An initiative of

Improving Pharmacist

Inhaler Devices

Technique and Patient

Counseling

Sarah Y. Hur, Pharm.D.

Kaiser Permanente

Ambulatory Care Services

Disclosures

The speaker has no actual or potential conflicts of

interest in relation to this program

Learning Objectives

At the end of this session, the participant will be able to:

Demonstrate understanding of inhaler devices and their proper use and care

Compare and contrast the various inhaler devices by reviewing features of each devices that are relevant for optimal delivery and patient response

Identify poor inhaler technique and how to coach patients to improve their use of respiratory delivery devices

Describe specific examples of communication strategies to use with patients on inhaler technique and improve adherence to therapy

Describe the role of the pharmacists in helping patients with asthma or COPD achieve optimal results

How well do you know your

inhalation devices?

Remembering Information A reported 40% to 80% of medical information

that patients receive is forgotten immediately(1)

Up to 50% of the information retained is recalled

incorrectly(2)

Only about 46-59% subjects able to demonstrate

proper ICS inhaler technique(3)

Systemic review reported that 4%-94% of patients

did not use DPI inhalers correctly (4)

Kessels RP. J R Soc Med. 2003;96:219-22.

Anderson JL et al. Rheumatology. 1979;18:18-22.

Cochrane MG et al. Chest 2000;117: 542-50

Lavorini F et al. Respir Med. 2008; 102: 593-604.

Patient Counseling for

Inhalation Devices

Why use Inhalation Devices?

Targeted delivery

Lower doses can be used

Less risk for systemic side effects and

adverse reactions

Faster onset of action in many cases

Types of Inhalation DevicesA. pMDI – Pressurized Metered Dose Inhalers

Medication delivered in an aerosol

Can be used with spacer

B. Soft Mist Inhalers

Respimat – Uses interval spring to generate

aerosol and doesn’t require propellant or

inspiratory flow rate

C. DPI – Dry Powder Inhalers

Multiple dose: Diskus, Turbuhaler, Flexhaler,

Twisthaler, Pressair

Capsules devices: Handihaler, Aerolizer

D. Jet or ultrasonic Nebulizers

Breathing In: FAST or SLOW?

MDI or soft spray inhalers –Breathe in SLOWLY

DPI – Breathe in FAST

If breathing in too slow,

medication may end up in the

mouth, not in the lungs

If breathing in too fast,

medication may end up in the

throat, not in the lungs

Question 1A rapid and forceful inhalation effort is optimal

when using a:

a. Metered Dose Inhaler

b. Metered Dose Inhaler with spacer

c. Dry Powder Inhaler

d. Jet nebulizer device

Most Common Mistakes

Failure to exhale

Failure to correctly hold device

Unable to coordinate pressing and breathing

Failure to generate adequate inspiratory flow

rate (too fast or too slow)

Failure to hold breath

Pressurized Metered Dose Inhaler

(pMDI)

Pressurized Metered Dose Inhaler

(pMDI)

Poor inhalation technique associated with marked decrease in lung

deposition

pMDI: Priming

1. Prime the MDI (spraying 2-4 puffs into the air before

use) as instructed on package insert

pMDI Prime

Atrovent HFA 2 puffs if new or not used for 3 days

Advair HFA 4 puffs if new, 2 puffs if not used for <4wks or dropped

Flovent HFA 4 puffs if new, 1 puff if not used for >7days

Proair HFA 3 puffs if new or not used for 2wks

Proventil HFA 4 puffs if new or not used for 2wks

QVAR HFA 2 puffs if new or if not used for >10 days

Symbicort HFA 2 puffs if new or not used for 7 days or dropped

Ventolin HFA 4 puffs if new or not used for 14 days, 1 puff if dropped after washing

Xopenex HFA 4 puffs if new or not used for 3 days

Dulera HFA 4 puffs if new or not used for 5 days, do not remove the canister from

the actuator

Alvesco 3 puffs if new or not used for 10 days

pMDI: Preparation2. Remove the cap from the MDI and shake well for 5

seconds

3. Breathe out all the way

4. Keep your chin up

5. Use one of the 3 techniques

pMDI: Inhalation6. As you start to breathe in slowly, press down on the

canister one time

7. Keep breathing in slowly to completely fill your

lungs. (It should take about 5 -7 seconds to

completely breathe in)

8. Hold your breath for 10 seconds (count to 10

slowly) to allow the medication to reach the airways

of the lung

9. Repeat the above steps for each puff ordered by

your doctor. Wait about 1 minute between puffs

10.Replace the cap on the MDI when finished

pMDI: Counseling Tips

Inhale SLOWLY and steadily

A few devices have dose counter but not all.

Count each doses or use dose counter to keep

track of remaining doses

Do not float the canister in water

Recommend to use with spacer

pMDI: Cleaning

Remove the metal canister by pulling it out. Never wash the metal

canister or put it in water

Wash the actuator through the top with warm running water for 30

seconds. Then wash the actuator again through the mouthpiece

May use mild soap and water

Shake off water then let the plastic parts dry in the air

Clean regularly (weekly is best). Buildup may actually affect

delivery

Exception: Alvesco, Dulera, Symbicort, Advair – do not remove

canister. Clean opening and mouthpiece with dry swab or tissue

Question 2Which counseling point is incorrect for MDIs:

A. When inhaling dose, patient should breathe in

slowly and steadily

C. Clean regularly since buildup may actually affect

delivery

B. When inhaling dose, patient should inhale dose

quickly and forcefully

D. All must be primed before first use, approximately

2-4 times depending on product

Spacers Spacers and holding chambers provides reservoir

for medication in aerosol and reduces

oropharyngeal deposition

Valved holding chambers help with actuation and

inhalation coordination

Can reduce ADR with ICS

pMDI with Spacer1. Remove the cap from the MDI and Spacer

2. Insert the MDI into the open end of the spacer (opposite the

mouthpiece)

3. Shake well for 5 seconds

4. Breathe out all the way

5. Place the mouthpiece of the chamber between your teeth

and seal your lips tightly around it

6. Spray 1 puff into the spacer by pressing down the inhaler

7. Breathe in SLOWLY through your mouth to completely fill

your lungs. You’re breathing too quickly if you hear a "horn-

like" sound

8. Hold breath for 10 seconds (count to 10 slowly)

Spacer (w/ or w/o Facemask) Spacer (without Facemask)

Inhale up to 5 seconds

1 actuation into chamber for each inhalation

Spacer (with Facemask)

5 inhalations per actuation

Spacer: Cleaning Remove back piece (colored rubber ring)

Mix soap with lukewarm water. Place spacer/VHC

in the soapy water for 15 minutes (this helps to

cover up static charge). Agitate slowly

Rinse with running water & air dry (standing

vertically)

Most are dishwasher safe: place in top rack ONLY,

avoid in heat >158*F. Do not boil or sterilize

Wash prior to first use and then weekly. Replace

after 12months of use

Soft Mist Inhalers:

Respimat

Spiriva Respimat Combivent Respimat Striverdi Respimat

Soft Mist Inhalers:

Respimat

Uses spring mechanism to release the medication, does not contain

propellants

Respimat: Preparation (1st Use)

1. Press safety catch while pulling off clear base

2. Write discard by date on back label (Discard 3 months after cartridge is inserted)

3. Push narrow end of cartridge into inhaler (Use hard surface to push cartridge completely in, when correctly inserted 1/8” of the cartridge will remain visible)

4. Replace the clear base, do not remove clear base or cartridge after assembled

Respimat: Priming (1st use)1. Hold top of inhaler and TWIST clear base 180* in

the direction of the white arrows (on back label)

until “click” (Ensure orange cap is closed to avoid

accidental release of dose)

2. Flip open orange cap

3. Press dose release button

4. Close orange cap

5. Repeat above steps until spray is visible

Prime 3 puffs if new or if not used for >21 days

Prime 1 puff if not used for >3 days

1. Turn the base, open the cap

2. Close your lips around the mouthpiece

3. Press the dose-release button

4. Inhale

Respimat: Inhalation

Respimat: Inhalation1. Hold top of inhaler and twist clear base 180* in the

direction of the white arrows (on back label) until “click” (Ensure orange cap is closed to avoid accidental release of dose)

2. Flip open orange cap

3. Exhale completely, out of mouth

4. Seal lips around mouthpiece without covering air vents, hold inhaler horizontally

5. As you begin to inhale SLOWLY, press the dose release button to release a puff

6. Continue to inhale SLOWLY and fully

7. Hold breath for 10 seconds or as long as possible

8. Exhale SLOWLY

Respimat: Counseling Tips

1. No need to shake the inhaler before use

2. No need to use spacer

3. Do not remove the cartridge once it has been

inserted into the inhaler

4. When closed, the cap helps prevent you from

accidentally pressing the button. The protective

lid also helps keep the mouthpiece clean

5. If Respimat hasn’t been used for >3 days, release

1 puff toward the ground to prepare for use. If

hasn’t been used for >21 days, release 3 puffs to

prepare for use

Dose indicator shows approximately how much medicine is left

When it reaches the RED zone, there’s enough medicine for 7 days (30 dose product) or 3 days (14 dose product)

• Discard 3 months from the date the cartridge is

inserted

• Automatic Lock: The inhaler locks when there’s

no more medicine left

Respimat: When to Replace

Respimat: Cleaning & Storing

Clean the mouthpiece, including the metal

part inside the mouthpiece, with a damp

cloth or tissue only, at least once a week

If the outside of the inhaler gets dirty, wipe

it with a damp cloth

Store at room temperature, do not freeze

Diskus (DPI)

Diskus (DPI): Preparation

1. No need to prime

2. Hold the diskus horizontally like a

hamburger

3. Slide open the diskus until “click”

to expose mouthpiece and lever

4. Slide lever until “click”. This

action loads the dose of

medication. You will see the dose

counter decrease by one. Do not

shake.

Diskus: Inhalation5. Exhale away from the diskus

6. Place the diskus mouthpiece in your mouth

and breathe in rapid, strong and steady, and

fill your lungs completely. If too slow, med

ends up in mouth. If too fast, med ends up

in throat

7. Hold your breath for up to 10 seconds

4. Remove the diskus from your mouth and

exhale slowly

5. Close the diskus

6. Rinse mouth with water “Swish and Spit” if

using ICS

Diskus: Inhalation

1. Open

2. Click

3. Exhale

4. Inhale

Diskus: Counseling Tips Breath-activated. Inhale rapidly

Cannot be used in children under 6 years, elderly, unconscious patient, in presence of severe airflow obstruction (undergoing mechanical ventilation)

No need to prime or use spacer

You may not taste, smell, or feel the dry powder

If using ICS, rinse mouth and gargle after use. Do not swallow rinsed water.

Cleaning: If residue powder in the diskus, open and tap to remove powder

Storing: Protect from moisture. Store in a dry place at room temperature

Dispose 30 days after opening pouch or when 60 blisters used, whichever comes first

Flexhaler

Flexhaler: Priming (1st Use)

The only DPI that requires priming

1. Hold the Flexhaler upright (brown grip at bottom).

2. Twist and remove the cover

3. Holding it in the middle, twist the brown grip on

the bottom in one direction until it stops and then

fully back again. You will hear a click. It does not

matter which direction you twist first

4. Repeat a second time

5. No need to prime again even if you do not use it

for a long period of time

Flexhaler: Inhalation

Flexhaler: Inhalation1. Twist the cover and lift it off

2. Twist the brown grip fully in one direction as far as it

will go and then fully back again. You will hear a click.

The Flexhaler is now loaded with a dose

3. Turn your head away from the inhaler and breathe out

4. Place the device in your mouth and breathe in FAST

and forcefully

5. Hold your breath for 10 seconds

6. Take the Flexhaler away from your mouth and exhale

slowly

7. Replace the white cover and twist it completely to close

Flexhaler: Counseling Tips Do not use for sudden, severe symptoms of

asthma

The only DPI that requires priming at FIRST

use

No need to use spacer

You may not taste, smell, or feel the dry

powder or there may be a slight sweet taste

Store in a dry place at room temperature.

Never place the DPI in water or increased

humidity. Never shake or breathe into the

DPI

Flexhaler: When to Replace

• Dose indicator shows how many doses are left

in the inhaler

• Look at the middle of the window

• Dose indicator usually moves each time you

use about 5 doses

• Inhaler is empty when the number “0” on the

red background reaches the middle of the

dose indicator window

Twisthaler (DPI)

Twisthaler: Preparation1. While holding the

Twisthaler upright, twist

the white cap counter

clockwise

2. As you twist and lift off the

cap, the dose counter will

decrease by one and the

dose will be loaded. The

medicine is now ready to

be inhaled

Twisthaler: Inhalation1. Exhale completely away from Twisthaler

2. Hold horizontally and place the

mouthpiece between your teeth sealing

your lips tightly around the mouthpiece

3. Breathe in rapidly and deeply

4. Hold breath for 10 seconds

5. Replace the cap and twist clockwise.

Make sure it CLICKS to completely close

it. (This must be done to properly load

the next dose)

6. Rinse your mouth and gargle (do not

swallow)

Twisthaler: Counseling Tips DO NOT LOSE THE CAP. Dose counter automatically

counts down the dose when the cap is removed. This

action also loads the dose of medication

No need to prime or use spacer

Never shake or breathe into the DPI

You may not taste, smell, or feel the dry powder or

there may be a slight sweet taste

Do not use for sudden, severe symptoms of asthma

or if you have allergy to milk proteins

Store in a dry place at room temperature. Never

place the DPI in water or increased humidity

Twisthaler: When to Replace The Twisthaler will need to be thrown out

45 days after removal from foil pouch or

when the dose counter reads "00”

When the counter reads "00" there is no

medicine left in the Twisthaler

Cap will lock automatically after the last

dose

Ellipta

Arnuity Ellipta

Fluticasone (ICS)

Anoro Ellipta

Umeclidinium (Ich)

+

Vilanterol (LABA)

Incruse Ellipta

Umeclidinium

(Ich)

Breo Ellipta

Fluticasone (ICS)

+

Vilanterol (LABA)

Ellipta: Preparation1. Wait to open the cover until you are ready to take

your dose

2. Before the inhaler is used for the first time, the

counter should show the number 30. This is the

number of doses in the inhaler

3. Open the cover of the

inhaler. Slide the cover

down to expose the

mouthpiece. You should

hear a CLICK

4. The counter will count

down by 1 number

Ellipta: Inhalation1. Exhale away from the inhaler

2. Put the mouthpiece between your lips and close your lips firmly around it. Your lips should fit over the curved shape of the mouthpiece

3. Take one long, steady, deep breath in through your mouth. Do not breathe in through your nose

4. Do not block the air vent with your fingers

5. Remove the inhaler from your mouth and hold your breath as long as comfortable for you (3-4 secs)

6. Breathe out slowly and gently

7. Close the inhaler by sliding the cover up

8. Rinse mouth if ICS (Arnuity or Breo)

Ellipta: Counseling Tips

If you open and close the cover

without inhaling the medicine,

you will lose the dose

Do not block the air vent with

your fingers

Clean the mouthpiece if needed using a dry tissue

before closing the cover

You may not taste of feel the medicine, even when

you are using the inhaler correctly

Do not take another dose from the inhaler even if you

do not feel or taste the medicine

Ellipta: When to Replace When you have less than 10

doses remaining in your

inhaler, the left half of the

counter shows RED as a

reminder to get a refill

After you have inhaled the

last dose, the counter will

show “0” and will be empty

Discard 6 weeks after the

date you opened the tray

Pressair

Pressair: Preparation (1st Use)

1. Remove the protective cap

2. Hold the green button facing straight up, do not tilt

3. Before you put the inhaler into your mouth, press

the green button all the way down. Then release

the green button. Do not continue to hold the

green button down

4. Stop and check the control window to make sure

the dose is ready for inhalation

Stop and check the Control

Window to make sure your dose if

ready for inhalation

Look to see if the colored control

window has changed from RED to

GREEN

If the control window stays red,

repeat the Press and Release

actions until the control window is

green

Pressair: Priming (1st Use)

Pressair: Inhalation1. Breathe out completely away from the

inhaler

2. Put your lips tightly around the mouthpiece of the Pressair inhaler

3. Breathe in QUICKLY and deeply through your mouth

4. Breathe in until you hear a “click” sound. Keep breathing in, even after you have heard the inhaler “click” to be sure you get the full dose

5. Do not hold down the green button while you’re breathing in

6. Hold breath for as long as is comfortable then breathe out slowly

Pressair: Inhalation7. Check the control window to see if

it has turned to RED (from green).

If the window is red, you have

inhaled your full dose of medicine

correctly. If still green, repeat

breathing in or check to make sure

green button released properly

8. Dose indicator counts down in

intervals of 10: 60, 50, 40, 30, 20,

10, 0

Pressair: Counseling Tips Do not hold the green button down while you’re

inhaling

When you press and release the green button, the

colored control window will change from RED to

GREEN. Once you inhale, the colored control

window changes from GREEN to RED

No need to clean Pressair other than wipe the

outside of the mouthpiece with a dry tissue or

paper towel

Pressair: When to Replace RED band will begin to appear within the dose indicator

when you’re nearing your last dose

The marking “0” with the red background shows in the middle of the dose indicator

The device locks out

45 days have passed since the inhaler was taken out of the sealed pouch

DPI – Capsule Devices Handihaler, Aerolizer, Neohaler

Do not remove a capsule from the blister card until

you are ready for a dose

Throw away any capsule that is not used right away

after it’s taken out of the blister package

Do not swallow capsules. The contents of the

capsule should only be inhaled through the

appropriate device (Aerolizer, Handihaler, Neohaler)

Handihaler (DPI - Capsule)

Handihaler – Inhalation1. Open the HandiHaler device. Separate only one of the

blisters from the blister card; then open the blister

2. Insert the SPIRIVA capsule and close the mouthpiece firmly against the gray base until you hear a click

3. Press the green piercing button once until it is flat (flush) against the base, then release

4. Breathe out completely

5. Then, with the HandiHaler in your mouth, breathe in deeply until your lungs are full. You should hear or feel the SPIRIVA capsule vibrate (rattle)

6. Remember, to take your full daily dose, you must inhale twice from the same SPIRIVA capsule

Neohaler (DPI - Capsule)

Neohaler: Preparation1. Pull off cap

2. Tilt the mouthpiece to open inhaler

3. Remove a capsule from the blister. Only remove immediately before use

4. Insert capsule into the capsule chamber

5. Close the inhaler. You should hear a CLICK as it fully closes

6. Hold the inhaler upright. Pierce the capsule by pressing both buttons fully one time. You should hear a CLICK as the capsule is being pierced. Do not pierce more than once. Release the buttons fully

Neohaler: Inhalation1. Breathe out fully away from the mouthpiece

2. Place the mouthpiece in your mouth and close your lips around the mouthpiece. Hold the inhaler with the buttons to the left and right

3. Inhale FAST and steadily, as deeply as you can

4. As you breathe in through the inhaler, the capsule spins around in the chamber and you should hear a WHIRRING noise

5. If you do not hear a whirring nose, capsule may be stuck so open the inhaler and carefully loosen the capsule by tapping. Do not pierce buttons to loosen the capsule

Neohaler: Inhalation6. Continue to hold breath as long as comfortably

possible while removing the inhaler from your

mouth. Then breathe out

7. Open the inhaler to see if any powder is left in the

capsule. If there is powder left in the capsule,

close the inhaler and repeat process

8. Remove the empty capsule by tipping it out and

discarding it

Asthma Medication Overview

Short Acting “Rescue” Long Acting “Control”

Used only as needed Used daily, regularly

Short Acting B2 Agonists

(SABA)

Inhaled Corticosteroids

(ICS)

Anticholinergics ICS + LABA Combination

COPD Medication Overview

COPD Medications

Short Acting B2 Agonists (SABA)

Long Acting B2 Agonists (LABA)

Anticholinergics (Ich)

Combination:

Albuterol + Ipratropium: SABA + Ich

Umeclidinium + Vilnaterol:

Fluticasone + Vilanterol

Short Acting B2 Agonist (SABA)

Generic Brand

Albuterol Proventil HFA

Ventolin HFA

Proair HFA

Proair RespiClick

Levalbuterol Xopenex HFA

SABA SABA is a quick-relief (rescue) inhaler. It will

work within minutes to help breathing easier

It relaxes muscles around your airways to

prevent or treat shortness of breath

If more than 1 puff needs to be inhaled,

separate puffs by 1 minute (vs. no wait for

ICS)

Anticholinergic

Generic Brand

Ipratropium Atrovent HFA

Tiotropium Spiriva Handihaler

Spiriva Respimat

Aclidinium Tudorza Pressair

Umeclidinium Incruse Ellipta

Glycopyrrolate Seebri Neohaler

Glycopyrrolate Lonhala Magnair

Anticholinergic Do not let the powder from the capsule get into your

eyes. Your vision may get blurry and the pupil in your eye may get larger (dilate). If this happens, call your doctor

If you have vision changes or eye pain or if you have difficulty passing urine or painful urination, stop taking the medication and call your doctor right away

Inform your doctor if you have glaucoma, problems passing urine or an enlarged prostate as those may worsen with an anticholinergic medication. Tell your doctor if you have kidney problems or are allergic to milk proteins

Most common side effect is dry mouth. Others include constipation and trouble passing urine

Inhaled Corticosteroid (ICS)

Generic Brand

Beclomethasone QVAR HFA

QVAR Redihaler

Budesonide Pulmicort Flexhaler

Pulmicort Respules

Ciclesonide Alvesco HFA

Flunisolide Aerospan HFA

Fluticasone Flovent HFA

Arnuity Ellipta

ArmonAir RespiClick

Mometasone Asmanex Twisthaler

ICS Should be used regularly and at the same time each

day, as prescribed by your provider. Regular use decreases airway swelling and opens small airways. Not used to treat acute symptoms

Patient may not get the most benefit for 1-2 wks or longer after using ICS

No need to wait between ICS puffs

Separate different types of inhalers (for eg. SABA vsICS) by 5-10 minutes. Use bronchodilator first, then maintenance inhalers

Rinse with water “swish and spit” after use to decrease oral thrush. If using face mask, rinse face with water

Safe for use, even in children. Corticosteroids do not produce the same effect as anabolic steroids

Question 3What do you advise an asthmatic patient taking

albuterol and beclomethasone?

A. Take albuterol first then immediately take

beclomethasone

B. Take albuterol every day routinely

C. Take albuterol then wait 1 minute to take

beclomethasone

D. Take beclomethasone first then take albuterol

Question 4When a patient is using QVAR MDI 1 puff BID and

Xopenex 2 puffs q3-4h PRN for wheezing?

A. Wait 1 minute between the QVAR and Xopenex HFA

B. Use QVAR first then Xopenex HFA

C. Wait 15 minutes between Xopenex HFA puffs

D. Rinse mouth with water after using QVAR

Question 5Which of the following consultation information is

correct for a patient who starts using fluticasone

(Flovent) inhaler?

A. This medication will need to be shaken prior to

administration

B. This medication should be taken as needed for

asthma symptoms

C. This medication will quickly alleviate symptoms

of asthma

D. This medication may cause diarrhea during the

first week of therapy

Long Acting B2 Agonist (LABA)

Generic Brand

Formoterol Perforomist

Nebulizer

Indacaterol Arcapta Neohaler

Salmeterol Serevent Diskus

Arformoterol Brovana Nebulizer

Olodaterol Striverdi Respimat

Contraindicated for use as monotherapy in asthma

SMART trial

Showed increase in asthma-related deaths

LABA Do not use for relief of acute symptoms.

Concomitant SABA can be used as needed for

acute relief

All LABA are contraindicated in patients with

asthma without use of a long-term asthma

control medication. Monotherapy is not

indicated for the treatment of asthma

Combination (ICS + LABA)Generic Brand

Budesonide + formoterol Symbicort

Mometasone + formoterol Dulera

Fluticasone + salmeterol Advair HFA/Diskus

Fluticasone + vilanterol Breo Ellipta

Combination (Anticholinergic + LABA)

Generic Brand

Umeclidinium + vilanterol Anoro Ellipta

Glycopyrrolate + Formoterol Bevespi Aerosphere

Combination (LABA + LAMA)Generic Brand

Indacaterol + glycopyrrolate Utibron Neohaler

Importance of Patient Education

about Inhalation Devices

Manufacturers’ instructions are not adequate

Verbal instruction improves technique

Group or individual instruction is effective

Devoted time is important; and reinforcement is

necessary

Training aids for specific devices are useful

Lavorini F et al. Prim Care Respir J. 2010; 19:335-41

The Role of the Pharmacist Provide Education

Device training – medication type and technique

Avoidance of triggers and exacerbators: Tobacco

smoke, dust mites, pets, etc

Vaccines:

Anual flu vaccine for all asthmatic patients

Pneumococcal vaccine x1 at 19-64yo and revaccinate at

65yo or older with at least 5 years between doses

Monitor medication

Importance of adherence, especially for asthma

Overuse and underuse

Device training via “teach back therapy”

Teach-Back Explain

Demonstrate

Discuss

Summarize key points

Quiz key points

Request patient to repeat

Observe

Congratulate!

Clarify and emphasize

Reinforce and assess periodically

Examples of Teach-Back “I want to be sure that I explained this correctly.

Can you tell me how you will use this inhaler?”

“We discussed a lot of details about your lung

condition today. Let’s review a few important

points. What are three things for you to do at home

to control your asthma?”

“How will you use your inhaler when you wake up in

the morning?”

“Please show me how you will use your inhaler.”

Question 6Describe the role of the pharmacists in helping

patients with asthma or COPD achieve optimal

results?

A. Provide device training

B. Monitor medication overuse and underuse

C. Provide education on medication type and

technique

D. All of the above

Question 7The “teach-back” method of patient instruction

involves:

A. Summarizing the key points of instruction at the end of the session

B. Providing a quiz to the patient about the

key points

C. Asking the patient to repeat the

instructions in his or her own words

D. All of the above

Summary Inhalation therapies are central in the

management of common lung diseases

Good inhalation technique is essential for optimal benefit from pharmacotherapy

All patients should receive education and training regarding use of prescribed inhalation devices

Individual delivery devices have specific instructions regarding use

Patients should undergo periodic assessments regarding use of prescribed inhalation devices

ResourcesThese are excellent resources to review and use when developing

plans for educating and advising patients about the use of

inhalation devices

MDI: http://www.youtube.com/watch?v=Rdb3p9RZoR4

Spacer: http://www.youtube.com/watch?v=a54MAjo_xXQ

Respimat: http://www.youtube.com/watch?v=U1NV10RuV6Y

Diskus: https://youtu.be/_Sc7j9iW9TM

Flexhaler: https://youtu.be/kD4CdrT-l84

Twisthaler: https://youtu.be/E9OAWEjPmZo

Ellipta: https://youtu.be/l-ac6lRu7kE?t=10s

Pressair: https://youtu.be/NJlbN_kJ7gM?t=10s

Handihaler: https://youtu.be/KYS3-Kp672Y

Aerolizer: https://youtu.be/VvKi7OEKQYk

Neohaler: https://youtu.be/D3DeShJhdyQ?t=5s

Please Do Not Take the Devices!Contact list to obtain demo devices

Manufacturer

Demo Devices Contact

Astra Zeneca Flexhaler, Pressair http://www.astrazeneca-

us.com/contact-us-hcp-

request-for-pharmaceutical-

samples

Boehringer

Ingelheim

Handihaler,

Respimat

1-800-243-0127

GSK Ellipta, Diskus 1-888-825-5249

Merck Aerolizer, Twisthaler 1-908-740-4000

Novartis Neohaler 1-888-669-6682

Questions?

An initiative of