InhalersThe Perfect technique

Vicky Walker Clinical Lead for Respiratory Services

Sarah Wilson

Respiratory Nurse Specialist

Which inhaler is right for your patient?

Contents

Quiz - test your current knowledge Information on devices Practical demonstrations of common

inhalers, through DVD and audience participation (that’s you!)

case studies Our role - how we can help? What to do next……………….

Aims of the teaching

Update and increase knowledge on different devices

Test baseline knowledge ( to improve at the end of the session!)

To become more familiar with delivery devices

Increase skills in assessment of technique How to trouble shoot

Quiz time

Metered dose inhalers (MDI)

Cheap, Quick & convenient to use Poor inhaler technique is common When used correctly only 10%-20% of the

drug reaches the lungs may continue to deliver propellant after

active drug gone if not shaken correctly important to wait 30-60 secs between doses

due to 2nd actuation being of poorer quality

Breathe actuated inhalers

Spring mechanism is triggered by inspiratory flow rate of 22-36 l/m

drug delivery less dependent on technique When cap is removed the inhaler is primed

and ready to fire

Ref: AJ Corlett 1996 Caring for Older People: Aids to compliance with medication BMJ 1996;313:926-929 12 October

Spacer devices

Removes the need for co-ordination of breathing and actuation

Pharyngeal deposition is greatly reduced smaller particles penetrate further into lungs

depositing a greater proportion of drug Available with mask Electrostatic charge reduces delivery

Dry Powder inhalers (DPI)

Inspiratory airflow releases the fine powder - therefore no co-ordination needed

dose counters helps patients to know when empty (between 60-200 doses)

DPI can make some patients cough Inspiratory flow rate needed may be a

problem with some devices

Dry Powder inhalers (DPI) continued

More expensive than MDI’s DPI’s such as turbohalers have no

taste, hence there could be uncertainty it has been taken by the patient

Turbohalers delivers 20%-30% of drug Diskhaler delivers 11%-15% of drug

Ref:Optimizing deposition of aerosolizesd drug in the lung

Important points

Patient needs to be in a good upright position to use inhaler

Important to check inhaler technique regularly

Bad habits form quickly If a patient is requiring repeat

prescriptions – alarm bells should be ringing

DVD & Inhaler demonstration

Case Study 1

73 year old lady with severe COPD referred for Pulmonary Rehabilitation probable low inspiratory breath using Turbohalers but struggling Tested with Turbotrainer whistle Switched to MDI and Volumatic spacer beautiful technique with tidal breathing

Case Study 2

• 88 year old with moderate COPD• Using MDI & aerochamber• Struggling to fire inhaler consistently• Tried on turbohaler trainer whistle• Successful with whistle• Switched to turbohaler • Reviewed by CSW 1 month later managing

well, with good benefit

Case Study 3

Bingo dobber V turbohaler

The Good, The Bad and The Ugly

The Bad

Allergy to the cat Down the nose Christmas present Current prescription Blowing Upside down Huff and puff If at first……..

Mrs Smith has moderate COPD the GP asks for your advice on combination therapy.

Which device would you recommend?

Trick question ?

How we can help patients?

Home visits

Perform spirometry in patients home

Advice on smoking cessation

Inhaler technique

check

Telehealth in the patients home

Early discharge scheme from

LTHT

Refer to our Pulmonary

Rehabilitation programme

Patients can self refer to the Respiratory Team

Home exercise programme for

patients

What to do when ill

A name for your chest problem

Refer to the

respiratory team if

commenced on

oxygen

Do they need a portable/ambulat

ory cylinder

Telephone support and

advice

What to do next?

If you are still struggling with a tricky or complex patient then please refer on to your local Respiratory Team

contact details East Wedge 2953499 South Wedge 2954641 West Wedge 3059293 (west, north west &

north east)

Which inhaler is right for your patient?The one they can use.