Inhalers

Question 1

Explain technique for Pressurised meter dose inhaler (pMDI).

Answer 1

1. Sit up straight or stand up and lift chin to open airways
2. Remove cap from the mouthpiece
3. Shake the inhaler
4. Breathe out gently
5. Immediately put the mouthpiece in your mouth and put your teeth around it (not in front and do not bite)
6. Start to breathe in slowly and deeply through the mouthpiece. As you breath in, simultaneously press the canister to release one puff of the medication. Do not keep pressing the canister
7. Hold your breath for 10 secs, or as long as possible
8. If a second dose of the medication is required, wait 30-60 secs before taking a second puff. Repeat if necessary
9. Replace the cap

Question 2

Explain how to use a pMDI with spacer.

Answer 2

Single Breath Technique
1. Remove cap of pMDI
2. Shake the inhaler and insert into the spacer device
3. Place the mouthpiece into mouth
4. Ensure the valve can be opened by breathing in and out slowly (you will hear a clicking sound)
5. Press the canister, keeping the inhaler in the chamber
6. Take a deep, slow breath and hold the breath for about 10 secs or for as long as possible then breath out through the mouthpiece
7. Remove the device from mouth
8. For a further dose, wait about 30-60 secs before repeating the technique
Multiple Breath Technique
1. Follow steps 2-6 above
2. Breathe in and out five times (tidal breathing)
3. Remove the device from mouth

Question 3

When is a spacer useful?

Answer 3

Patient has poor coordination
High doses of inhaled corticosteroids are needed
Infants and toddlers require inhaled medicine

Question 4

How would one clean a spacer?

Answer 4

• Monthly
• Wash in warm soapy water - do not rinse - leave to air dry
• Mouthpiece should be wiped clean of detergent before and after use
• Important to check that the one way valve still works
• Replace spacers every 12 months

Question 5

Explain the procedure for a dry powder inhaler (aka accuhaler)

Answer 5

1. Check dose counter
2. Open using thumb grip
3. Holding horizontally, load dose by sliding the lever until it clicks, this makes the dose available for inhalation and moves dose counter on
4. Breathe out gently away from mouthpiece
5. Place mouthpiece in mouth and seal lips
6. Breathe in steadily and deeply
7. Hold breath for about 10 secs or for as long as comfortable
8. While holding breath, remove the inhaler from mouth
9. Breathe out gently away from mouthpiece
10. If an extra dose is needed then do same again
11. Close cover and click shut.