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
