Key Counseling Points - Pulmonary/Anaphylaxis

Question 1

Albuterol Inhaler

Answer 1

Instruct patient on inhaler technique, including priming and shaking well before using. Wash the mouthpiece and air dry thoroughly at least once a week (may cease to deliver medication if mouthpiece becomes blocked). Part of the extended-release tablet may pass into stool. Contact prescriber if more is needed to control symptoms than usual as this may indicate acute asthma exacerbation. Do not use more frequently than recommended. DPI does not require shaking or priming but does require deep inhalation for use. When inhaling contents, hold breath for at least 10 s, if possible, to allow it to travel deeper into the lungs.

Question 2

Budesonide Inhaler

Answer 2

Advise patient on proper inhalation technique. Gently swirl nebulizer suspension before use. Use entire vial of inhalation suspension immediately after opening to avoid contamination; deliver over 5-15 min using a jet nebulizer with mouthpiece or face mask. After administration, rinse mouth with water and spit, and wash face to minimize risk of developing oral candidiasis. Provided as a strip of five small plastic containers with sealed caps; each container holds 1 dose. The strip of containers is sealed inside a foil pouch. Keep any unused containers inside the pouch. Once foil pouch is opened, the containers will only be good for 2 wk.

Question 3

Budesonide/Formoterol Inhaler

Answer 3

Advise patient on proper inhalation technique. If >1 inhalation is prescribed, wait 1 min after initial inhalation and shake the inhaler again before the next inhalation. After administration, rinse mouth with water and spit, and wash face to minimize risk of developing oral candidiasis. Wash the mouthpiece and air-dry thoroughly at least once a week.

Question 4

Epinephrine

Answer 4

Instruct patient on proper administration technique. Immediately seek medical assistance, even if the patient feels better after epinephrine use. Inject into the anterolateral aspect of thigh, and not into buttock, digits, hands, or feet. Leg should be held firmly during injection. Autoinjector for IM or SUBQ administration—should not be used IV.

Question 5

Fluticasone Inhaler

Answer 5

Proper administration technique for the specific inhaled product prescribed. Instruct on rinsing mouth with water after each use to prevent oral infections. Monitor for signs of toxicity, especially adrenal insufficiency, oral candidiasis, and worsening pulmonary function. Provide package insert and other education materials and educate both adults and children on proper administration, usage, and storage. Repeat training or demonstration at regular checkups

Question 6

Fluticasone/Salmeterol Inhaler

Answer 6

Proper administration technique for specific inhaled product prescribed; rinse mouth with water after each use to prevent oral infections. Monitor for signs of toxicity, especially adrenal insufficiency, oral candidiasis, and worsening pulmonary function.

Question 7

Ipratropium/Albuterol Inhaler

Answer 7

Instruct patient on appropriate inhaler technique. Wash the mouthpiece in warm water and air-dry thoroughly daily (may cease to deliver medication if mouthpiece becomes blocked). Store the inhaler at room temperature; avoid excessive humidity; do not freeze. Nebulizer technique: use entire vial of inhalation solution immediately after opening to avoid contamination; deliver over 5-15 min. Seek medical attention if the prescribed dose does not provide relief or if symptoms worsen.

Question 8

Levalbuterol Inhaler

Answer 8

Instruct patient on proper inhaler technique. Wash the mouthpiece and air dry thoroughly at least once a week (may cease to deliver medication if mouthpiece becomes blocked). Store the inhaler at room temperature, away from heat and direct light. Do not freeze. Do not keep this medicine inside a car where it could be exposed to extreme heat or cold. Contact prescriber if the need to use more to control symptoms than usual as this may indicate asthma deterioration.

Question 9

Montelukast

Answer 9

Not indicated for acute asthma attacks. Report increased use of short-acting inhaled bronchodilators and advise patients not to discontinue or decrease the dose of other asthma medications unless instructed by a HCP. Patients with asthma or allergic rhinitis should take dose in the evening.

Question 10

Tiotropium Inhaler

Answer 10

Advise patients that this drug is not indicated for acute bronchospasm (rescue therapy). This drug may cause increased HR, dry mouth, constipation, urinary difficulty and retention, respiratory tract infection, and sinusitis. Warn patients that the drug capsules are for inhalation only and are not to be swallowed; instruct patients on the use of the inhalation device. When using HandiHaler, patients should inhale the contents of each capsule twice to ensure drug delivery. Maximum benefit in asthma may not be seen for 1-2 mo.