Docstoc

Inhaler Devices and Peak Flow Measurements

Document Sample
Inhaler Devices and Peak Flow Measurements Powered By Docstoc
					   Inhaler Devices and
       Techniques

       Angela Scott
Respiratory Nurse Specialist
Learning Outcomes.

   To become familiar with the common
    inhaler devices available.
   To be able to identify correct inhaler
    technique.
Factors influencing the choice of
inhaler device.
Patient.
 Acceptance of the diagnosis.
 Age.

 Lifestyle.

 Ease of use.

 Inspiration flow rate.
 Dexterity.
 Taste.

 Appearance of device.
Factors influencing the choice of
inhaler device.
Practitioner.
 Cost.

 Consistency of delivery.

 Availability of various drugs in the same

  device.
 Compatibility with other devices.

 Easy to teach technique.

 Effectiveness of the device.
Devices and technique.
 Need for clear specific training for patients of
  correct inhaler technique.
 Up to 50% of patients in Europe are unable to use
  inhaler correctly.
 Patients forget instructions and skills deteriorate
  over time – reassessment and re education.
 Most patients, nurse and doctors are unable to use
  pMDIs correctly. 57-70%.
(Crompton G.K.et al (2006). Respiratory Medicine.
  The need to improve inhalation technique in
  Europe: A report from the Aerosol Drug
  Management Improvement Team).
                         Quiz
   Name as many
    inhaler devices as
    you can
   (Not drugs – but
    actual inhaler
    devices!!)
    What amount of drug inhaled do you think actually
    reaches the lungs with the following devices?


    Metered dose inhaler
      80-100%        60-80% about 50% 30-50% 20-30%
      10-20% less than 10%
    Metered dose inhaler and small volume spacer
     80-100%        60-80% about 50% 30-50% 20-30%
     10-20% less than 10%
    Metered dose inhaler and large volume spacer
     80-100%        60-80% about 50% 30-50% 20-30%
     10-20% less than 10%
    Breath actuated metered dose inhaler
     80-100%        60-80% about 50% 30-50% 20-30%
    10-20% less than 10%
 Turbohaler
  80-100%         60-80%   about 50% 30-50% 20-30%
  10-20% less   than 10%
 Accuhaler
  80-100%         60-80%   about 50% 30-50% 20-30%
  10-20% less   than 10%
 Handihaler
  80-100%         60-80%   about 50% 30-50% 20-30%
  10-20% less   than 10%
 Nebuliser
  80-100%         60-80%   about 50% 30-50% 20-30%
  10-20% less   than 10%
Metered Dose Inhaler.
1.   Remove the cap.
2.   Shake the canister.
3.   Breathe out gently.
4.   Put the mouthpiece in the mouth and at the
     start of inspiration, which should be slow and
     deep press the canister down and continue to
     inhale deeply.
5.   Hold the breath for 10 seconds or as long as
     possible, then breathe out slowly.
6.   Wait a few seconds before repeating steps 2-5.
7.   Replace cap.
Tidal Breathing Technique with
Spacer.
1.   Take cap off, shake inhaler well and place
     in hole in end of spacer.
2.   Hold spacer with both hands, place
     mouthpiece in mouth and gently breath
     right out into spacer.
3.   Press inhaler once.
4.   Gently breath in and out five times.
5.   Remove from mouth. Wait 30 seconds to
     1 minute before repeating above steps as
     many times as prescribed.
One Breath Technique with Spacer.
1.   Remove the cap.
2.   Shake the inhaler and insert into the device.
3.   Place the mouthpiece in the mouth.
4.   Press the canister once to release a dose of the
     drug.
5.   Take a deep, slow breath in.
6.   Hold the breath for about 10 seconds, then
     breathe out through the mouthpiece.
7.   Breathe in again but do not press the canister.
8.   Remove the device from the mouth.
9.   Wait about 30 seconds before repeating steps
     2-8.
Accuhaler.
1.   Hold the outer casing of the accuhaler in one hand whilst
     pushing the thumb grip away until a click is heard.
2.   Hold the accuhaler with the mouthpiece towards you, slide
     the lever away until it clicks. This makes the dose available
     for inhalation and moves the dose counter on.
3.   Holding the accuhaler level, breathe out gently away from
     the device, put mouthpiece in mouth and take a breathe in
     steadily and deeply.
4.   Remove the accuhaler from the mouth and hold breath for
     about 10 seconds.
5.   To close, slide the thumb grip back towards you until it
     clicks.
6.   For a second dose repeat steps 1-5.
Turbohaler.
1.   Unscrew and lift off white cover.
2.   Hold turbohaler upright and twist the grip
     forwards and backwards as far as it will go. You
     should hear a click.
3.   Breathe out gently, put the mouthpiece between
     the lips and teeth and breathe in as deeply as
     possible. Even when a full dose is taken there
     may be no taste. (do not breathe out into the
     turbohaler. (60L/min insp.flow).
4.   Remove the turbohaler from the mouth and hold
     breath for about 10 seconds. Replace the white
     cover.
5.   For a second dose repeat steps 2-4.
Handihaler (1).
1.   Open the dustcap of the handihaler by pulling it
     upwards.
2.   Open the mouthpiece by pulling it upwards.
3.   Peel back the foil, exposing one capsule and
     remove it.
4.   Place the capsule in the chamber in the middle
     of the handihaler.
5.   Close the mouthpiece and press it down until you
     hear a click.
6.   Press in the green button on the side as far as it
     will go and then release.
Handihaler (2).
1.   Breathe out completely. Not into inhaler.
2.   Close lips tightly around mouthpiece.
3.   Keeping your head upright, breathe in slowly and
     deeply. You will hear and feel the capsule vibrate
     if you breath in correctly. (15L/min insp. flow).
4.   Hold your breath for as long as is comfortable.
5.   Remove the inhaler and breathe out normally.
6.   To empty the capsule completely repeat steps 1-
     5.
Breath Actuated Inhalers.
Easi-Breathe/Autohaler.
1. Shake the inhaler.
2. Hold the inhaler upright. Open the cap. (Autohaler-push
   the lever up).
3. Breathe out gently. Keep the inhaler upright and put the
   mouthpiece in the mouth and close the lips around it.
4. Breathe in steadily through the mouth. DON’T stop
   breathing when the inhaler ‘clicks’ and continue taking a
   really deep breath.
5. Hold the breath for up to 10 seconds.
6. Wait several seconds before repeating steps 1-5 for a
   second dose.
NOTE: Autohaler –The lever must be pushed up(‘on’) before
   each dose, and pushed down(‘off’) afterwards, otherwise it
   will not operate.
Reliever bronchodilators
(usually blue)
Inhaled steroids (usually
brown/orange)
Long acting beta 2 agonists
(Always green)
Long acting antimuscarinic
Combined inhaled steroid/long
acting beta agonist
Spacer devices
Nebuliser chambers
   Ventstream for antibiotics/steroids
   Sidestream for all other medication

				
DOCUMENT INFO