Teaching time for metered-dose inhalers in the emergency setting

Abstract

Numata Y, Bourbeau J, Ernst P, et al (McGill University, Montreal, Quebec, Canada; Kanazawa University, Kanazawa City, Japan) Practitioners in some acute care settings are reluctant to use bronchodilator treatment with metered-dose inhalers (MDIs) as standard management, because such therapy requires clinicians to ensure optimal device use. The time required to teach patients correct inhaler use for the emergency treatment of asthma and chronic obstructive pulmonary disease was investigated prospectively. The patients were participants in a single-center, randomized clinical study comparing bronchodilator administration by MDI with a delivery enhancement device (MDI/DED) versus delivery by wet nebulizer. Sixty-one patients with asthma and 32 with chronic obstructive pulmonary disease were assigned to the MDI/DED arm and received instruction. Patients with asthma had a mean forced expiratory volume in 1 second (percent predicted) of 63.5%, and patients with chronic obstructive pulmonary disease, 39.5%. Five patients were unable to complete MDI teaching and thus subsequently received wet nebulization. For the remaining 88 patients, the median teaching time was 6.5 minutes. Independent factors associated with shorter teaching times were a higher initial arterial oxygen saturation, home DED use after previous MDI instruction, and a single initial bronchodilator treatment by wet nebulization. Most patients reported satisfaction with their MDI/DED teaching and treatment. In the emergency setting, MDI/DED teaching followed by self-medication can be accomplished successfully with a simple protocol. Subsequent MDI teaching may be facilitated by a single bronchodilator dose given by wet nebulization.