1. BASE HOSPITAL GROUP ONTARIO Metered Dose Inhaler (MDI) Ontario Base Hospital Group Education Subcommittee 2008

2. OBHG Education Subcommittee Metered Dose Inhaler (MDI) AUTHOR Alim Pardhan, MD Hamilton Base Hospital REVIEWERS/CONTRIBUTORS Mark Hunter, RN, AEMCA, BScN Paramedic, Emergency Telecommunications Advanced Care Paramedic Programs Fanshawe College Tim Dodd, AEMCA, ACP Chair, OBHG Education Subcommittee Hamilton Base Hospital 2008 Ontario Base Hospital Group

3. OBHG Education Subcommittee Changes During Administration 1) Prior to administering the first dose of Ventolin to the patient, waste the first puff. 2) There does not need to be a 30 second delay between puffs. The delay between actuations need only be 5 seconds. Note - The MDI should still be shaken between actuations

4. OBHG Education Subcommittee The Evidence  Timing of Doses Several studies indicate that 5 seconds is a sufficient delay between actuations.

5. OBHG Education Subcommittee The Evidence  Timing of Doses: Immediate re-actuation seems to have a 10-20% decrease in delivered dose 2,3 A 5 second delay seems to allow enough time for the inhaler valve to refill and deliver a full dose 2 2. “Factors affecting total and "respirable" dose delivered by a salbutamol metered dose inhaler” ML Everard, Thorax, Vol 50, 746-749, 1995. 3. “In vitro evaluation of the effect of metered-dose inhaler administration technique on aerosolized drug delivery.” Shalansky KF, Pharmacotherapy. Vol 13(3):233-8, 1993.

6. OBHG Education Subcommittee The Evidence  First Dose: One of the studies did indicate that the first puff administered by an MDI contains significantly less medication (up to 25%) when compared to subsequent doses. 2 2. “Factors affecting total and "respirable" dose delivered by a salbutamol metered dose inhaler” ML Everard, Thorax, Vol 50, 746-749, 1995.

7. OBHG Education Subcommittee MDI Use

8. BASE HOSPITAL GROUP ONTARIO QUESTIONS?

9. BASE HOSPITAL GROUP ONTARIO Well Done! Education Subcommittee STARTQUIT