3 x 3 Steps to Decrease the Vocal Impact of Inhaled Corticosteroids (ICS)

1-2-3 to decrease the impact on voice of inhaled steroids.

1) Three teaching points - Reinstruct in optimal technique, including:

    a) Upright posture with chin up. 

    b) Active oral rinse & spit after dose(s).

    c) Correct inspiratory flow for the delivery device.

2) Three device options to consider*

    a) Add a valved holding chamber to the pMDI if appropriate. 

    b) Consider a SMI (Soft Mist Inhaler, Respimat).

    c) Replace a DPI with a pMDI/holding chamber or SMI or neb.

3) Three alternative ICS options*

    a) Alvesco pMDI

    b) QVAR pMDI

    c) Pulmicort & quality nebulizer

*  Contact the ordering provider as appropriate.  

ICS = Inhaled Corticosteroids

pMDI = Pressurized Metered Dose Inhaler

DPI = Dry Powder Inhaler

SMI = Soft Mist Inhaler

Adventitious Lung Sounds 3 x 3

 3 Primary Parenchymal Adventitious Sounds -  3 Descriptions

Oakes Respiratory Care Pocket Guide

Oakes Respiratory Care Pocket Guide (2021-10th Edition)

The classic "blue book" of respiratory therapy has come out with its 10th edition. 
I agree with the publisher and this is the best edition to date. 

The accuracy, professionalism, and affordability have made these pocket reference guides the standard in portable respiratory care texts for decades.

 https://respiratorybooks.com/collections/respiratory-pocket-guides/products/oakes-respiratory-care-pocket-guide-2021-10th-edition

A.D.A.P.T. & Physical Assessments of the Lungs

A.D.A.P.T.

5 primary findings can be determined by the physical assessment of the lungs and thorax:

1) Airway patency

2) Density of underlying tissue

3) Adventitious lung sounds

4) Presence or absence of lung

5) Tracheal shift