Aerosol Delivery Guide

AARC Updates Most Popular Document We Have Ever Offered

“A Guide to Aerosol Delivery Devices for Respiratory Therapists, 2nd Edition”

Aerosol therapy has gone through some pretty significant changes over the past few years.Not only are there more of these medications on the market today than ever before, but

we’ve seen a major phase-out of metered-dose inhalers containing chlorofluorocarbons— traditionally a mainstay in the treatment of people with asthma and COPD.

For patients and families, these changes have led to confusion and, in somecases, downright frustration as they try to get used to new formulations of theirinhaled medications. For respiratory therapists, it’s meant the need to brush up

on the knowledge of aerosol delivery across the board to be sure we are provid-ing the best care to our patients.

“There is a tremendous need to ensure RTs understand all facets of aerosol delivery, because it is the respiratory therapist who teaches the patients and families,” says AARC

Executive Director Sam Giordano, MBA, RRT, FAARC. “Much has changed in the past threeyears — new medications, new delivery devices, better understanding of the barriers to

adherence to aerosol therapy. We are the experts, and we must be up to date.”

In order to meet these needs, the AARC has just published an updatedversion of its popular “A Guide to Aerosol Delivery Devices for Respi-

ratory Therapists,” authored by Arzu Ari, PhD, RRT, PT, CPFT;Joseph L. Rau, PhD, RRT, FAARC; Dean Hess, PhD, RRT, FAARC;

and Timothy R. Myers, BS, RRT-NPS. It includes a forewordby Giordano. Supported by an unrestricted grant from

Philips Respironics, the second edition is available atwww.aarc.org/education by selecting “AARC Continu-

ing Education Courses.” AARC members who readthe guide and take an online post test can earn six

free CRCE contact hours.

What’s in the expanded version and how canyou put it to use in your practice? We turned

to one of the guide’s authors, Dr. Arzu Ari, afaculty member in the division of respira-

tory therapy at Georgia State Universityin Atlanta, to walk us through it.

52 AARC Times December 2009

AARC Times December 2009 53

Aerosol Delivery Guide

“Making an informed decision about which aerosoldelivery system to use for a specific patient and teachingthat patient how to properly use that device will augmentnot only clinical excellence but also professionalrepresentation and recognition,” says Dr. Ari. She offers sixways bedside RTs can put the guide to work on the job:

Identify how to useeach device properly.

Take-HomeMessages

6BedsideStrategies

4According to Dr. Ari, “Aerosol medicine is experi -

encing a period of tremendous growth with many newand exciting developments. With the vast number ofaerosol delivery devices available on the market andalso in development, there is a need to improve theefficiency, precision, and consistency of aerosol drugdelivery to patients with pulmonary diseases.”

We asked the AARC member to come up with hertop four take-home messages from the updated guide,and here is what she said:

1Identify the bestdevice to meet theneeds of your patient.

2

Repeat patient educationduring follow-up visits.4

Find time to teachpatients and usetechniques such asdemonstration andreturn demonstration.

3All three types of aerosol generators canbe equally effective if they are usedcorrectly by the appropriate patient.1The criteria to select an aerosol generatorinclude patient-related, drug-related, and device-related factors, as well asenvironmental and clinical factors.

2Aerosol drug administration differs inchildren and infants as they are notanatomically scaled-down adults. Considerage, and physical and cognitive ability, aswell as patient-device interface whenselecting an aerosol delivery device forchildren.

3Aerosol drug delivery can be effectiveonly if patients or care providers areeducated in correct use of aerosoldevices and patient adherence in aerosoldrug administration is achieved.

4

Notify the orderingphysician whenpatient and deviceare not properlymatched. The drugsdon’t work whenthe patient can’t orwon’t administer them properly.

5

Keep implementingthe informationprovided in theguide in yourclinical practice. A knowledgeablerespiratorytherapist canprovide valuableinput to physiciansand patients alike.

6

One Down, Two To Go

“A Guide to Aerosol Delivery Devicesfor Respiratory Therapists, 2nd Edition” isjust the first in a series of three aerosolguides to be published by the AARC. “Tofollow will be a book that will covermany of the concepts in this book butwill be written at the level of thepatient,” says AARC COO ThomasKallstrom, BS, RRT, AE-C, FAARC. Thepatient guide will take various literacylevels into account, enabling just aboutany patient or family to benefit from theinformation. Then the third version ofthe guide will target healthprofessionals outside of respiratory care.“By taking three different approaches,we hope to bring caregivers, patients,and respiratory therapists to a betterposition of understanding on aerosoltherapy devices,” says Kallstrom.

Given the popularity of the originalguide — the AARC saw more than aquarter million downloads of thebooklet from people all over the world— Kallstrom is confident the three-guideseries will make a significant impact onthe health and well being of peoplewho depend on aerosol delivery devicesto treat their respiratory conditions.“It is with this momentum that we are

excited to release this new edition ofthe first book.” ■

54 AARC Times December 2009

Aerosol Delivery Guide

While bedside RTs can do a lot on their own to implement the guide in theirday-to-day care of patients, it takes a manager to really incorporate the documentinto official practice. “The AARC has quickly responded to changes in aerosolmedicine and kept its members current on the latest information in the professionby providing them with the premier publications and cutting-edge education onaerosol delivery devices,” says Dr. Ari. “‘A Guide to Aerosol Delivery Devices forRespiratory Therapists, 2nd Edition’ is a way of increasing the power of therespiratory care profession and fostering professional growth and success, not onlyin your hospital, but across the United States and around the world.” Here are herseven key assignments for managers of respiratory care:

7Assignments for Respiratory Care Managers

1

5

6

7

2

3

4

Incorporate the informationprovided in the guide intothe policies and proceduresof your department. It isessential to involve yourtherapists in theimplementation plan as soon as you can because youneed their commitment inorder to be successful.

Provide in-service educationabout new policies andprocedures on aerosoldelivery devices that arebased on the information inthe guide. Training yourrespiratory therapists is thekey to optimizing aerosoldelivery to patients andimplementing new policiesand procedures successfullyat your institution.

Incorporate some questionsinto your training sessions todetermine how staff learningis progressing and to identifypoints that need to bereviewed for betterunderstanding.

After initial training and hands-on experience, monitor policiesand procedures for qualityassurance with the aim ofoptimizing aerosol drug deliveryto patients and determiningcompliance with newprocedures on aerosol therapy.

The guide provides techniqueboxes explaining steps forcorrect use, general steps toavoid reduced or no dosing,troubleshooting, and cleaningprocedures for each aerosoldelivery device. Instruct yourstaff to utilize the techniqueboxes to go over commonproblems, disadvantages, anderrors with each type of aerosoldevice when educating patientsin correct use of their devices.

The guide provides valuableinformation on establishing aninfection control managementsystem in aerosol drug deliveryand maintaining theoccupational health and safetyof respiratory therapists. Utilizethis section for the well-being ofyour patients and staff. ■

Schedule time for yourtherapists to have hands-on experience with all ofthe aerosol delivery devicesused at your institution.This will not only makethem feel more comfortablein using each aerosol device but will also improve their techniquesand the effectiveness ofaerosol therapy.

Dr. Arzu Ari first became interested in

aerosol therapy research as a student at

Georgia State University (GSU). “Dr. Joseph

L. Rau nurtured an appreciation of aerosol

medicine in me and the importance of in

vitro testing in providing guidance to

clinicians for both device selection and

use,” she recalls.

Now a member of the GSU faculty, she’s

continuing that interest under the tutelage

of James B. Fink, PhD, RRT, FAARC. “Both Joe

and Jim have served as role models and

mentors in aerosol research, providing

constructive feedback on lab methods,

study design, publication development,

and strategies to help maintain and

develop the role of the aerosol laboratory

at GSU as a center of excellence. Our goal is

to attract graduate students who wish to

do their thesis research in aerosol science.”

She learned about plans to

update the AARC’s “A Guide to Aerosol

Delivery Devices for Respiratory Therapists,”

originally authored by Dr. Rau, Dr. Hess, and

Timothy Myers during conversations with

AARC Executive Director Sam Giordano,

MBA, RRT, FAARC, and COO Thomas J.

Kallstrom, BS, RRT, AE-C, FAARC, at the 2008

European Respiratory Society Congress in

Berlin, Germany. “When I was offered the

great honor of updating the guide, I had no

doubt that I would finish writing the guide

with a great sense of accomplishment as

the result of their genuine support and

valuable guidance,” says Dr. Ari. ■

AARC Times December 2009 55

Aerosol Delivery Guide

AARC members can earn six free CRCEcontact hours for reading “A Guide toAerosol Delivery Devices for RespiratoryTherapists, 2nd Edition” and passing anonline post test. To access the guide, go towww.aarc.org/education and click on“AARC Continuing Education Courses.”Then scroll down the list to find the guide.Nonmembers can access the booklet andpost test for a $15 fee. ■

About Author Arzu Ari

Free CRCEs for AARC Members

Arzu Ari, PhD, RRT, PT, CPFT

“A Guide to Aerosol Delivery Devices for RespiratoryTherapists, 2nd Edition,” will be distributed at the AARCCongress in San Antonio this December.