Patients should be encouraged to use oxygen at least 15 hours a day. The use of these medications is predicted on instruction of the patient in their proper use. A spacer should be used with most metered dose inhalers. Additionally patients should be given instructions about what to do if they notice a need for increased amounts of medication to remain symptom free or if their symptoms persist despite the use of normal doses of bronchodilators. Since response varies over time, even those with a poor response on postbronchodilators PFTs should be given a long-term trial of inhaled bronchodilators.
PRN usage seems to provide better control than scheduled use.
However, salmeterol is not useful for the control of acute symptoms. Its effect is additive to the inhaled beta-agonists. Normal dose is 2 puffs every 6 hours. Also available for nebulization. Generally, those who are responsive to inhaled bronchodilators and have acute attacks of dyspnea will be responsive to steroids.