art of metered-dose inhalers and dry powder inhalers.