Transcript Slide 1

ONTARIO
BASE HOSPITAL GROUP
Metered Dose Inhaler (MDI)
Ontario Base Hospital Group
Education Subcommittee
2008
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
OBHG Education Subcommittee
Changes During Administration
1)
2)
Prior to administering the first dose
of Ventolin to the patient, waste the
first puff.
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
OBHG Education Subcommittee
The Evidence
 Timing

of Doses
Several studies
indicate that 5
seconds is a
sufficient delay
between actuations.
OBHG Education Subcommittee
The Evidence
 Timing
of Doses:
Immediate re-actuation seems to have a
10-20% decrease in delivered dose2,3
 A 5 second delay seems to allow enough
time for the inhaler valve to refill and
deliver a full dose2

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.
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.
OBHG Education Subcommittee
MDI Use
OBHG Education Subcommittee
ONTARIO
BASE HOSPITAL GROUP
QUESTIONS?
ONTARIO
BASE HOSPITAL GROUP
Well Done!
Education Subcommittee
START
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