A patient who has been prescribed a bronchodilator via a metered-dose inhaler (MDI) has difficulty coordinating her breath with the actuation of the MDI. What should the therapist recommend for such a patient?

A. Use a valved holding chamber.
B. Practice the technique many times using the MDI.
C. Nebulize the drug with a small-volume nebulizer.
D. Use a dry powder inhaler.

?ANS: A
A. Correct response: Using either a spacer or a valved holding chamber eliminates the problem associated with coordinating the breath and the actuation of the MDI. The patient simply needs to dispense the contents of the MDI into either the spacer or valved holding chamber, then inhale the medication from the spacer or valved holding chamber.
B. Incorrect response: See explanation A.
C. Incorrect response: Using a small-volume nebulizer may not always be practical for the patient, especially if the patient is away from home. The patient may need quick relief from a bronchodilator while out shopping or at some social event. Again, a SVN would not be available or practical.
D. Incorrect response: The patient may be incapable of generating the high inspiratory flows (40 L/min to 60 L/min) that are required to effectively use a dry powder inhaler.