1. Respiratory Measurement and Treatment Gail M. Maier, Ph.D., R.N. Associate Director, ED&R The Ohio State University Wexner Medical Center Peak Flow and MDI

3. Peak Flow Meters A peak flow meter is a portable, hand held device which measures the maximum expiratory flow rate. Readings can be obtained by health care staff and the patient Readings can help the provider recognize early changes of worsening pulmonary function

4. Bronchoconstriction Constriction of the air passages is a common occurrence in patients with asthma Reduced peak flow readings correlate with severity of bronchoconstriction Decreased expiratory flow rate can be recognized before demonstrable symptoms occur

5. Green Zone Peak flow reading is 80-100% of the patient’s normal peak flow readings. Considered “under control” Regular maintenance level of medications is continued

6. Yellow Zone The measured peak flow rate is 50-80% of the patient’s normal peak flow measurement. This indicates the beginning of narrowing of the air passages. The patient should use their “rescue inhaler” or take a nebulizer treatment

7. Red Zone The measured peak flow rate is less than 50% This indicates severe bronchoconstriction and symptoms will be observed, i.e. wheezing and shortness of breath Rescue inhaler needs to be taken immediately and the physician notified A hospital visit may be required

8. Inhalers for Respiratory Medication Two types of inhalers Metered dose inhaler (MDI) Dry powder inhaler (DPI)

9. Using a MDI An MDI can be used with or without a spacer A spacer makes it easier for some to use the MDI Watch the video demonstration of the MDI at the end of this program. Review the attachment for the correct procedure

10. Using a Dry Powder Inhaler Delivers medication to the lungs in the form of a dry powder May require a procedure to prepare a measured dose of powder to be ready for the patient to take Medication is commonly held either in a capsule for manual loading or a proprietary form from inside the inhaler

11. Using a DPI Remove the cap or cover Load a dose of medication May have an opening that you push medication into May have a lever that is pushed or twisted until it clicks

12. DPI procedure continued Turn your head to the side and breathe out as much as possible Lungs should be as clear as possible so all medication can be inhaled

13. DPI procedure continued Close your lips around the DPI firmly so that no medication is able to escape Continue breathing in until your lungs are completely full. Hold your breath for at least 10 seconds Slowly breathe out

14. DPI procedure continued If more than one dose is required, wait one full minute before taking the second dose. Place cover on the DPI. Avoid getting moisture or dirt into the inhaler as it may clog the opening and reduce the amount of medication that is being delivered.

15. Peak Flow Video 1:46 minutes

16. MDI Video 2:44 minutes

17. In summary Proper use of inhalers, either the MDI or the DPI, is important for health care staff and patients to understand and to practice as it will increase the likelihood that the prescribed amount of medication is being delivered to the patient. Please watch the following videos on the proper technique of obtaining peak flow meter readings and the use of an MDI and DPI type of inhaler.

18. Thank you for completing this module If you have any questions, please contact me. Gail.Maier@osumc.edu

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