Confusion in the Use Procedures of Inhalation Devices Essay

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Currently, there are three major types of aerosol generators frequently used in the treatment of airway disease. This includes metered-dose inhalers, dry-powder inhalers and small-volume nebulizers. A variation of the metered-dose inhaler is the breath-actuated MDI (pMDI), designed to synchronize inhalation and actuation. Another category includes holding chambers and spacers, though these are used in combination with metered-dose inhalers to improve effectiveness of the drug being administered. In regards to metered-dose inhalers, there are two propellant systems, both chlorofluorocarbon (CFC) and hydrofluoroalkane (HFA). Chlorofluorocarbon propellants are almost completely phased out at this point due to their detrimental effects on the environment, specifically the ozone layer. A patient with chronic obstructive pulmonary disease (COPD), is likely to have an MDI or SVN with a short-acting bronchodilator in conjunction with a DPI that contains a long-acting bronchodilator. However, studies show the use of several devices may lead to confusion for these patients, resulting in incorrect procedure and inadequate drug dosage. Figure 1 demonstrates the diverse variety of inhalation devices available.
Referencing Table 2 in “Practical problems with aerosol therapy in COPD”, the most prevalent error in MDI use amongst patients is error in technique, specifically failure to coordinate the MDI. Following coordination, other errors include inadequate breath-holding, rapid inspiratory flow and failure to shake the MDI before use. It is estimated that 28-68% of patients do not benefit from their MDIs or DPIs due to their misuse of the apparatus. This misuse results in billions of dollars wasted on a drug that is not being administer...

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...atients are able to use DPIs with minimum inspiratory flow.
Small volume nebulizers are simple to use as they require only normal tidal volume with no breath hold. The challenges with SVNs are related to their design, as they are often large in size and require an external power source. Additionally, a compressor or gas source is needed and the treatment time can be lengthy. SVNs are recommended for patients who cannot coordinate an MDI, or patients that cannot activate a DPI due to dyspnea. Individuals with difficulty using a standard MDI may find a breath-actuated MDI a better option. The Duo-Haler was the first breath-actuated MDI, followed by the Autohaler™. 97% of patients with airflow restriction were able to actuate the Autohaler™ on their first attempt. Breath-actuated MDIs received the highest performance scores and are vastly favored amongst patients.

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