Which of the following are true about the use of a metered dose inhaler?
1. Inertial impaction can be reduced if the patient holds the inhaler in the mouth.
2. Smaller particles will be produced in a cold environment.
3. Larger particles will be produced in a cold environment.
4. The optimum temperature for an inhaler canister is 37° C.
5. The inhaler needs to be shaken before actuation.
a. 1, 3, and 4 c. 2 and 5
b. 2 and 4 d. 3, 4, and 5
ANS: D
If an adult patient positions the outlet of the pressure metered dose inhaler approximately 4 cm (two finger widths) in front of an opened mouth with a low inspiratory flow rate, this practice can increase the dose delivered to the lower respiratory tract from a range of approximately 7% to 10% to 14% to 20% and decrease oropharyngeal impaction. A cold ambient temperature (i.e., a temperature of less than 10? C) dramatically decreases the output of chlorofluorocarbon pres-sure metered dose inhalers.
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