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Recent advances in capsule-based dry powder inhaler technology. Kamps AW, Brand PL, Roorda RJ. Variation of l s d inspiratory flow through dry powder inhalers in children with stable and unstable asthma. Nielsen KG, Auk IL, Bojsen K, L s d M, Klug B, Bisgaard H.

Clinical effect of Diskus dry-powder inhaler at low and high inspiratory flow-rates in asthmatic children. Ram L s d, Wright J, Brocklebank D, White JE.

Systematic review of clinical l s d of pressurised metered dose inhalers versus other hand held devices for delivering beta 2 agonists bronchodilators in asthma.

Kenilworth, NJ: Schering Corporation. Panning C, DeBisschop M. Tiotropium: An inhaled long acting anticholinergic drug for chronic obstructive pulmonary disease. Comparison of the l s d effects of albuterol delivered by valved vs.

Esposito-Festen J, L s d H, Hop W, van Vliet F, de Jongste J, Tiddens H. Aerosol therapy by pressured metered-dose inhaler-spacer in sleeping young children: to do or not to do?.

Aerosol delivery devices l s d the treatment of asthma. Reznik M, Jaramillo Y, Wylie-Rosett J. Demonstrating and assessing metered-dose inhaler-spacer l s d pediatric care providers' self-reported practices and perceived barriers.

Gillette C, Rockich-Winston N, Kuhn JA, Flesher S, Shepherd M. Inhaler technique in children main characteristics of attention asthma: a systematic review. Michael R Filbin, MD, FACEP Clinical Instructor, Department of Emergency Medicine, Massachusetts General Hospital Michael R Filbin, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Society for Academic Emergency MedicineDisclosure: Nothing to disclose.

The authors and editors of eMedicine gratefully acknowledge the contributions of Shankar Buddiga for photography of aerosol delivery devices, Nathan R Hollman, Doctor of Pharmacy Candidate, for creating the tables summarizing the various devices, and Pari Respiratory Equipment, Inc, for reference Marinol (Dronabinol Capsules)- Multum regarding nebulizers and pediatric masks.

A diagram of an MDI is shown in the image below. Sensitivity or cardiotoxicity anal toilet propellants is a contraindication for MDI use. DPIs are not indicated in patients who cannot generate an adequate inspiratory flow rate. View Media Gallery Provide therapy for patients who cannot use other inhalation modalities (eg, MDI, DPI) Technique The technique for metered dose inhaler (MDI) use is as follows: Take off the cap and hold the inhaler upright.

Tilt the head back slightly and slowly breathe out completely for 3-5 seconds. Repeat the above process if more than 1 puff (actuation) is prescribed. After opening the inhaler and loading the dose, tilt the head slightly back. Position the inhaler horizontally, with the outlet between l s d lips, slightly inside the mouth.

Seal lips around the Diskus orifice (ie, mouthpiece), as shown in the image below. View Media Gallery Remove the cover and hold the base of the inhaler, as shown in the l s d below. View Media Gallery Place the capsule from the blister into the well at l s d base of the inhaler.

Hold the device in a horizontal orientation and breathe in deeply. View Media Gallery Close the mouthpiece firmly until a click is heard, leaving the dust cap open.

After the dose, open the mouthpiece, remove the used capsule, and dispose of it. Hold the inhaler straight up with the pink portion (the base) at the bottom.

Hold the pink base and twist the cap in a counterclockwise direction to remove it. Hold the Twisthaler device in a horizontal orientation and breathe in deeply.

Close the Twisthaler l s d ensure that the next dose is properly loaded. L s d the mouth out with water and spit (do not swallow the water).

Hold the inhaler in an upright position with the mouthpiece up when loading the dose. When finished, place the cover back on the inhaler and twist shut. Breathe l s d a normal pace and actuate the MDI at the start of inspiration. After cleaning, allow the device to air-dry completely before the next dose is administered.

Replace disposable parts to avoid bacterial growth, as recommended by the manufacturer. Do not spray 2 actuations of medication into a holding chamber or spacer at one time. Assemble the nebulizer apparatus and plug in the power source, as shown in the image below.

Place the medicine in the l s d dose in the nebulizer cup and close it. Attach the top portion of the nebulizer cup to the mouthpiece or to the mask, as shown in the image below.

View Media Gallery Connect the bottom of the nebulizer cup with tubing to the air compressor.

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