ABSTRACT
BACKGROUND: The selection of accessory devices for pressurized metered-dose inhalers (pMDIs) by health care professionals is typically cost driven without consideration of how the device modifies clinical outcomes. OBJECTIVE: To evaluate nonconventional accessory devices and the open-mouth technique with and without ideal coordination of actuation and inhalation to identify and understand the considerations for recommending potential inexpensive devices. METHODS: In vitro performance parameters of the beclomethasone dipropionate pMDI were evaluated with several devices (AeroChamber, toilet paper roll, paper towel roll, rolled paper, plastic bottle spacer, bottle-holding chamber, and nebulizer reservoir tubing). RESULTS: Compared with the pMDI alone, all the accessory devices evaluated have significantly lower drug exposure and throat deposition and higher respirable fractions, with the paper towel roll having the greatest effect of the devices evaluated (exposure decreased from a mean [SD] of 76.1 [4.8] µg to 49.2 [2.0] µg, throat deposition decreased from 32.0 [3.2] µg to 0.8 [0.3] µg, and respirable fraction increased from 49.8% [3.2%] to 96.4% [0.4%]). Introduction of a delay between actuation and inhalation resulted in greater variability in performance metrics for the devices evaluated, and the bottle-holding chamber and paper towel roll were most effective in mitigating the effect of the delay. The open-mouth technique was found to decrease throat deposition and respirable mass compared with the pMDI alone. CONCLUSION: In addition to cost, the amount of drug that deposits in the throat and the lungs and the effect of asynchronous actuation and inhalation can vary with the selection of an accessory device, which may affect the therapeutic benefits of the pMDI selected.
Subject(s)
Anti-Asthmatic Agents/chemistry , Beclomethasone/chemistry , Metered Dose Inhalers/classification , Models, Anatomic , Administration, Inhalation , Humans , Metered Dose Inhalers/economics , Particle SizeABSTRACT
This article assesses the suitability of inhaler devices for patients with asthma according to their individual needs. Three main types of inhalers are discussed: pressurised metered dose inhalers, breath-actuated inhalers and dry powder inhalers. The advantages and disadvantages of these devices are discussed in relation to lifestyle, ability and suitability for individuals.
Subject(s)
Asthma/drug therapy , Metered Dose Inhalers/supply & distribution , Nursing Assessment/methods , Patient Selection , Activities of Daily Living , Administration, Inhalation , Aged , Anti-Asthmatic Agents/administration & dosage , Asthma/nursing , Asthma/psychology , Choice Behavior , Equipment Design , Female , Hand Strength , Humans , Inhalation , Life Style , Metered Dose Inhalers/classification , Nurse's Role , Powders , Pressure , Self Administration/methods , Self Administration/nursing , Self Administration/psychologyABSTRACT
OBJECTIVES: This study investigated the ability of patients to assess when a metered dose inhaler (MDI) is empty. METHODOLOGY: A total of 17 patients assessed, by shaking, the number of doses remaining in a salbutamol MDI that had been partially emptied. Another 100 patients were asked to collect all salbutamol MDIs they considered to be empty and would have thrown away. These MDI canisters were weighed and the number of doses that had been used was estimated. RESULTS: Using the 'shaking method', patients overestimated the amount remaining by around 40 doses. The mean number of doses delivered from an MDI labelled to contain 200 doses before it was discarded was 224 (range, 155-289). CONCLUSIONS: These findings confirm that patients are unable to determine when an MDI should be discarded, resulting in insufficient drug delivery at the end of the life of an MDI for the majority of patients, and wastage of the drug for others.
