A presentation created for Pulmonary Rehab about inhalation therapy. Overview of MDI, DPI, and nebulizers. Also reviews proper use and cleaning.

1. Welcome to
Pulmonary Rehab
Inhalation Therapy For COPD & Asthma
Babette Parthum, RRT
Clinical Coordinator
Respiratory Therapy

2. Types
● Pressurized Metered Dose
Inhaler (MDI)
● Dry Powder Inhaler (DPI)
● Nebulizers

3. Pressurized MDI

4. Propellants
● Provides the force to generate the aerosol
cloud
● The medium for which the active
component is dissolved
● Typically make up more than 99% of the
delivered dose

5. ● Chlorofluorocarbons (CFCs)
○ Used to be the most commonly used
propellants
○ Banned due to adverse effect on ozone layer
● Hydrofluoroalkanes (HFA)
○ More effective
○ Produces an aerosol with a smaller particle
size which improves deposition in the small
airways and provides greater efficacy

6. ● When the valve is actuated the propellant
and medication leave the inhaler at a high
velocity
● Majority of medication impacts in the
oropharynx
● Less than 25% reaches the lung

8. How To Efficiently Use Your MDI
1. Shake the canister
2. Place the MDI mouthpiece between your lips
3. Breathe out steadily
4. Press the metered dose inhaler down once to
release the medication into your mouth
5. Breathe in slowly and as deep as possible
6. Hold the breath in while counting to 10

10. Advantages of MDIs
● Compact, portable, convenient
● Multi-dose delivery capable
● Lower risk of bacterial
contamination
● Suitable for an emergency situation

11. Disadvantages of MDIs
● Needs correct actuation and inhalation
coordination - can be difficult in children and
elderly patients
● Cold freon effect
● High pharyngeal drug deposition
● Flammability possibility of new HFA propellants
● Remaining dose is difficult to determine

12. MDI with Spacer

13. Using a Spacer With an MDI
● Insert the inhaler into spacer and shake
● Breathe out
● Put the spacer mouthpiece into your mouth
● Press down on the inhaler once
● Breathe in slowly and deeply (3-5 seconds)
● Hold breath for 10 seconds

14. Advantages of MDI with Spacer
● Compensates for poor
technique/coordination with MDI
● Allows more medication to reach your lungs
● Prevents medication from escaping into the
air
● Fewer side effects from corticosteroid
residue in the mouth

15. Disadvantages of MDI with Spacer
● Large size and volume of device
● Bacterial contamination is
possible - clean the device
periodically

16. Cleaning Your Spacer
● Wash the mouthpiece and the spacer in warm,
soapy water at least once a week. More frequently
when sick.
● Dry carefully with a clean, lint-free cloth.
● Wipe off mouthpiece daily.
● Keep the cap on the mouthpiece when not in use.
● DO NOT share your inhaler or spacer with others.
● Have an extra spacer on hand if possible.

17. Dry Powder Inhaler (DPI)
● Single Dose Devices
o Have to be reloaded with a capsule containing
micronized medication in a large particle carrier powder
o Contains just the medication, no propellant
Left: Spiriva®
Right: Foradil®

18. Dry Powder Inhaler (DPI)
● Multi-Dose Devices
o Medication is in the device, no capsule
o No propellant
Advair®

19. How to Use Your DPI
1. Remove the cap
2. Load a dose of the medication (depends on the type of
inhaler you have)
3. Turn your head and breathe out as much air as you can (try
to empty your lungs)
4. Put the dry powder inhaler in your mouth with your lips
firmly around the opening
5. Using just your mouth, breathe in once, very deep and
fast. Fill your lungs as deeply as you can. NEVER breathe
into the inhaler.

20. 6. Take your mouth off the inhaler, hold your
breath, and count to 10. Then slowly breathe out.
7. If your doctor prescribed more than one dose of
the medication, wait about 1 minute before
taking the next dose.
8. Replace the cap on the dry powder inhaler. If
using a steroid-type inhaler, gargle and rinse
your mouth with water.

22. Advantages of DPI
● Breath actuated
● Less patient coordination required
● Spacer not necessary
● Compact, portable
● No propellant
● Usually higher lung deposition than a
pressurized MDI

23. Disadvantages of DPI
● Work poorly if inhalation is not forceful
enough
● Most are moisture sensitive - humidity can
cause the powder to clump therefore
reducing the dispersal of fine particle mass
● In single dose devices, need to reload the
capsule each time

24. Nebulizer
● Changes liquid medication into a fine
mist to let you breathe it into your
airways
● Given to help you breathe easier
● The nebulizer equipment and medication
must be prescribed by a doctor

26. How to Efficiently Use Your Nebulizer
1. Wash your hands with an antibacterial soap
2. Connect the hose to an air compressor
3. Fill the medicine cup with your prescription.
Close the medicine cup tightly to avoid spills.
4. Attach the hose and mouthpiece/mask to the
nebulizer.
5. Sit up straight and keep the nebulizer vertical.

27. 6. Place the mouthpiece in your mouth keeping
your lips firm around the mouthpiece. OR
Place the mask over your nose and your mouth.
If using a mouthpiece, breathe through your
mouth until all of the medication is used. If
using a mask, breathe in through your nose and
out through your mouth until all of the
medication is used. Usually takes 10-20
minutes to use all of the medication.

28. 7. Tap the medication cup several times to
ensure all the medication is nebulized.
8. Turn off the machine when done.
9. Clean the nebulizer, mouthpiece, and mask.
**Remember to cough and bring up the loose
mucus at the end of your treatment.

29. Advantages of Using a Nebulizer
● Provides therapy for patients who cannot use
other inhalation devices (MDIs and DPIs)
● Allows administration of large doses of
medications
● Patient coordination not required
● Can be used with supplemental oxygen

30. Disadvantages of Using a Nebulizer
● Decreased portability
● Longer set-up and administration time
● Higher cost
● Electrical power source required
● Higher risk of contamination

31. How To Clean Your Nebulizer
● After each treatment: Rinse the nebulizer cup
with warm water, shake off excess water, and
air dry.
● At the end of each day: Wash the nebulizer
cup and mask or mouthpiece in warm soapy
water using a mild detergent. Rinse thoroughly
and allow to air dry. Do not clean the tubing.

32. ● On Monday, Wednesday, and Friday:
disinfect the equipment using a vinegar/water
solution. Mix together 1 part vinegar to 3
parts water. Soak the equipment in the
vinegar solution for 20 minutes. Rinse well
under a steady stream of water. Shake off the
excess water and allow to air dry on a paper
towel.

33. ● Change the nebulizer filter as recommended
in your owner’s manual, or when it appears
grey or dirty. Failure to change the filter
will make your compressor unit work harder
than it should and will eventually cause the
unit to fail.

34. ● Proper care of your equipment prevents
infection
● Cleaning should be done in a dust-free, smoke-
free environment away from open windows
● Always allow equipment to completely dry
before storing in a plastic, zippered bag
● It is a good idea to have an extra nebulizer,
mouthpiece, mask, and tubing

35. Storing Your Equipment & Medication
● Cover the compressor with a clean cloth when not in use.
Keep it clean by wiping with a clean, damp cloth as needed.
● Do not put the compressor on the floor either for treatments
or for storage.
● Medications should be stored in a cool, dry place. Some
medications require refrigeration and some require
protection from light. Check your medications often for
discoloration or crystal formation. If either of these happens,
throw the medication away.

36. Conclusion
● There are 3 main types of inhalation
devices to treat pulmonary disease.
● Each has its own advantages,
disadvantages, and side effects.
● The key to successful treatment is proper
inhalation technique.
● Proper cleaning techniques will decrease
the risk of infection.

37. Important Reminder
Cold and flu season worsens between October and
April and now we have the new risk of the Ebola
Virus.
● Get your flu shot
● Get you pneumonia shot if you haven’t had one
in the last 5 years
● The main key to staying well is proper hand
washing.

39. References
● American Thoracic Society
● Asthma Society of Canada
● Dr. Aslam Calicut, Junior Resident MD
Respiratory Medicine at Pariyaram Medical
College
● Mayo Clinic
● Ohio State University Wexner Medical Center
● West Virginia Asthma Education & Prevention