NAECB Inhaler Technique & Delivery Devices 2 — Questions and Answers
Question 1: A patient with severe hand tremors and poor hand-breath coordination has difficulty using a standard pressurized MDI. Which device would BEST address this limitation?
- A standard pMDI used without a spacer
- A high-resistance DPI requiring strong inspiratory effort
- A breath-actuated MDI that fires automatically on inhalation (Correct answer)
- A large-volume nebulizer requiring extended treatment time
Correct answer: A breath-actuated MDI that fires automatically on inhalation
A breath-actuated MDI (BAI) triggers automatically when the patient inhales, eliminating the need to manually coordinate pressing the canister while breathing in.
Question 2: Which spacer or valved holding chamber configuration is most appropriate for an 18-month-old child requiring inhaled corticosteroid therapy?
- Standard adult-sized spacer with mouthpiece
- Spacer fitted with an appropriately sized face mask (Correct answer)
- Standard MDI used without any accessory device
- Low-resistance DPI with dose counter
Correct answer: Spacer fitted with an appropriately sized face mask
Young children who cannot form a proper lip seal around a mouthpiece require a face mask attached to the spacer to ensure an adequate seal and drug delivery.
Question 3: When cleaning a metered-dose inhaler mouthpiece, the recommended method is to:
- Submerge the entire canister assembly in a bowl of water
- Wipe only the outside of the canister with a dry cloth
- Remove the canister and rinse the plastic mouthpiece with warm water, then air-dry (Correct answer)
- Use alcohol wipes directly on the canister to sterilize the valve
Correct answer: Remove the canister and rinse the plastic mouthpiece with warm water, then air-dry
Removing the canister and rinsing only the plastic actuator/mouthpiece with warm water prevents blockage from medication residue without damaging the canister or valve.
Question 4: A patient using a pressurized metered-dose inhaler should hold the device in which orientation?
- Upside down with the canister on the bottom
- Horizontal with the canister on the side
- Upright with the canister on top and mouthpiece at the bottom (Correct answer)
- Any orientation is equally effective
Correct answer: Upright with the canister on top and mouthpiece at the bottom
Holding the MDI upright (canister up, mouthpiece down) ensures the propellant and drug mixture is properly positioned at the valve for accurate dose delivery.
Question 5: The soft mist inhaler (SMI), such as the Respimat, differs from a standard pressurized MDI primarily because it:
- Requires a chlorofluorocarbon propellant for drug delivery
- Produces a slow-moving, long-lasting aerosol cloud without a propellant (Correct answer)
- Demands a faster peak inspiratory flow than a DPI
- Cannot be used with any form of spacer or holding chamber
Correct answer: Produces a slow-moving, long-lasting aerosol cloud without a propellant
The Respimat uses a spring-driven mechanism to generate a slow, fine mist that travels at a low velocity, requiring less coordination and allowing more time for inhalation.
Question 6: Which patient would be LEAST appropriate for a dry powder inhaler (DPI) as the primary delivery device?
- A 14-year-old with moderate persistent asthma
- An adult with newly diagnosed mild asthma
- A 3-year-old child with recurrent severe wheezing (Correct answer)
- A 65-year-old with stable well-controlled asthma
Correct answer: A 3-year-old child with recurrent severe wheezing
Young children cannot generate the peak inspiratory flow rate (typically 30–60 L/min or more) required to disaggregate the powder and carry it into the lower airways.
Question 7: How frequently should a valved holding chamber (spacer) typically be replaced under normal use conditions?
- Every week to prevent electrostatic charge buildup
- Every month regardless of condition
- Every 6–12 months or per the manufacturer's recommendation (Correct answer)
- Only when the device is visibly cracked or damaged
Correct answer: Every 6–12 months or per the manufacturer's recommendation
Spacers degrade over time with repeated cleaning and use; replacing every 6–12 months per manufacturer guidance ensures the valve and chamber function optimally.
NAECB Inhaler Technique & Delivery Devices 2
A patient with severe hand tremors and poor hand-breath coordination has difficulty using a standard pressurized MDI.
Which device would BEST address this limitation?