Teaching time for metered-dose inhalers in the emergency setting.

OBJECTIVES In some acute-care settings, practitioners are reluctant to institute bronchodilator therapy with metered-dose inhalers (MDIs) as standard management. Such therapy requires that personnel ensure optimal use of these devices. We prospectively evaluated the time required to teach patients correct inhaler use for the emergency treatment of asthma and COPD, and patient factors associated with duration of teaching. DESIGN MDI arm within a single-center randomized clinical trial comparing bronchodilator administration by MDI with a delivery enhancement device (MDI/DED) vs delivery by wet nebulizer. SETTING All subjects were treated for asthma or COPD exacerbations at the respiratory acute-care day hospital of the Montreal Chest Institute, immediately after presentation to our emergency department. Inhaler-use education was provided according to a predetermined protocol. MEASUREMENTS Subjects' baseline characteristics were obtained from medical charts, spirometry, and questionnaires; satisfaction was evaluated by questionnaire. All inhaler-use education was observed and timed. RESULTS Sixty-one patients with asthma (median age, 46 years) and 32 patients with COPD (median age, 68.5 years) were randomized to treatment by MDI/DED. Mean FEV1 (percent predicted) was 63.5% for patients with asthma and 39.5% for patients with COPD. Five patients could not complete MDI teaching and therefore received subsequent treatment by wet nebulization. For the 88 other patients, the median teaching time was 6.5 min. Shorter teaching-time requirements were independently associated with higher initial arterial oxygen saturation, home DED use after previous MDI instruction, and a single initial bronchodilator treatment by wet nebulization. Most subjects expressed satisfaction with MDI/DED teaching and treatment. CONCLUSIONS Successful MDI/DED teaching followed by self-medication is feasible in the emergency setting, based on a simple protocol. A single bronchodilator dose administered by wet nebulization may facilitate subsequent MDI teaching.