how good is your patient with the inhaler

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How good is your patient with

the inhalerDr kasim kolakkadanMBBS,MD,MRCP-UK 

Consultant pulmanologist  Alshifa hospital perinthalmanna

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Why the question Ask it to your patients

 Ask to yourself  More and more patients are on inhalers

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India 10 million people with asthma

70% not on regular treatment  Loss of work , school

Poor quality of life

 Asthma leading to COPD

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Why inhalers Inhaler phobia

Patient side Doctors side

Slowly changing

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Case scenario 15 year old girl

Seen a GP Diagnosed as asthma

Put on inhalers

Went to a corporate hospitalcardiologist 

? Can I get rid of the inhalers

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Doctor said yes Gave prednisolone 10 mg od,

montiluekast levocetrizine combination

Followed him up for 6 months

Put on weight and became verybeautiful and very happy

Developed steroid induced acniformerruption all over and come for 2nd opn

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 Acniform rash

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Scenario 2 14 yr old boy

Small and stout , cushioned at a glance ? is he on any medication

On a powder from manthawadi Rs 100/

wk Told them cheaper here if you wish to

continue the same

Put on inhaler terrible withdrawal, willnever re ain his lost hei ht 

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2 options Comply with patient wish

Convince them to take the treatment they need

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Inhaled treatment  Why inhaler

 Action on the site

So no unwanted actions

Prevent long tern deterioration inasthma

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Dry powder inhalers

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Prongs and cones Easy to use

Still people make errors Need a driving force other wise the

drug is deposited in the mouth

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Nebuliser

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Easy to use

Need power source Costly

Over use of beta agonist 

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Inhaler

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Doest need another device to use

Can carry in pocket  Can use at low flow

Need good co-ordination

Technique is very important 

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Overcome the faulty technique Use a spacer

Lose the portability

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 Autohaler

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Lever 

Top Cap

Sleeve

Body

Aerosol

Valve

Trigger 

AssemblyMouthpiece

Mouthpiece

Cover  Slide

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Method

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Key features of the Autohaler

Patient inhalation triggers the release of 

the drug No need to coordinate actuation and

inhalation

 Activated at a flow rate of 20-30 L/min Audible soft click or a whoosh sound to

confirm dose dispensing

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Press & Breath inhaler 

poor coordinationAutohaler� Inhalation Device

same patient

20.8%7.2%

Drug Deposition with the

Autohaler� Inhalation Device

MEAN Lung Deposition

Newman SP, Weisz AW, Talaee N, et al. Improvement of drug delivery with a breath actuated pressurized aerosol for  patients with poor inhaler technique. Thorax. 1991; 46(10):712-716 

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Take home Never prescribe an inhaler device

without discussing with the patient 

Demonstrate the inhaler technique

Recheck the inhaler technique

 Again recheck

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 Video

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THANK YOU