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¢ CEA . eae g te a 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 morealit in 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