NAECB Inhaler Technique & Delivery Devices 1 — Questions and Answers
Question 1: When using a metered-dose inhaler (MDI) without a spacer, what is the recommended inhalation technique?
- Fast, forceful inhalation
- Slow, deep inhalation over 3–5 seconds (Correct answer)
- Normal tidal breathing for 1–2 breaths
- Rapid shallow inhalation followed by breath-hold
Correct answer: Slow, deep inhalation over 3–5 seconds
A slow, deep inhalation over 3–5 seconds allows medication particles to travel deeper into the airways rather than impacting in the oropharynx.
Question 2: What is the primary advantage of using a valved holding chamber (spacer) with a metered-dose inhaler?
- Eliminates the need for breath-holding after inhalation
- Increases medication deposition in the oropharynx
- Reduces the need for hand-breath coordination (Correct answer)
- Increases the cost-effectiveness of the medication
Correct answer: Reduces the need for hand-breath coordination
A spacer holds the aerosolized medication cloud so patients do not need to precisely coordinate actuation with inhalation, significantly improving drug delivery.
Question 3: For a dry powder inhaler (DPI), what is the optimal inhalation technique to ensure adequate drug deposition?
- Slow, gentle inhalation
- Fast, forceful inhalation (Correct answer)
- Normal tidal breathing
- Breath-hold with no active inhalation
Correct answer: Fast, forceful inhalation
DPIs rely on the patient's inspiratory effort to disaggregate the powder; a fast, forceful inhalation generates the turbulence needed to disperse the medication into respirable particles.
Question 4: What is the recommended breath-hold duration after inhaling from a metered-dose inhaler?
- 2–3 seconds
- 5–10 seconds (Correct answer)
- 15–20 seconds
- No breath-hold is needed
Correct answer: 5–10 seconds
A breath-hold of 5–10 seconds allows inhaled particles to settle by gravity and diffusion in the airways before exhalation removes them.
Question 5: Which patient population is MOST likely to benefit from a nebulizer rather than a pressurized MDI or DPI for routine asthma therapy?
- Teenagers with mild persistent asthma
- Young adults with exercise-induced bronchoconstriction
- Infants unable to use MDI or DPI devices (Correct answer)
- Adults with moderate persistent asthma on stable therapy
Correct answer: Infants unable to use MDI or DPI devices
Infants and very young children cannot generate adequate inspiratory flow or cooperate with MDI/DPI technique, making nebulizers the most practical delivery option.
Question 6: Before using a new metered-dose inhaler or one that has not been used for more than 2 weeks, a patient should:
- Rinse the canister under warm running water
- Prime the inhaler by releasing the recommended number of test sprays into the air (Correct answer)
- Soak the mouthpiece in normal saline for 5 minutes
- Refrigerate the canister for 30 minutes to stabilize the propellant
Correct answer: Prime the inhaler by releasing the recommended number of test sprays into the air
Priming ensures the valve is loaded with a full dose and the propellant-drug mixture is uniform, so the first dose delivered to the patient is accurate.
Question 7: Which of the following is a common critical error when using a dry powder inhaler (DPI)?
- Inhaling too forcefully through the device
- Exhaling forcefully into the device mouthpiece before inhalation (Correct answer)
- Holding the device at a horizontal angle
- Using the device in a seated position
Correct answer: Exhaling forcefully into the device mouthpiece before inhalation
Exhaling into a DPI introduces moisture that can clump the powder and block the dose, and it may waste the loaded dose before inhalation occurs.
NAECB Inhaler Technique & Delivery Devices 1
When using a metered-dose inhaler (MDI) without a spacer, what is the recommended inhalation technique?