title: The use of inhalers in patients with tracheal stomas or tracheostomy tubes.
abstract: Patients with chronic obstructive airways disease (COAD) or asthma who have a tracheostomy tube or tracheal stoma have difficulty using metered dose inhalers (MDIs) because of a failure to achieve a good seal between the tracheostomy tube or stoma and the MDI or spacer device mouthpiece. Many such patients therefore utilize nebulizers. MDIs in comparison to nebulizers have the advantages of being more compact, portable, easy to use, less time-consuming, and cheaper. We present the case of a 74-year-old man who underwent a laryngectomy with tracheal stoma formation who had a poor response with nebulizers and required oral steroids. He was subsequently, with the help of a number of attached devices, able to use his MDIs to good effect. We describe a number of devices and adaptors to enable patients with laryngectomy stomas or tracheostomy tubes to utilize MDIs and undergo respiratory function tests. We recommend that all such patients should have the benefit of a consultation with a dedicated respiratory nurse who can provide the appropriate MDIs, devices and adaptors to optimize the treatment of their lower respiratory tract condition.
authors.affiliation: Department of Otolaryngology, Hope Hospital, Salford Royal Hospitals NHS Trust, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mirza
authors.forename: L
authors.initials: L
authors.lastname: Hopkinson
authors.forename: T H
authors.initials: TH
authors.lastname: Malik
authors.forename: D J
authors.initials: DJ
authors.lastname: Willatt
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects; D008173:Lung Diseases, Obstructive / Q000188:drug therapy; D008297:Male; D009330:Nebulizers and Vaporizers; D012129:Respiratory Function Tests; D054047:Surgical Stomas; D014139:Tracheostomy / Q000295:instrumentation*
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol