Inhaler Devices and Techniques

1. Inhaler Devices and Techniques Angela Scott Respiratory Nurse Specialist

2. Learning Outcomes. To become familiar with the common inhaler devices available. To be able to identify correct inhaler technique.

3. Factors influencing the choice of inhaler device. Patient. Acceptance of the diagnosis. Age. Lifestyle. Ease of use. Inspiration flow rate. Dexterity. Taste. Appearance of device.

4. Factors influencing the choice of inhaler device. Practitioner. Cost. Consistency of delivery. Availability of various drugs in the same device. Compatibility with other devices. Easy to teach technique. Effectiveness of the device.

5. Devices and technique. Need for clear specific training for patients of correct inhaler technique. Up to 50% of patients in Europe are unable to use inhaler correctly. Patients forget instructions and skills deteriorate over time � reassessment and re education. Most patients, nurse and doctors are unable to use pMDIs correctly. 57-70%. (Crompton G.K.et al (2006). Respiratory Medicine. The need to improve inhalation technique in Europe: A report from the Aerosol Drug Management Improvement Team).

6. Quiz Name as many inhaler devices as you can (Not drugs � but actual inhaler devices!!)

7. What amount of drug inhaled do you think actually reaches the lungs with the following devices? Metered dose inhaler 80-100% 60-80% about 50% 30-50% 20-30% 10-20% less than 10% Metered dose inhaler and small volume spacer 80-100% 60-80% about 50% 30-50% 20-30% 10-20% less than 10% Metered dose inhaler and large volume spacer 80-100% 60-80% about 50% 30-50% 20-30% 10-20% less than 10% Breath actuated metered dose inhaler 80-100% 60-80% about 50% 30-50% 20-30% 10-20% less than 10%

8. Turbohaler 80-100% 60-80% about 50% 30-50% 20-30% 10-20% less than 10% Accuhaler 80-100% 60-80% about 50% 30-50% 20-30% 10-20% less than 10% Handihaler 80-100% 60-80% about 50% 30-50% 20-30% 10-20% less than 10% Nebuliser 80-100% 60-80% about 50% 30-50% 20-30% 10-20% less than 10%

9. Metered Dose Inhaler. Remove the cap. Shake the canister. Breathe out gently. Put the mouthpiece in the mouth and at the start of inspiration, which should be slow and deep press the canister down and continue to inhale deeply. Hold the breath for 10 seconds or as long as possible, then breathe out slowly. Wait a few seconds before repeating steps 2-5. Replace cap.

10. Tidal Breathing Technique with Spacer. Take cap off, shake inhaler well and place in hole in end of spacer. Hold spacer with both hands, place mouthpiece in mouth and gently breath right out into spacer. Press inhaler once. Gently breath in and out five times. Remove from mouth. Wait 30 seconds to 1 minute before repeating above steps as many times as prescribed.

11. One Breath Technique with Spacer. Remove the cap. Shake the inhaler and insert into the device. Place the mouthpiece in the mouth. Press the canister once to release a dose of the drug. Take a deep, slow breath in. Hold the breath for about 10 seconds, then breathe out through the mouthpiece. Breathe in again but do not press the canister. Remove the device from the mouth. Wait about 30 seconds before repeating steps 2-8.

12. Accuhaler. Hold the outer casing of the accuhaler in one hand whilst pushing the thumb grip away until a click is heard. Hold the accuhaler with the mouthpiece towards you, slide the lever away until it clicks. This makes the dose available for inhalation and moves the dose counter on. Holding the accuhaler level, breathe out gently away from the device, put mouthpiece in mouth and take a breathe in steadily and deeply. Remove the accuhaler from the mouth and hold breath for about 10 seconds. To close, slide the thumb grip back towards you until it clicks. For a second dose repeat steps 1-5.

13. Turbohaler. Unscrew and lift off white cover. Hold turbohaler upright and twist the grip forwards and backwards as far as it will go. You should hear a click. Breathe out gently, put the mouthpiece between the lips and teeth and breathe in as deeply as possible. Even when a full dose is taken there may be no taste. (do not breathe out into the turbohaler. (60L/min insp.flow). Remove the turbohaler from the mouth and hold breath for about 10 seconds. Replace the white cover. For a second dose repeat steps 2-4.

14. Handihaler (1). Open the dustcap of the handihaler by pulling it upwards. Open the mouthpiece by pulling it upwards. Peel back the foil, exposing one capsule and remove it. Place the capsule in the chamber in the middle of the handihaler. Close the mouthpiece and press it down until you hear a click. Press in the green button on the side as far as it will go and then release.

15. Handihaler (2). Breathe out completely. Not into inhaler. Close lips tightly around mouthpiece. Keeping your head upright, breathe in slowly and deeply. You will hear and feel the capsule vibrate if you breath in correctly. (15L/min insp. flow). Hold your breath for as long as is comfortable. Remove the inhaler and breathe out normally. To empty the capsule completely repeat steps 1-5.

16. Breath Actuated Inhalers.Easi-Breathe/Autohaler. Shake the inhaler. Hold the inhaler upright. Open the cap. (Autohaler-push the lever up). Breathe out gently. Keep the inhaler upright and put the mouthpiece in the mouth and close the lips around it. Breathe in steadily through the mouth. DON�T stop breathing when the inhaler �clicks� and continue taking a really deep breath. Hold the breath for up to 10 seconds. Wait several seconds before repeating steps 1-5 for a second dose. NOTE: Autohaler �The lever must be pushed up(�on�) before each dose, and pushed down(�off�) afterwards, otherwise it will not operate.

17. Reliever bronchodilators (usually blue)