inhaler types Flashcards
4 types
- pMDI
- breath actuated MDI
- dry powder inhalers
- soft mist inhalers
pMDI requires
dexterity and the ability to coordinate actuation with inhalation
where this is an issue, a spacer device can be used or an alternative inhaler device can be considered
breath actuated MDI and DPI requires
minimum inspiratory effort to be able to generate enough inspiratory flow to allow effective drug delivery
A minimum level of inspiratory effort is necessary to use these inhalers effectively, as insufficient inhalation can result in poor medication delivery to the lungs, reducing therapeutic efficacy. For patients with very low inspiratory flow, alternative options, like nebulizers or traditional MDIs with spacers, may be more appropriate.
on changing from pMDI to DPI, patients may notice the following
lack of sensation in mouth and throat previously associated with each actuation
coughing may also occur
If a pt is on high ICS dose, and they are on pMDI, they must always have
spacer device
This inhaler type delivers a fiche number of medication doses per canister, and after thee doses have been used it, the inhaler will continue to actuate, expelling propellant gas but no API!
MDI
this inhaler type is associated with unnecessary expulsion of harmful propellant gas into the environment
MDI
patients on this type of inhaler may inadvertently use ‘empty’ inhalers and inhale only propellant gas once all the medicated doses have been used up which could lead to exacerbation and destabilisation of their condition
MDI
true or false - shaking, weighing or flaring the inhaler device, or using it until it not longer actuates is an accurate way of seeing when the inhaler runs out
false. not accurate and not recommended.
MHRA advice: pMDI - risk of airway obstruction from aspiration of loose objects
reports of pt who have inhaled objects into back of throat, in some cases these were aspirated causing airway obstruction
remove mouthpiece cover fully, soak inhaler device and check that both outside and inside of mouthpiece are clear and undamaged before inhaling dose
always store inhaler with mouthpiece cover on
the MHRA released safety information concerning this inhaler type after there were reports of patients inhaling objects into the back of the throat, in some cases these were aspirated leading to airway obstruction
pMDI
spacer devices can be used for this type of inhaler
pMDI
advantages of using spacer device with pMDI
- removes need for coordination between actuation of pMDI and inhalation
- reduce velocity of aerosol and subsequent impaction on oropharynx, and allow more time for evaporation or propellant so that large proportion of particles can be inhaled and deposited into lungs
- useful if poor inhalation technique, elderly, high dose ICS, prone to oral thrush with ICS
are spacer devices interchangeable
no
pt should be advised not to switch between spacer devices
when should patients inhale from spacer device after actuation and why?
ASAP because drug aerosol is very short lived
techniques when inhaling from spacer device
- One puff at a time either using the TIDAL (multiple) breathing method or SINGLE breath and hold method
- do this until total dose (may be more than a single puff) has been administered
True or false - when inhaling puffs from space device, tidal breathing is as effective as single breath method
true
how often to clean spacer devices and how to clean
once a month
wash in mild detergent and allow to air dry
clean mouthpiece free from detergent before using
why should you avoid cleaning spacer device more often than once a month
electrostatic charges can affect drug delivery
how often to replace spacers
every 6-12 months
spacer device - what is tidal breathing (aka multiple breathing) ? and when is it recommended over single breath and hold method?
- usually recommended if you can’t hold breath for 5 seconds after using inhaler, or if you are having asthma attack
- lips around mouthpiece to make a tight seal, then press canister on inhaler once to release the medicine, then breathe in and out SLOWLY and STEADILY into spacer five times
- if prescribed a second puff, keep spacer away from mouth, wait a min, then shake inhaler again, then repeat the steps
TIDAL = 5X BECAUSE 5 LETTERS IN TIDAL
tidal breathing spacer technique - how do you actually breathe?
breathe in and out SLOWLY AND STEADILY into spacer 5 times once you have pressed the canister
how to use pMDI inhaler with spacer using the single breath and hold method
breathe out gently and slowly until lungs feel empty and you are ready to breathe in
put lips around mouthpiece to make a tight seal, then press canister on inhaler once and breathe in slowly and steadily until lungs feel full
take mouthpiece of spacer out mouth and keep lips closed, and hold breath for up to 10 seconds or for as long as you comfortably can
then breathe out gently away from the spacer
if a patient is having an asthma attack and they are using a spacer and pMDI, what method of breathing is recommended
tidal breathing (aka multiple breaths)
name an example of a soft mist inhaler
Respimat
how to use a soft mist inhaler
Breathe out gently and slowly away from the inhaler until your lungs feel empty and you feel ready to breathe in. Put your lips around the mouthpiece of the inhaler to make a tight seal without blocking the two holes on either side. Start to breathe in slowly and steadily, and at the same time, press the big grey button on the inhaler once. Continue to breathe in slowly until your lungs feel full. Take the inhaler out of your mouth and hold your breath for up to ten seconds, or for as long as you comfortably can. Then breathe out gently away from your inhaler. Wait for 30 seconds and repeat for a second puff
How to use a pMDI (aka puffer)
Breathe out gently and slowly away from the inhaler until your lungs feel empty and you feel ready to breathe in. Put your lips around the mouthpiece of the inhaler to make a tight seal. Start to breathe in slowly and steadily and, at the same time, press the canister on the inhaler once. Continue to breathe in slowly until your lungs feel full. Take the inhaler out of your mouth and with your lips closed hold your breath for up to ten seconds or for as long as you comfortably can. Then breathe out gently away from your inhaler. If you’ve been prescribed a second puff wait 30 seconds to a minute and shake the inhaler again, then repeat the steps.
Examples of a DPI
Accuhaler
Spiromax
NEXThaler
Ellipta
Turbohaler
Handihaler
Breezhaler
Easyhaler
Genuair
Zonda
Forspiro
How to use DPI e.g. Accuhaler, Spiromax, NEXThaler, Ellipta, Turbohaler, Handihaler, Breezhaler, Easyhaler, Genuair, Zonda, Forspiro
Breathe out gently and slowly away from the inhaler, until your lungs feel empty and you feel ready to breathe in. Put your lips around the mouthpiece to make a tight seal. Breathe in quickly and deeply until your lungs feel full. Take the inhaler out of your mouth and hold your breath for up to ten seconds or for as long as you comfortably can. Then breathe out gently away from your inhaler. If you’ve been prescribed a second puff, slide the cover closed to reset the inhaler and repeat the steps. When you’ve finished, close the cover.
DPI require you to breathe in …
quickly and deeply until your lungs feel full
How to use breath-actuated inhaler e.g. Easi-Breathe, Autohaler
Breathe out gently and slowly away from the inhaler until your lungs feel empty and you feel ready to breathe in. Put your lips around the mouthpiece of the inhaler to make a tight seal. Breathe in slowly and steadily. Continue to breathe in when you feel the inhaler puff in your mouth until you have taken a full deep breath in. Take the inhaler out of your mouth and hold your breath for up to ten seconds or for as long as you comfortably can, then breathe out gently away from the inhaler.
breath actuated inhalers require you to breathe
in slow and steadily
summarise the type of breathing needed with each 4 types of inhaler
soft mist, pMDI, breath actuated: slow and steady
DPI: quickly and deeply
this inhaler type requires you to breathe in quickly and deeply
DPI
