how good is your patient with the inhaler
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8/6/2019 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