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01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 1
Inhaler techniques.
Additional information/guide...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 2
Inhalation therapy
The inhaled route is the pre...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 3
Inhalation therapy 2
Devices available to deliv...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 4
Drugs Administered Via Inhalers.
Corticosteroid...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 5
Metered dose aerosol inhaler
Metered dose aeros...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 6
Metered dose aerosol inhaler
 Disadvantages
Req...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 7
Using a metered dose inhaler
 Remove cap and ch...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 8
Using a spacehaler device
 Remove cap
 Shake i...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 9
Using an Easi-breathe inhaler
 Shake inhaler
 ...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 10
Dry Powder Inhaler devices
Dry powder devices
...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 11
Dry Powder Inhaler devices
 Advantages
 Easy ...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 12
Using Accuhaler Device
 Hold the outer casing ...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 13
Using a Turbohaler
1. Unscrew and lift off cove...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 14
Spacer devices
 Spacer devices and expansion c...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 15
Volumatic device
 Remove cap, shake inhaler an...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 16
Aerochamber
 Remove cap
 Shake inhaler and in...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 17
Maintenance & Hygiene
 Spacer devices should b...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 18
Nebuliser Therapy
http://www.brit-thoracic.org....
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 19
Advantages of nebulisers:
 patients whose cond...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 20
Disadvantages of nebulisers
Not very portable
...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 21
Jet nebuliser
 Jet of gas forced
through narro...
01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 22
Used for
 Emergency treatment
 acute asthma
...
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Inhaler Devices

  1. 1. 01/22/16 © 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
  2. 2. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 2 Inhalation therapy The inhaled route is the preferred route of administration for most anti-asthma therapy By 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
  3. 3. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 3 Inhalation therapy 2 Devices 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.
  4. 4. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 4 Drugs Administered Via Inhalers. Corticosteroids. (Anti inflammatory) Beclometasone Beta agonists ( Bronchodilators) Salbutamol & Terbutaline. Anti muscarinic bronchodilators. Ipratropium bromide Combination therapy. The above drugs may be administered separately or combined into one inhaler device.
  5. 5. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 5 Metered dose aerosol inhaler Metered dose aerosol (MDI) Convenient, low dose form of therapy Advantages Low dose Portable Cheap Fixed dose Can feel & hear dose being delivered
  6. 6. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 6 Metered dose aerosol inhaler  Disadvantages Requires good hand/breath co-ordination Not good for those with decreased dexterity Jet 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 properly Don’t know how much is left in device
  7. 7. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 7 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
  8. 8. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 8 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
  9. 9. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 9 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.
  10. 10. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 10 Dry Powder Inhaler devices Dry 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
  11. 11. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 11 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
  12. 12. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 12 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.
  13. 13. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 13 Using a Turbohaler 1. 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
  14. 14. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 14 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
  15. 15. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 15 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
  16. 16. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 16 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
  17. 17. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 17 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
  18. 18. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 18 Nebuliser Therapy http://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
  19. 19. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 19 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
  20. 20. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 20 Disadvantages of nebulisers Not 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.
  21. 21. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 21 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 reservoir Compressed gas Reservoir of drug droplets Venturi baffle Aerosol of drug for inhalation
  22. 22. 01/22/16 © Clinical Skills Resource Centre, University of Liverpool, UK 22 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
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