CPT2: Inhalers and technique

Question 1

Name some examples of inhaler devices

Answer 1

• Turbohalers
• Easy breathe inhalers
• MDI
• Pressurised multi dose inhalers (MDI)
• Autohalers
• Ellipta inhalers

Question 2

What does choice of inhaler depend on?

Answer 2

Primary consideration when choosing an inhaler is the ability of the patient to develop and maintain an effective technique. This may depend on: Age, dexterity, Coordination, Inspiratory flow

Question 3

Describe how MDIs work

Answer 3

• The drug is suspended (or dissolved) in propellant within a pressurised container. The inhaler is activated when the container is pushed down on, releasing a fine spray of drug and prollelant.
• This is the most commonly prescribed inhaler
• Good-breath coordination is required as the drug is released at 70mph. This means it is important to have the correct technique and activation and breathhing coordination.

Question 4

What are examples of some situations where an MDI may not be suitable

Answer 4

• Strength is required to activate the inhaler. Therefore patients with frail hands or artheritis may have difficulty with this device
• The propellant may irritate the back of the mouth and cause coughing. Therefore in this case an inhaler without propellant may be more suitable e.g. dry powder inhaler

Question 5

Why is it important that inhalers are prescribed by brand?

Answer 5

Different brands have different drug potencies so ensure continuty of treatement

Question 6

Benefits an negatives of MDI

Answer 6

• Cheapest
• Require greatest coordination and dexterity

Question 7

What are spacer devices?

Answer 7

PLastic chambers with a hole at one end for an MDI inhaler (compatibility applies) and a mouth piece or mask at the other end

Question 8

Why are these useful?

Why are they not?

Answer 8

• They reduce hand-breath cooridination required.
• They slow the drug and allow for more time for evaporation of the propellant so more drug can be inhaled.
• Increases drug in the airway and reduces drug in the mouth/ throat therefore less adverse local effects and systemic absorption.
• Bulky and not portable

Question 9

What groups would benefit from using a spacer?

Answer 9

• Children (mask)
• Poor inhaler technique
• High Corticosteriod dose

Question 10

What are examples of breath activated MDIs?

How do these work?

Answer 10

• Autohaler and easy breathe inhaler
• These inhalers are automatic - there is no need for hand-breath coordindation.
• On inspiration the valve is activated and drug released.
• Cannot be used with spacer

Question 11

Who might this inhaler not be suitable for?

Answer 11

• Frail patients
• Patients with severe conditions

may not be able to breathe in deeply enough to activate it

Question 12

What is a dry powder inhaler?

How do you use it?

Answer 12

It is an inhaler in which the medicine is formulated as a dry powder with no propellant.

A sharp deep inhalation is required to active the inhaler. It removes the need for hand-breath coordination as the drug is carried into the lung by inspiration force

Expensive but not more effective

Question 13

What are nebulisers?

Answer 13

• They disperese a liquid medicine into a fine mist which can be inhaled through a mouth piece or mask
• They deliver high doses with minimal effort requied - useful in acute breathless ness

Question 14

When are nebulisers used?

Answer 14

• In patients too ill to use their inhalers or when large doses of inhaled med is required
• Used in distressing or disabling breathlessness despite maximal use of inhalers

Question 15

Problems with nebulisers?

Answer 15

• Bulky
• Require power source
• Expensive
• Restricts patient movement

Question 16

Good link on how to use inhalers:

https://www.asthma.org.uk/inhalervideos

Question 17

Considerations for choosing inhaler

Answer 17

Consider whether the patient is physically capable of carrying out each step of the inhaler technique correctly:

do they have sufficient hand-breath coordination?

are they able to form a good seal over the mouthpiece?

are they able to open, manipulate, and prime the device?

are they able to inhale at the correct speed?

Consider the impact of cognitive impairment:

does the patient have the ability to remember all the necessary steps, and to remember when to take their inhaler?

Comorbidities (e.g. obesity or respiratory muscle weakness) and ageing can negatively affect inspiratory flow rate and may cause the patient to have difficulty using a particular device

If a patient demonstrates difficulty in using a particular device or with treatment adherence, consider an alternative device that may, for example, have a reduced number of operational steps, include a dose counter, or support a formulation with a lower dosing frequency