Breathe easy: 5 steps to better breathing with your metered-dose inhaler (MDI)

Breathe easy: 5 steps to better breathing with your metered-dose inhaler (MDI)

Accepted Manuscript Breathe easy: 5 steps to better breathing with your metered-dose inhaler (MDI) Evan H. Allie, Ellen B. O'Kelley, Katie H. Fisches...

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Accepted Manuscript Breathe easy: 5 steps to better breathing with your metered-dose inhaler (MDI)

Evan H. Allie, Ellen B. O'Kelley, Katie H. Fischesser, Lawrence B. Stack, Donald H. Arnold PII: DOI: Reference:

S0735-6757(17)30378-9 doi: 10.1016/j.ajem.2017.05.014 YAJEM 56686

To appear in: Received date: Revised date: Accepted date:

6 April 2017 ###REVISEDDATE### 12 May 2017

Please cite this article as: Evan H. Allie, Ellen B. O'Kelley, Katie H. Fischesser, Lawrence B. Stack, Donald H. Arnold , Breathe easy: 5 steps to better breathing with your metereddose inhaler (MDI), (2017), doi: 10.1016/j.ajem.2017.05.014

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT Breathe Easy: 5 steps to better breathing with your Metered-Dose Inhaler (MDI) Manuscript category: Insights and Images

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Evan H. Allie, MD; Ellen B. O’Kelley, PNP-BC, AE-C; Katie H. Fischesser, BS, RRT-NPS; Lawrence B. Stack, MD; Donald H. Arnold, MD, MPH From the Department of Pediatrics, Division of Emergency Medicine (Allie, Arnold) and Division of Pulmonary Medicine (O’Kelley); Pediatric Respiratory Care (Fischesser); Department of Emergency Medicine (Stack); and the Center for Asthma Research (Arnold), Vanderbilt University School of Medicine, Nashville, TN, USA.

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Corresponding author: Donald H Arnold, MD, MPH Associate Professor Pediatrics and Emergency Medicine Vanderbilt University School of Medicine Nashville, TN 37232 Email: [email protected] Phone: 615-579-0516 Fax: 615-507-1943

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The authors request designation of Drs. Stack and Arnold as co-senior authors as the contributions of these individuals were equivalent.

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Co-author email addresses: Allie: [email protected] O’Kelley: [email protected] Fischesser: [email protected] Stack: [email protected]

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Declaration of potential conflicts: Funding information: Funding for development of the video was provided by the 2013 American Thoracic Society-Aerocrine Fellows Program Award in Asthma, Allergy, Immunology and Pulmonary Critical Care (Dr. Arnold). Disclosure of potential conflict of interest: The authors have no conflicts of interest to report beyond the Funding support noted above. Short summary: Proper use of the metered-dose inhaler (MDI) is for medications to prevent and treat acute asthma exacerbations. This training video teaches children and clinicians correct technique for MDI use. Abbreviations: MDI: Metered-dose inhaler VHC: Valved holding-chamber 1

ACCEPTED MANUSCRIPT Key words: Asthma; prevention; exacerbation; inhaled corticosteroid; metered-dose inhaler Video length: 5 minutes, 07 seconds Word count: 254 Each author has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.

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Running head: Teaching Metered Dose Inhaler technique

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Inhaled corticosteroids are the most effective preventive asthma treatment, and inhaled albuterol is the most effective immediate treatment for acute asthma exacerbations.1 Moreover, administration of these medications by metered-dose inhaler (MDI) results in greater drug delivery to the lung, substantially less swallowed drug, and fewer side effects from swallowed and systemically-absorbed drug in comparison with nebulized medication.2, 3 Use of the MDI with a valved holding-chamber (VHC) for albuterol treatment in the emergency department also provides a teachable moment in which to ascertain and reinforce proper technique and to demonstrate to the parent and child that albuterol administered by MDI is indeed effective in treating most mild- and moderate-severity acute asthma exacerbations. As such, pediatricians and emergency department clinicians need to be knowledgeable and confident in teaching parents and children appropriate technique for MDI use with a VHC.

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In this instructional video we demonstrate correct use of the MDI and VHC. Key points for instruction of parents and children include:

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1. Proper selection of the correct medication before use with emphasis on the differences between a controller and rescue medication; 2. Tight fitting face mask and non-crying child;2 3. Appropriate technique for priming a new inhaler prior to first use; 4. Emphasis on consistent use of a VHC with every dose of MDI medication; 5. Appropriate posture and breathing technique when using an MDI; and 6. Administering the appropriate dose of medication for asthma symptoms and deciding when to seek additional medical care for asthma symptoms. Video available at: Spanish version: https://vimeo.com/196925763 English version: https://vimeo.com/194189987

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References

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Abbreviations: MDI: Metered-dose inhaler VHC: Valved holding-chamber

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[1] NHLBI. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program. Bethesda, MD: National Institutes of Health. National Heart, Lung, and Blood Institute; 2007. [2] Erzinger S, Schueepp KG, Brooks-Wildhaber J, Devadason SG, Wildhaber JH. Facemasks and aerosol delivery in vivo. Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine. 2007;20 Suppl 1:S78-83; discussion S-4. [3] Arnold DH, Saville BR, Moore PE, Abramo TJ, Resha DJ, Wang W, et al. Changes of Serum Potassium and Spirometry during Treatment for Acute Asthma: A Double-Blind, Randomized Pilot Trial of Four Albuterol Regimens. Pediatric Academic Societies. Denver, CO: Proc Ped Acad Soc E-PAS2011:754618; 2011.

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