Current respiratow care, Part 2: Lung expansion therapy, delivering aerosols: Often, patient as well as physician must understand the proper use of devices

To prevent or treat atelectasis, incentive spirometry is the best choice if the patient is able and wining to perform the maneuver. If not, and for patients with atelectasls that is not responsive to other therapy, consider intermittent positive pressure breathing. Aerosolized medications may be delivered by means of a number of different devices. A metered-dose inhaler (MDI) or dry-powderiinhaler can be as effective as a small-volume nebulizer (SVN). For most patients in acute-care settings, MDIs with large-volume spacers are probably most appropriate. For severe, acute asthma, consider bron-chodilator therapy administered via a continuous large-volume nebulizer. Newer devices, such as patient-actuated MDIs and SVNs, should be evaluated in terms of cost, utility, and acceptance by patients.