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By Debra A. Togger, MSN, RN, and Phyllis S. Brenner, PhD, Fi
_ Metered Dose
Inhalers
When it comes to knowing
how to use these devices
effectively, nurses and patients
alike have been found wanting
Demonstrate each step to
ensure that your patients are
getting all they can from their
inhaled medications.
Bra some distant, misty past a person wit
asthma might have been advised to lie wi
AB the Farry side of a muskrat hide over his lun
fox ocallee spider webs, roll hem ino a be
Hin his hand, and swallow them. Today w
have what we consider more powerful medicatior
for treating asthma, and the most common rou
of administration, inhalation through 2 metere
dose inhaler (MDI}, seems effordess by compar
son with chose folk remedies. Bur studies hav
shown that many people—nurses and other car
givers as well a patients—often don’t know ho
to use these devices cotzecty, and the consequenct
of suboptimal dosing can be devastating.
Asthma currently affects more than 26 million people in the United States, accor
ing to the atest results of the revised National Health Interview survey.’ Yer althoug
asthma is genecally considered to be a chronic condition manageable in an ambulator
‘care setting, and despite advances in treatment modalities, morbidity and morealitin 1997 by the National Heart, Lung, and Blood |
Instore (NHLBI), identifies four areas of asthma
management: assessment and monitoring, control
of factors contributing to asthma severity, pharma-
cologic therapy, and education.* This article focuses
oon the use of metered dose inhalers with regard t0
pharmacologic therapy and education.
One of the main goals of pharmacologic therapy
is “airway remodeling,” controlling the inflamma-
tory process associated with asthma and preventing,
scarring of the lungs. This is accomplished through
the use of long-term control medications for chronic
symptoms and quick-relief medications for flare-up
episodes and exacerbations. Both types of medica-
tions are typically administered with metered dose
inhalers. Yer studies have shown thar many patients
exhibit poor techniques with these devices.” For
example, a study by Shrestha and colleagues
showed ‘that only 21% of patients who used
inhalers performed ail inhalation steps correctly.’ A
patients ability to use an inhaler correctly depends |
largely on the knowledge and skill of whoever
reaches him; studies have also found poor tech-
niques among the nurses, physicians, and respira
tory therapiss responsible for educating patients."
Because nurses are often patients’ primary educa:
tors, they can directly influence the patiens’ abilities
to manage their asthma. Thus, it's vital that nurses
have both knowledge and hands-on skills suficient |
to allow them to teach and demonstrate inhaler use
cffectively. We'll discuss some fairly common deficits |
in these areas among nurses, explain correct metered
pee
ee eee)
inhal
dose inhaler and spacer
‘usage techniques, and briefly
consider how these devices
are changing. We will also discuss patient education
and provide chars to help guide your teaching.
(Please nove that although mecered dose inhalers are
also used by patients with chronic obstructive pul-
monary diseases such as chronic bronchitit and
Mietered Dose Inhalers:
Who Are the Primary Educators?
How Often Is Education
on Metered Dose inhaler
Use Provided?
Question not
‘answered
Frequently -
Infreauently