How to Use InhalersWorkshop

Dr Riham Hazem RaafatLecturer of Chest Diseases

Module 1

Introduction• Inhalation therapy refers to the delivery of a drug

to the body via the airways by delivering it in an

aerosol (spray) form.

Advantages of inhalation therapy:

• Direct delivery to the site of action.

• Small quantity of drug.

• Rapid onset of action.

• Minimal systemic absorption → decreases

systemic side effects.

Disadvantages of inhalation therapy:

• Time and effort consuming

History of Inhalers

Pharmacokinetics of Inhaled Drugs

So for Successful Drug Delivery:

•Particle Size of the Aerosol

•Design of the Device

• Inspiratory Flow & Breath Hold

•Airway Caliber & Disease Distortion

•Correct Technique

(1) Physical factors

(2) Ventilatory factors

(3) Anatomic factors

(4) Patient-related factors

SO TO SUMMERIZE:

Lung Deposition of Different Inhalers

Module 2

Types of Inhalers

1- Metered Dose Inhalers

(With or W/O Spacer)

2- Dry Powder Inhalers

(Single/ Multiple Dose)

3- Nebulizers

(Jet/Ultrasonic/Mesh)

Poor Technique

SO,

More lung deposition

(No cold Freon effect)

(Gas at lower temp)

Since 2010

More consistent even near empty

Tail Off Effect(near empty)

Technique of MDIs:

Care and Maintenance: Priming and Wasting Doses:

N.B.

Factors Affecting Performance: Advantages & Disadvantages:

counter

• Disadvantages:

How to Know it’s Empty:

(OLD METHOD) If No Counter

Autohaler - Breath Actuated MDI Inhaler (BA – MDI)

- Consists of a pressurized canister of medication in a plastic case with a mouthpiece.

- Is breath activated. This means when you inhale, the Autohaler automatically

releases a mist of medication.

Aero-chamber

Adv/Disadv. of MDI with Spacer:

Technique of MDI with Spacer:

Care and Maintenance:

Advantages: Disadvantages:

HANDIHALER

Tiotropium BromideSpiriva (18ug)

AEROLIZER & BREEZHALER

o Formoterolo Budesonide

Foradil (12ug)Miflonide(200-400mg)

o Indacetrolo Glycopyroniumo Indac/Glyco

Onbrez (150-300 ug)Seebri (44ug)Ultibro (110/50 – 85/43)

Soft Mist Inhalers (SMI)RESPIMAT

Some inhalers

require

forceful/strong and

deep inhalation

while others require

calm/slow and deep

inhalation

depending on the

internal inhaler

resistance

Technique of Diskus:

Technique of Turbohaler:

Technique of Aerolizer:

Technique of Handihaler:

Technique of Respimat (SMI):

NEBULIZERS (mist inhalation form)

using compressed gas

Conventional Pneumatic (JET)

Advantages: Disadvantages:

• Useful in children ,

• Handicapped persons ,

• Seriously ill patients Ventilated patients

• Elderly individuals

• High doses can be given

• Combination drugs can be given

• Enhancement of secretion clearance

• Sputum induction (physiotherapy)

• Humidification of respired gases

• Prevent dehydration

• Prevent or relieve bronchospasm

• Plenty of drugs can be used

• Bronchospasm

• Over hydration

• Delivery of contaminated aerosols

• Tubing condensation

• Swelling of retained secretions

Technique:1. Measure correct amount of saline solution using a clean dropper. Put the saline into the nebulizer cup.

2. Measure correct amount of medicine using a clean dropper and add it to nebulizer cup containing the saline.

3. If you are using a premixed medicine, add the correct amount.

4. Attach mouthpiece to T-shaped part. Fasten this unit or mask to the cup.

5. Turn on air compressor. - If connected to ventilator: to inspiratory limb with airflow 6-8 L/min

6. Put mouthpiece in mouth, between teeth and seal lips tightly around it.

7. Take slow, deep breaths in through the mouth

8. If you are unable to take slow, deep breaths, breathe normally into mask.

9. Hold each breath for 1 -2 sec before breathing out or hold each breath for 1-5 sec every 3-5 inhalations.

10. Continue breathing this way until medicine is gone from the cup (about 5-15 minutes).

Technique of Nebulizer:

Crucial Errors Nebulizers

Incorrect size for child

Not fitting tightly on face/mouth/nose

Not holding nebulizer upright

Stopping too early, before dose done

Module 3

Drugs Used for Inhalation

Distilled Water / NS

Available Devices in Egypt

Decision Tree

•Efficacy and safety

•Availability (and affordability) of prescribed drug in certain device

•Patient’s ability to use the device correctly

•Patient preferences

•Preferably prescribe same type of device (with comparable instruction) in

individuals if using several inhaled drugs

Age Requirements for Use of Inhalers