inhaler devices

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06/08/22 © Clinical Skills Resource Centre, University of Liverpool, UK 1 Inhaler techniques. Additional information/guidelines can be found at: http://www.asthma.org.uk/ using_your_inhaler.html http://www.asthma.org.uk http://www.lunguk.org http://www.ginasthma.com

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Page 1: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 1

Inhaler techniques.

Additional information/guidelines can be found at:http://www.asthma.org.uk/using_your_inhaler.html

http://www.asthma.org.uk http://www.lunguk.org

http://www.ginasthma.com

Page 2: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 2

Inhalation therapyThe inhaled route is the preferred route of

administration for most anti-asthma therapyBy this route

the active ingredient can be delivered to the smallest airways

the dose required is much smaller than needed for an equivalent effect via oral route

minimises risk of systemic side effects onset of action faster

Page 3: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 3

Inhalation therapy 2Devices available to deliver inhaled

medication include pressurised metered-dose inhalers, breath-actuated metered dose inhalers, dry powder inhalers and nebulisers.

Spacer (or holding chamber) devices make inhalers easier to use.

Page 4: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 4

Drugs Administered Via Inhalers.Corticosteroids. (Anti inflammatory)

BeclometasoneBeta agonists ( Bronchodilators) Salbutamol

& Terbutaline.Anti muscarinic bronchodilators. Ipratropium

bromideCombination therapy. The above drugs may

be administered separately or combined into one inhaler device.

Page 5: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 5

Metered dose aerosol inhaler

Metered dose aerosol (MDI) Convenient, low dose form of therapy

AdvantagesLow dose PortableCheap Fixed doseCan feel & hear dose being delivered

Page 6: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 6

Metered dose aerosol inhaler

Disadvantages

Requires good hand/breath co-ordinationNot good for those with decreased dexterityJet aerosol can cause deposition of the drug in the

oropharynx – reduces dose available to the airways and predisposes to local side effects (i.e. oral candidiasis)

25-30% of patients unable to use properlyDon’t know how much is left in device

Page 7: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 7

Using a metered dose inhaler Remove cap and check

mouthpiece is clear Shake inhaler Breathe out gently Place mouthpiece in mouth and

seal with lips At the start of breathing in,

press canister Continue to breath in as deep

as possible Hold breath for up to 10

seconds Wait half a minute before

repeating a dose

Page 8: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 8

Using a spacehaler device Remove cap Shake inhaler Breathe out gently Put mouthpiece in mouth

and at the start of inspiration, which should be slow and deep, press canister down and continue to inhale deeply

Remove from mouth, and hold breath for 10 seconds

Page 9: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 9

Using an Easi-breathe inhaler Shake inhaler Hold inhaler upright. Open the cap Breathe out gently. Keep inhaler

upright, put mouthpiece in mouth and close lips and teeth around it (the airholes on the top must not be blocked by your hand)

Breathe in steadily through the mouthpiece. Don’t stop breathing when the inhaler puffs continue taking a deep breath.

Remove from mouth and continue to hold breath for 10 seconds.

After use, hold inhaler upright and immediately close cap.

Page 10: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 10

Dry Powder Inhaler devicesDry powder devices

require no special co-ordination work well even with low inspiratory flow rates suitable for younger children should avoid exhaling through the device as this

will dampen the dry powder any air holes in the device must not be covered

during inspiration Includes accuhaler, disk inhaler and turbohaler

devices

Page 11: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 11

Dry Powder Inhaler devices Advantages

Easy to use No co-ordination needed Patient breath actuated Know how many doses left

Disadvantages Air can escape if you don’t form a good seal around the

mouthpiece Expensive in comparison to MDI’s May need a higher respiratory effort

Page 12: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 12

Using Accuhaler Device Hold the outer casing of the

accuhaler in one hand whilst pushing the thumb grip away until a click is heard

Hold accuhaler with mouthpiece towards you, slide lever away until it clicks. This primes the dose.

Holding the accuhaler horizontal, breathe out gently away from the device, put mouthpiece in mouth and suck in steadily and deeply.

Remove from mouth and hold breath for about 10 seconds.

To close, slide thumb grip back towards you as far as it will go till it clicks.

Page 13: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 13

Using a Turbohaler1. Unscrew and lift off cover.

Hold turbohaler upright and twist grip forwards and backwards as far as it will go. You should hear a click.

2. Breathe out gently, put mouthpiece between lips and breathe in as deeply as possible. Even when a full dose is taken there may be no taste

3. Remove from mouth and hold breath for 10 seconds

Page 14: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 14

Spacer devices Spacer devices and expansion chambers

reduce jet effect overcome hand-breath co-ordination problems disperses aerosol discharge within a chamber

may breathe in and out of chamber without breath holding - this may suit small children.

Less effort. Decreases local side effects Increases drug concentration delivered to the small airways

so maximises treatment without having to increase dose Work at least as well as nebulisers at treating most asthma

attacks in children and adults

Page 15: Inhaler Devices

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Volumatic device Remove cap, shake inhaler and

insert into device Place mouthpiece in mouth or

mask over mouth and nose Depress canister and leave device

in same position. Take a deep breath (this will make

a clicking sound as the valve opens and closes) and hold your breath for ten seconds (or for as long as is comfortable) then breathe out slowly.

If you find it difficult to take deep breaths, breathing in and out of the mouthpiece several times is just as good

Remove device from mouth Wait 30 seconds before repeating

Page 16: Inhaler Devices

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Aerochamber Remove cap Shake inhaler and insert in back of

aerochamber Place mouthpiece in mouth Press the canister once to release a

dose of the drug Take a slow deep breath in. If you hear

a whistling sound you are breathing too quickly

Hold breath for about 10 seconds, then breathe out through the mouthpiece

If you find it difficult to take deep breaths, breathing in and out of the mouthpiece several times is just as good

Remove mouthpiece from mouth and breathe out

Page 17: Inhaler Devices

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Maintenance & Hygiene Spacer devices should be cleaned once a month in

warm soapy water and left to “drip dry” on a clean draining board.

After using corticosteroids via an inhaler patients should be encouraged to clean their teeth. The steroid particulate can damage teeth enamel as well as cause oral thrush.

Therefore all patients are encouraged to brush teeth after use of an inhaler or rinse mouth with water

Page 18: Inhaler Devices

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Nebuliser Therapyhttp://www.brit-thoracic.org.uk/page261.html

A nebuliser is a device which converts drug solution into an

aerosol for direct inhalation via a mask or mouthpiece The solution is contained within a reservoir through which

oxygen or compressed air is passed. It may be powered by electricity (mains or battery) or by a

compressed oxygen or air supply. A flow rate of 6-8 litres/minute is required to drive the

nebuliser. normal breathing over 5-10 minutes is usually sufficient for

drug delivery

Page 19: Inhaler Devices

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Advantages of nebulisers: patients whose condition makes MDI use difficult

shortness of breath weakness

Simple to apply Effective in use Large doses can be administered Can be used for delivering drug direct to lungs

even if not available in inhaler form e.g. antibiotics

Page 20: Inhaler Devices

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Disadvantages of nebulisersNot very portable

Requires compressed gas, so only suitable for clinical environment unless bulky compressor used

inefficient only about 10% of the prescribed dose reaches

the lung.

Page 21: Inhaler Devices

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK 21

Jet nebuliser Jet of gas forced

through narrow opening (venturi)

negative pressure in reservoir

mist of droplets of drug solution

5- 10 microns size Larger droplets fall

back into reservoirCompressed gas

Reservoir of drug

droplets Venturi

baffle

Aerosol of drug for inhalation

Page 22: Inhaler Devices

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Used for Emergency treatment

acute asthma COPD

Long term bronchodilator treatment Preventive drugs for asthma Antibiotics

cystic fibrosis Bronchiectasis HIV/AIDS

Symptom relief in palliative care