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Respiratory devices 4 december 2018(21 nov)
The document discusses the importance of proper inhaler techniques for asthma and COPD patients, highlighting various inhaler types and their correct usage. It outlines common issues faced by patients, such as incorrect actuation and inhalation coordination, and offers recommendations for patient education and evaluation. Additionally, it covers the use of devices like spacers, soft mist inhalers, and various medications administered via inhalers.
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Respiratory devices 4 december 2018(21 nov)
- 1. Respiratory devices Dr AhmedSayeed, MD,MRCP(UK)
- 2. Case scenario 30year School teacher was diagnosed to have asthma since the age of 15 years. She is currently on Seretide 2 puffs twice a day Salbutamol MDI 2 puffs PRN Her symptoms are still not controlled https://youtu.be/zG2DVoRP86g
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- 4. Objectives of theworkshop To know different types of inhalers To know the uses of inhalers To learn techniques of inhaler use To know briefly about other devices
- 5. The quality ofinhaler teaching provided to patients as self- assessed by physicians before (grey bars) and after (black bars) the inhaler education.
- 6. Evaluation of InhalerTechniques Among Asthma Patients Seen in Nigeria
- 7. Study to assessinhaler technique in Saudi hospitalized patients with asthma & COPD Saudi Medical Journal, smj.2016.
- 8. INTRODUCTION INHALER DEVICES ARETHE MAJOR METHOD FOR DELIVERY OF ASTHMA MEDICATION EFFECTIVENESS CAN BE COMPROMISED IF THE PATIENT USES THE INHALER DEVICE INCORRECTLY
- 9. Drugs used ininhaler devices Inhaled beta agonist and anticholinergic bronchodilators for chronic obstructive lung diseases. Asthma, COPD, Bronchiectasis, Bronchiolitis.
- 10. Drugs used ininhaler devices Inhaled glucocorticoids for Asthma, Eosinophilic bronchitis, COPD
- 11. Drugs used ininhaler devices Airway secretion modifying agents for cystic fibrosis- acetylcysteine, DNase Inhaled pulmonary vasodilators for pulmonary hypertension- ileoprost Aerosol delivery of drugs (eg, opiates) may be used to treat some nonrespiratory diseases.
- 12. TYPES OF INHALERDEVICES The pressurized metered dose inhaler (MDI), The dry powder inhaler (DPI), The soft mist inhaler (SMI)
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- 14. Dry powder inhalers Breath-actuated devices that deliver micronized drug particles Drug is delivered to the airways by the inhalation of air over a punctured capsule, blister, or reservoir https://youtu.be/bXHHFmZ_DRI
- 15. Soft mist inhalers Release the medication in a soft mist, Respimat SMI have a mean aerodynamic diameter ≤5.8 µm The lower velocity of the aerosol decreases oropharyngeal deposition.
- 16. SPACERS AND HOLDINGCHAMBERS Allows the velocity of particles to decrease before reaching the mouth. Use of a valved holding chamber also allows sequential actuation and inhalation.
- 17. COMMON PROBLEMS WITHINHALER DEVICES Upper airway deposition Actuation-inhalation coordination Insufficient breath-hold
- 18. TEACHING INHALER USESKILLS The clinician should first demonstrate the steps on the checklist. The patient then practices in front of the clinician so that errors may be corrected. The patient's technique should be evaluated periodically & corrections made as necessary. Patients should be positively reinforced for correct inhaler technique.
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- 20. MDI inhalers mustbe cleaned Do not wash the canister or immerse it in water. Clean the top and bottom of the plastic mouthpiece by running warm tap water through them for 30 to 60 seconds. Shake off excess water and allow the mouthpiece to dry completely. Replace the canister in the mouthpiece when dry. Release one puff from the inhaler into the air away from the patient’s face.
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- 22. DPI technique DPIs comein two main types https://youtu.be/bXHHFmZ_DRI https://youtu.be/Kr02is6jVUk
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- 26. Soft mist inhalertechnique SMIs release the medication in a soft mist, which lasts in the air about six times longer than the aerosol from an MDI. Respimat SMI have a mean aerodynamic diameter ≤5.8 µm. Particles less than 1 µm tend to be exhaled, rather than impacting on the airway. https://youtu.be/NfI1ogOyWLE
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- 28. Use of Respimat®Soft Mist™ Inhaler in COPD patients Int J Chron Obstruct Pulmon Dis. 2006
- 29. Common errors whileusing inhaler devices
- 30. Determining when aninhaler device is empty Some MDIs are have integrated dose counters. Electronic dose counters such as the 3M Integrated Dose by Dose Counter. Maintain a log of the number of actuations. DPI devices have counters that display the number of puffs remaining.
- 31. Patients with tracheostomy Twosystems for delivery of nebulized medication. Either a mask can be placed over the tracheostomy opening. The nebulizer chamber can be attached to the tracheostomy tube using a T-piece made of ventilator tubing and a connector.
- 32. Mechanically ventilated patients Humidification of inhaled gas decreases aerosol deposition by approximately 40 %. Increased dosage of medication is often required. Inhaled medications can be delivered using either an MDI or a nebulizer. MDI may deliver a more consistent dose than a nebulizer.
- 33. INFORMATION FOR PATIENTS Twotypes of patient education "The Basics" "Beyond the Basics."
- 34. Other devices Incentive spirometryinvolves deep breathing facilitated by a simple mechanical device to provide visual feedback https://www.youtube.com/wat ch?v=uqwCZdXdDrI&list=FL heMeQDqGiXQW- SshP3Fyhg&index=2
- 35. The peak flowmeters The peak expiratory flow is the maximal rate that a person can exhale during a short maximal expiratory effort after a full inspiration. https://www.youtube.com/w atch?v=055fSYXgNKU&ind ex=4&list=FLheMeQDqGiX QW-SshP3Fyhg
- 36. Cough assist device Patientswith an ineffective cough due to muscular dystrophy, myasthenia gravis, poliomyelitis, https://www.youtube.com/watch?v=oUMy b9h2-2w
- 37. Take home messages Common problems with inhaler usage are deposition of medication in the oropharynx, poor coordination. Use of a spacer device reduces oropharyngeal deposition and improves coordination. MDI can be used in mechanically ventilated patients.
- 38. References Up-to-date 2018 YouTube for inhaler technique videos