Inhaler Techniques(New)

All inhalers require you to

check the mouth piece to ensure there is nothing loose that you can inhale

With all inhalers you should check that there is no foreign body in the mouthpiece to prevent choking on anything unexpected.

Sit upright to let you take a good breath in.

All inhalers require you to empty your lungs before you take your inhaler to give room for the medicine.

All inhalers require you to hold the medicine in your lungs to work. Ideally up to 10 seconds.

Use the cover to protect the mouth piece when not in use.

 

 

The number of devices and the different medicines may make it confusing.

Medicines are
SABA – short acting beta agonists – which make muscles work that open up the airway
SAMA – short acting muscarinic antagonists – which make other muscles that normally close the airway relax

LABA – long acting beta agonists – which make muscles work that open up the airway
LAMA – long acting muscarinic antagonists – which make other muscles that normally close the airway relax

Steroids which reduce soreness and sensitivity of the airways. These can be in inhaler form or are sometimes used during worsened control in tablet form.
Combinations of the above.

 

Types of active ingredients in inhalers ( These last three are often now days mixed in different combinations)

Short acting beta-agonists that open up the wind-pipe. They are for short term relief. If they are frequently needed or there are symptoms they are not sufficient or the technique is poor.e.g. ventolin

Steroid inhalers component to damp down the soreness and regular usage reduces the soreness and irritability of the airways reducing the  triggering of asthma. e.g. clenil

Long acting beta-agonists that open up the airways for longer ( when steroid inhalers do not control asthma) e.g. salmeterol, ingredient in fostair,seretide. These rely on regular use

Antimuscarinic drugs (generally used for COPD) such as tioptopium which relax the muscles in the airways which would normally close it up. e.g. tiotropium, braltus. These rely on daily use

 

Inhalers either use either :

a) a liquid which changes to a gas to push out the medication from the inhaler.
It is best to shake these to give them energy to change the liquid in the inhaler to a gas.
This is why it is best to do 1 puff at a time, and also take deep steady breath in at the correct time and then old it in for 10 seconds if possible.

b) a powder which needs to be sucked in hard and fast.

It is important when loading the device that some inhalers are held in certain directions during the twisting. e.g. symbicort.

 

 

 

mdi

Checklist for metered dose inhaler use

1 Stand or sit upright when using your inhaler.
2 Remove the inhaler cap.
3 Hold the inhaler upright and shake 4 or 5 times.
4 Breathe out fully.
5 Place the mouthpiece between your teeth without biting and form a good seal around it with your lips.
6 Breathe in through your mouth and press the canister down at the same time to release a puff of medicine.
7 Continue to breathe in slowly and deeply for 3-5 seconds.
8 Hold your breath and take the inhaler from your mouth.
9 Continue to hold your breath for 10 seconds or as long as is comfortable. Breathe out slowly.
10 If your doctor has told you to take two puffs, wait 30 seconds then repeat steps 3 to 9.
11 Replace the cap straight away to keep out dust.

Common problems

Common mistakes that people make with metered dose inhalers include:

  • Not standing, sitting or holding the inhaler upright.
  • Not shaking the inhaler before using it.
  • Inhaling too sharply, at the wrong time or not deeply enough.
  • Not holding your breath long enough after breathing in the contents.
  • Taking several puffs without waiting between them.
  • It can be difficult to tell when the inhaler is empty.

 

Useful tips

  • Practice in a mirror, if you see a ‘mist’ from the top of the inhaler or the sides of your mouth you should start again.
  • If your inhaler contains a corticosteroid rinse your mouth out with water after your dose.
  • A spacer device used with your inhaler could help with any co-ordination problem, help the medication reach the lungs and reduce any side effects.
  • Always read the patient leaflet provided with your inhaler for any specific instructions.
  • Speak to your nurse or pharmacist if you experience problems using your inhaler.

 

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