inhaler devices
TRANSCRIPT
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
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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
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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.
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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.
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Metered dose aerosol inhaler
Metered dose aerosol (MDI) Convenient, low dose form of therapy
AdvantagesLow dose PortableCheap Fixed doseCan feel & hear dose being delivered
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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
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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
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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
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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.
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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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