The use of inhalers in patients with tracheal stomas or tracheostomy tubes

Patients with chronic obstructive airways disease (COAD) or asthma who have a tracheostsmy tube or tracheal stoma have difficulty using metered dose i nhalers (MDIs) because of a failure to achieve a good seal between the trac heostomy tube or stoma and the MDI or spacer device mouthpiece. Many such p atients therefore utilize nebulizers. MDIs in comparison to nebulizers have the advantages of being more compact, portable, easy to use, less time-con suming, 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 o f a number of attached devices, able to use his MDIs to good effect. We des cribe a number of devices and adaptors to enable patients with laryngectomy stomas or tracheostomy tubes to utilize MDIs and undergo respiratory funct ion tests. We recommend that all such patients should have the benefit of a consultation with a dedicated respiratory nurse who can provide the approp riate MDIs, devices and adaptors to optimize the treatment of their lower r espiratory tract condition.