1. Inhalers The Perfect technique Vicky Walker Clinical Lead for Respiratory Services
Respiratory Nurse Specialist
2. Which inhaler is right for your patient?
3. Contents Quiz - test your current knowledge
Information on devices
Practical demonstrations of common inhalers, through DVD and audience participation (that’s you!)
Our role - how we can help?
What to do next……………….
4. Aims of the teaching Update and increase knowledge on different devices
Test baseline knowledge ( to improve at the end of the session!)
To become more familiar with delivery devices
Increase skills in assessment of technique
How to trouble shoot
5. Quiz time
6. Metered dose inhalers (MDI) Cheap, Quick & convenient to use
Poor inhaler technique is common
When used correctly only 10%-20% of the drug reaches the lungs
may continue to deliver propellant after active drug gone if not shaken correctly
important to wait 30-60 secs between doses due to 2nd actuation being of poorer quality
7. Breathe actuated inhalers Spring mechanism is triggered by inspiratory flow rate of 22-36 l/m
drug delivery less dependent on technique
When cap is removed the inhaler is primed and ready to fire
Ref: AJ Corlett 1996 Caring for Older People: Aids to compliance with medication BMJ 1996;313:926-929 12 October
8. Spacer devices Removes the need for co-ordination of breathing and actuation
Pharyngeal deposition is greatly reduced
smaller particles penetrate further into lungs depositing a greater proportion of drug
Available with mask
Electrostatic charge reduces delivery
9. Dry Powder inhalers (DPI) Inspiratory airflow releases the fine powder - therefore no co-ordination needed
dose counters helps patients to know when empty (between 60-200 doses)
DPI can make some patients cough
Inspiratory flow rate needed may be a problem with some devices
10. Dry Powder inhalers (DPI) continued More expensive than MDI’s
DPI’s such as turbohalers have no taste, hence there could be uncertainty it has been taken by the patient
Turbohalers delivers 20%-30% of drug
Diskhaler delivers 11%-15% of drug
Ref:Optimizing deposition of aerosolizesd drug in the lung
11. Important points Patient needs to be in a good upright position to use inhaler
Important to check inhaler technique regularly
Bad habits form quickly
If a patient is requiring repeat prescriptions – alarm bells should be ringing
12. DVD & Inhaler demonstration
13. Case Study 1 73 year old lady with severe COPD
referred for Pulmonary Rehabilitation
probable low inspiratory breath
using Turbohalers but struggling
Tested with Turbotrainer whistle
Switched to MDI and Volumatic spacer
beautiful technique with tidal breathing
14. Case Study 2 88 year old with moderate COPD
Using MDI & aerochamber
Struggling to fire inhaler consistently
Tried on turbohaler trainer whistle
Successful with whistle
Switched to turbohaler
Reviewed by CSW 1 month later managing well, with good benefit
15. Case Study 3 Bingo dobber V turbohaler
16. The Good, The Bad and The Ugly
17. The Bad Allergy to the cat
Down the nose
Huff and puff
If at first……..
18. Mrs Smith has moderate COPD the GP asks for your advice on combination therapy.
Which device would you recommend?
19. Trick question ?
20. How we can help patients?
22. What to do next?
If you are still struggling with a tricky or complex patient then please refer on to your local Respiratory Team
East Wedge 2953499
South Wedge 2954641
West Wedge 3059293 (west, north west & north east)
23. Which inhaler is right for your patient? The one they can use.