Embed Size (px)
Citation preview
Page 1
1
ผศ.ภก.ดร.วันชยั ตรยีะประเสรฐิภาควชิาเภสชักรรมปฏบิตั ิ
คณะเภสชัศาสตร ์จฬุาลงกรณ์มหาวทิยาลัย16 ก.ค. 2558
Tips and pitfalls in asthma device use
2
Type of inhaler device prescribed Rx
Ventolin evohaler 1 puff prn I
RxVentolin evohaler 1 puff prn IPulmicort turbuhaler 1 puff bid I
RxVentolin inhaler 1 puff prn IPulmicort turbuhaler 1 puff bid ISeretide accuhaler 1 puff bid I
Asthma medication devices
Page 2
Pitfalls in asthma device use Many devices Age of patients Steps of device use
3
4
Pitfalls: Many devices
Page 3
Tips: Use all same devices5
6
SABA LABA Combined ICS+LABA
Tips: Use all same devicesICS
Page 4
Tips: Use all same devicesMDI DPI
High velocity aerosols Aerosol velocity depends on inspiratory flow rate
Requires hand breath co-ordination
No hand breath co-ordination needed
Time consuming to teach Easy to teach
Requires deep& slow breathing only
Requires high inspiratory flow>28L/min
Lower cost Higher cost, Age > 5 yr
Turbuhaler Accuhaler Flow dependence DPI Flow independent DPI
DPI device selection: Speed of inspiration Tips: Use all same devices
Page 5
Pitfalls in asthma device use Many devices Age of patients Steps of device use
9
Common problems for older people Inadequate inspiratory flow rate (COPD) which
limits ability to use MDI or DPI difficulty connecting MDI to spacer Inability to coordinate breathing in with actuating
MDI Inability to activate MDI due to osteoarthritis,
stroke, muscle weakness of the hands Inability to achieve a firm seal around the
mouthpiece when using inhalers alone or with a spacer (particularly for patients with cognitive impairment).
10
Page 6
Tips: Choose appropriate device11
Problem Solution
Reduced maximal inspiratory flow
Reduced manual dexterity (e.g. due to osteoarthritis)
Inability to coordinate actuation and inhalation
Inability to form effective seal with lips around mouthpiece
Consider MDI alone or with spacer. Avoid DPI
Consider MDI with small-volume spacer or breath-actuated dry-powder inhale.Avoid MDI without spacer
Consider MDI with spacer, breath-activated MDI or breath-actuated DPI. Avoid MDI without spacer
Use spacer plus face mask
12
1-2 y MDI+spacer+face mask
3-4 y MDI+spacer
>5 y MDI, DPI
Elderly MDI+spacer, Easyhaler,
Autohaler
Tips: Choose appropriate device
Page 7
13
Tips: Use spacerhttp://youtu.be/GSUOiD9xwwo
Tips: Use autoinhaler14
Easyhaler (Autoinhaler)
Page 8
Pitfalls in asthma device use Many devices Age of patients Steps of device use
15
Tips: Teach via video Checklist Explain wrong use Take interactive quiz
16
Page 9
Video: Teach MDI use17
https://youtu.be/bq3E70xgSuY
Checklist: Steps in MDI use1. Shake the inhaler well before use (3 or 4 shakes) 2. Remove the cap 3. Breathe out, away from your inhaler 4. Bring the inhaler to your mouth. Place it in your mouth
between your teeth and close your mouth around it. 5. Press the top of your inhaler once. Immediately take a
slow breathe, pulling the aerosol deep into the lungs6. Remove the inhaler from your mouth, close your lips and
hold your breath for about 10 seconds, then breathe out 7. If you need a second puff, wait 30 seconds, shake your
inhaler again, and repeat steps 3-6.
18
Page 10
Checklist: Steps in MDI use19
Wrong use MDI 20
Page 11
Common error in MDI use Hand-breath discoordination Failure to hold breath for a sufficient time Inspiratory flow rate rapid Multiple actuations without waiting or
shaking in between doses Incorrect position of inhaler
21
National Asthma Council Australia 2008 Respir Care 2005;50(10):1360 –1374.
Website: How to use inhalers22
http://use-inhalers.com/common-mistakes-when-using-mdi
Page 12
Tips: Take interactive quiz23
24
Video: Teach turbuhaler usehttps://youtu.be/FhmYs-XGvvQ
Page 13
Checklist: Steps of turbuhaler use1.Remove the cap from the inhaler2.Keep inhaler upright3.Rotate grip anti-clockwise, then back until a click is heard4.Exhale all air out of lungs away from the inhaler5.Place mouthpiece between teeth and lips6.Inhale forcefully and deeply7.Hold breath for 10 seconds8. Exhale away from mouthpiece
25
26
Checklist: Steps of turbuhaler use
Page 14
Wrong use turbuhaler27
Common error in turbuhaler use Incorrect positioning of inhaler during
loading of a dose Failing to complete both steps of
loading (around and then back) Failure to breathe in deeply and with
enough force to deliver medication Excess moisture from humidity or
breathing into device
28
National Asthma Council Australia 2008
Page 15
Tips: Take interactive quiz29
Video: Teach accuhaler use30
https://youtu.be/HTbPfI0mlb4
Page 16
1. Open accuhaler hold it in the palm of your hand2. Put the thumb of your other hand on the thumb grip
and push the thumb grip until it “clicks” into place 3. Slide the lever away from you as far as it will go to
get your medication ready 4. Breathe out away from the device 5. Place the mouthpiece gently in your mouth and close
your lips around it 6. Breathe in deeply until you've taken a full breath 7. Remove accuhaler from your mouth 8. Hold your breath for about ten seconds, then breathe
out slowly 9. Always check the number in the dose counter
window to see how many doses are left.
31
Checklist: Steps of accuhaler use
Checklist: Steps of accuhaler use32
Page 17
Wrong use accuhaler33
Tips: Take interactive quiz34
Page 18
Common error in Accuhaler use Not loading dose before inhaling Failure to breathe in deeply and with
enough force to deliver medication Failure to hold breath for a sufficient
time after inhalation Excess moisture from humidity or
breathing into device
35
National Asthma Council Australia 2008
Video: Teach handihaler use36
https://youtu.be/bXHHFmZ_DRI
Page 19
Checklist: Steps of handihaler use1. Open the dust cap by pulling upward2. Open the mouthpiece3. Keep one end of the capsule in the center chamber4. Close the mouthpiece firmly. Leave the dust cap open5. Press piercing button once to release the medicine6. Exhale away from the inhaler7. Keeping mouthpiece in your mouth inhaler quick and deep. You'll hear the capsule rattle8. Hold your breath for 10 seconds. Exhale slowly through your mouth or nose9. Inhale through the mouthpiece once again. This ensures that you get your complete dose10. Open the mouthpiece, remove the used capsule and dispose it. Do not keep capsules in the Handihaler
37
Common error in handihaler use Not piercing capsule or, conversely,
piercing capsule multiple times Not using a new capsule for each dose Failure to breathe in deeply and with
enough force to deliver medication Not taking second breath to receive full
dose from capsule Swallowing capsule instead of inhaling it
through the HandiHaler
38
National Asthma Council Australia 2008
Page 20
Tips: Take interactive quiz39
Video: Teach swinghaler use40
https://youtu.be/y0PbW_2iNuE
