teaching inhaler technique

Question 1

overview

Answer 1

Key points:

• explain how it works
• demonstrate
• ask patient to perform procedure
• give feedback and explain common problems
• ask patient to repeat procedure
• invite questions and check understanding of important points

Question 2

first step

Answer 2

1. Introduce yourself to patient, check diagnosis and explain you are going to teach them how to use
   the inhaler.

Question 3

explain how it works

Answer 3

2. Explain how the bronchodilator works: “It relaxes the air passages in your lungs so it’s easier for
   you to breathe”.
3. Explain that the bronchodilator solution needs to:
   -“Reach as deep into your lungs as possible” and
   -“Stay in your lungs long enough to be absorbed”.

Question 4

talking through the procedure

Answer 4

4. Talk through the steps of the procedure:
   - remove the mouthpiece cover
   - shake the canister
   - hold the inhaler vertically in your dominant hand with your index finger over the top and the mouthpiece close to your mouth.
   - breathe right out
   - put the mouthpiece in your mouth with your lips tightly round it
   - press firmly down on the body of the inhaler as you start to breathe in
   - take in a deep breath slowly so that the spray goes deeply into your lungs
   - hold breath for 10
   - breathe out

Question 5

wrapping up

Answer 5

9. Ask patient if they have any questions, comments or concerns.
10. Test understanding – eg. “What do you think are the most important points in the explanation I
    have just given you?”
11. State that if you were teaching the patient to use an inhaled steroid you would also advise them to
    wash their mouth out after use.

Question 6

Why is it so important to teach good inhaler technique?

Answer 6

Even with good technique only 15% of the contents are inhaled – 85% are deposited on the wall of
the pharynx and swallowed.

Question 7

What could you do if you were sure that someone wasn’t able to use their inhalers correctly?

Answer 7

Think about giving them a spacer – this is a plastic conical sphere put between the patient’s mouth
and the inhaler. They reduce particle velocity so less drug is deposited in the mouth and reduce the
need for coordination between pressing inhaler and breathing in. They are very useful in children and
the elderly.

Another option is automatically triggered MDIs which only release the drug as the patient breathes in
– however, these are expensive.

Question 8

Some of the drugs used in asthma:

Answer 8

Salbutamol - β2 adrenoceptor agonist – short-acting bronchodilator
Salmeterol - β2 adrenoceptor agonist – long-acting bronchodilator
Ipratropium bromide – muscarinic antagonist/anticholinergic – bronchodilator (useful in COPD)
Sodium cromoglycate – anti-inflammatory
Beclomethasone/fluticasone – inhaled corticosteroid (can be low or high dose)

Prednisolone/methotrexate – oral corticosteroid
What are some of the important points about each type of drug?
β2 agonists and anti-cholinergics
- these rapidly control symptoms and can be taken as required, within a specified dose
range
- the recommended dose shouldn’t be exceeded – if they aren’t controlling symptoms, the patient should contact a doctor

Inhaled steroids
- these only work if taken regularly and aren’t effective if taken only during acute
attacks
- they can cause oral thrush in high doses – need to wash mouth out after using them

Salmeterol and cromoglycate
- they must be taken regularly, as with inhaled steroids

Question 9

how to use a spacer

Answer 9

While a spacer can make it easier to co-ordinate breathing in and activating an MDI, it can also make the MDI less portable because a spacer takes up extra space in a purse or a bag. However, inhaled corticosteroids are usually prescribed to be taken twice a day, so the spacer can be left at home for morning and evening use.

To Use a Spacer:
Shake the inhaler well before use (3-4 shakes)
Remove the cap from your inhaler, and from your spacer, if it has one
Put the inhaler into the spacer
Breathe out, away from the spacer
Bring the spacer to your mouth, put the mouthpiece between your teeth and close your lips around it
Press the top of your inhaler once
Breathe in very slowly until you have taken a full breath. If you hear a whistle sound, you are breathing in too fast. Slowly breath in.
Hold your breath for about ten seconds, then breath out.