The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

SELF-ADMINISTERED METERED DOSE INHALER THERAPY: AN ANALYSIS OF INSTRUCTION, TECHNIQUE, AND EFFICACY

CR Hall, MS, RRT, RPFT, RR Baker, PhD, RRT, RCPT, SC Mishoe, PhD, RRT, AA Taft, PhD, RRT, FH Dennison, M.Ed, RRT, RPFT. Medical College of Georgia, Augusta, GA

BACKGROUND: Adult patients are frequently left to self-administer their metered dose inhaler bronchodilator therapy in the hospital. These treatments are often ineffective for the following reasons: spacers may not be used, instruction may not be given, patient technique may be poor even after instruction, or patients may not be responsive to bronchodilator therapy. Ineffective MDI treatments can add unnecessary medical costs. This study assessed the source of initial instruction, the MDI technique, and bronchodilator efficacy in hospitalized patients self-administering their treatment.

Methods:
This study examined 16 hospitalized adult patients who were currently performing self-administered MDI bronchodilator therapy without a spacer (saMDI). Each patient was assessed within 72 hrs of the initial physician order. No treatment was given within 6 hours of a previous treatment. Each patient was told to perform their MDI treatment exactly as they were originally instructed. No further coaching or instruction was given. Patient MDI technique was assessed using steps derived from the Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma from the National Asthma Education and Prevention Program. To determine efficacy of bronchodilation, saMDI was compared to metered dose nebulization (MDN) using a crossover design. Baseline spirometry was performed prior to each treatment. Subjects initially received 180 mg of albuterol via either saMDI or MDN. Spirometry was performed 15 minutes later to assess bronchodilator response. A second 180 mg dose was given and spirometry was performed after 15 minutes. No adverse sequelae were noted in any treatment method.

Results:
Of the 16 study patients, 44% (n=7) were initially instructed by a nurse, 19% (n=3) by a respiratory therapist, and 37% (n=6) received no initial instruction. As a group, the respiratory therapy-instructed patients correctly performed 90% of the assessed MDI steps, nursing-instructed patients correctly performed 53%, and the non-instructed patients correctly performed only 38%. Of patients in the therapist-instructed group, 100% (n=3) performed greater than 50% of the steps correctly as compared to 57% (n=4) in the nursing-instructed group and 33% (n=2) in the non-instructed group. Only 44% of the total patients performed less than half of the MDI techniques correctly. Eight of 13 patients responded to any bronchodilator therapy but only 3 responded to MDI. Three of the 16 patients, 2 in the nursing-instructed group and 1 in the non-instructed group were unable to perform PFTs.

Conclusions:
Self-administered MDI therapy may not result in optimal therapy. Patients have better saMDI technique when instruction is provided by a respiratory therapist. Bronchodilator therapy should be attended by a health-care provider and outcomes monitored to assure treatment efficacy.

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