The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

ARE PATIENTS GENERATING APPROPRIATE INSPIRATORY FLOW FOR THEIR INHALED MEDICATIONS?

Brittany Crook, Bill Pruitt; Univ of South Alabama, Mobile, AL

BACKGROUND: Patients using dry powder inhalers (DPIs) and powered metered dose inhalers (MDIs) must use an appropriate inspiratory flow to properly self-administer their medications. We evaluated the inspiratory flows in a random sample of patients by using an inspiratory flow measuring device (IFMD). METHODS: The patient population for this study included adults 18 years or older who were currently using inhaled medications from MDIs and DPIs. Patients were asked to inspire through the IFMD and mimic their usual technique for inspiration (as if it was the device they used regularly). The measured flow was evaluated for appropriateness based on the manufacturer's recommended flow for the particular delivery device. We obtained the patients'age, gender, and pulmonary diagnosis. We also subjectively assessed the patients'technique and asked if their inhaled medication helped their breathing. RESULTS: Twelve patients were asked to participate and eleven completed the study (eight women and three men, all between ages 45 and 75 years). Eight patients were receiving a single inhaled agent; three were receiving two agents (each had an MDI and a DPI). This produced fourteen trials to check inspiratory flow. Eight patients had been using their medicine over a year; three had 1 to 3 months experience using the medication(s). Out of fourteen trials, only seven trials produced inspiratory flows in the proper flow range according to the manufacturer. The remainder had flows that far exceeded the recommended inspiratory flow. None of the trials showed inspiratory flows that were too low. Analysis of the amount of time using the inhaled medication showed that there was no correlation between time on the medication and ability to use it correctly. Two patients said that the medication "never helped" or "sometimes helped". Both were outside the acceptable range for their medication and there was a larger variance in proper technique for these patients as compared to those who were helped by their medication. CONCLUSION: Half of the patients tested were using inspiratory flow rates that were far too great. Experience did not appear to affect proper technique. Although this was a small trial, the findings are disturbing and point out the need for more careful instruction and monitoring of technique.
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