Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Inhaled medications are prescribed for conditions affecting the bronchi, which branch off of the trachea, and bronchioles, which are progressively smaller conducting airways spread throughout the lung tissue. These conditions can be classified as acute (i.e., temporary, with quick onset) or chronic (i.e., persistent and/or recurrent symptoms lasting months to years). Common acute conditions requiring inhaled medications include acute bronchitis, pneumonia, tuberculosis, pulmonary edema, and acute respiratory distress syndrome. Chronic conditions requiring inhaled medications encompass those classified as COPD (i.e., asthma, chronic bronchitis, and emphysema), as well as other chronic conditions, including cystic fibrosis, lung cancer, and pneumoconiosis.

These conditions often require medications to open airways, decrease airway inflammation, and promote airflow. The delivery of medications directly into the airways allows for a faster response when compared to systemically administered medications and decreases the impact of systemic side effects. Inhaled medications come in different forms and delivery devices. Common inhaled medications include short- and long-acting bronchodilators and corticosteroids. These may be delivered using various types of inhalation delivery devices, such as metered-dose inhalers, dry-powder inhalers, and breath-activated inhalers. These devices require either a chemical propellant, deep inhalation, or a fine mist to deliver the medication. Regardless of the type of delivery, the goal is the same: to deliver the medications to the lower bronchi and bronchioles. For those using metered-dose inhalers and who have difficulties inhaling the medications into the lower airways, a device called a spacer may be used to help coordinate breathing with medication release from the device.

Because these medications require administration that is coordinated with the breathing cycle, it is important to educate the patient about the procedure prior to administering the medication and for the patient to have a working understanding of the process before beginning inhaled medication administration. A thorough respiratory assessment should also be completed prior to administering any inhaled medication to ensure the appropriateness of the medication and delivery device and the ability to comply with administration procedure.

This demonstration will present the preparation and administration of inhaled medications using the metered-dose inhaler as the prototype delivery device.