The document discusses inhalation therapy, detailing various inhalers such as metered dose inhalers, dry powder inhalers, and nebulizers, along with their advantages and disadvantages. It highlights essential factors for successful drug delivery, including particle size, device design, and patient technique. Additionally, the document emphasizes the importance of choosing appropriate inhalers based on efficacy, safety, and patient preferences.

1. How to Use Inhalers
Workshop
Dr Riham Hazem Raafat
Lecturer of Chest Diseases

2. Module 1

3. 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

5. History of Inhalers

7. Pharmacokinetics of Inhaled Drugs

9. 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

16. SO TO SUMMERIZE:

21. Lung Deposition of Different Inhalers

24. Module 2

25. Types of Inhalers
1- Metered Dose Inhalers
(With or W/O Spacer)
2- Dry Powder Inhalers
(Single/ Multiple Dose)
3- Nebulizers
(Jet/Ultrasonic/Mesh)

31. Poor Technique

32. SO,

36. More lung
deposition
(No cold Freon effect)
(Gas at lower temp)
Since 2010
More consistent
even near empty
Tail Off Effect
(near empty)

37. Technique of MDIs:

38. Care and Maintenance: Priming and Wasting Doses:
N.B.

39. Factors Affecting Performance: Advantages & Disadvantages:
counter
• Disadvantages:

40. How to Know it’s Empty:
(OLD METHOD) If No Counter

43. 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.

46. Aero-chamber

47. Adv/Disadv. of MDI with Spacer:

49. Technique of MDI with Spacer:

50. Care and Maintenance:

54. Advantages: Disadvantages:

55. HANDIHALER
Tiotropium Bromide
Spiriva (18ug)
AEROLIZER & BREEZHALER
o Formoterol
o Budesonide
Foradil (12ug)
Miflonide
(200-400mg)
o Indacetrol
o Glycopyronium
o Indac/Glyco
Onbrez (150-300 ug)
Seebri (44ug)
Ultibro (110/50 – 85/43)

56. Soft Mist Inhalers (SMI)
RESPIMAT

57. Some inhalers
require
forceful/strong and
deep inhalation
while others require
calm/slow and deep
inhalation
depending on the
internal inhaler
resistance

58. Technique of Diskus:

59. Technique of Turbohaler:

60. Technique of Aerolizer:

61. Technique of Handihaler:

64. Technique of Respimat (SMI):

67. NEBULIZERS (mist inhalation form)
using
compressed gas
Conventional Pneumatic (JET)

68. 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

69. 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).

70. Technique of Nebulizer:

71. Crucial Errors Nebulizers
 Incorrect size for child
 Not fitting tightly on face/mouth/nose
 Not holding nebulizer upright
 Stopping too early, before dose done

72. Module 3

73. Drugs Used for Inhalation

75. Distilled Water / NS

77. Available Devices in Egypt

81. Decision Tree

82. •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

83. Age Requirements for Use of Inhalers