W5 Respiratory Diagnostics Flashcards
What are the diagnostic tests for asthma? (6)
FeNO
Obstructive spirometry
Bronchodilator reversibility test
BDR test
Peak flow variability
Direct bronchial challenge test with histamine or methacholine
Diagnostic summary
(for info)
What is right breathe?
for info
Videos on inhaler technique
- Inhalers
- Spacers
- Pathways (guidelines)
What is a BAI?
What are some examples of them?
Breath-actuated metered dose inhaler
Easi-breathe, Autohaler, K-haler
What are some general tips for inhalers?
- Turbuhalers, Respimat and pMDI devices should be primed before they are used for the first time.
- For inhalers with a dose counter, it is important to check there are sufficient doses remaining in the inhaler before each use.
- For the Respimat inhaler, ensure the cartridge has been loaded into the device before using the inhaler for the first time.
- All pMDIs should be shaken before each dose. Do not shake dry powder inhalers (DPIs).
- For all types of inhalers, it is important to keep the chin tilted up so the medicine reaches the lungs effectively.
- After use, wipe down the mouthpiece of the inhaler with a dry cloth.
- For inhalers containing corticosteroids, it is important to rinse the mouth out with water after using the inhaler to remove any residual medicine. This will reduce the likelihood of voice changes and oral thrush
pMDI inhaler technique:
Breathe in gently, or dose will all hit back of throat as when sprayed, it comes out with force
1, Remove inhaler cap
2. Hold inhaler upright and shake well
3. Breathe out gently away from the inhaler
4. Put mouthpiece between teeth without biting and close lips to form a good seal
5. Breathe in slowly through the mouth and, at the same time, press down firmly on canister
6. Keep breathing in slowly and deeply and hold breath for 5 seconds or as long as comfortable
7. While holding breath, remove inhaler from mouth
8. Breathe out gently, away from the inhaler
9. If an extra dose is needed, repeat steps 2 to 8
10. Replace cap
pMDI & spacer
- Prepare the spacer*
- Remove inhaler cap
- Hold inhaler upright and shake well before inserting into spacer
- Put mouthpiece between teeth without biting and close lips to form a good seal
- Breathe out gently, into the spacer
- Hold spacer level and press down firmly on inhaler canister once
- Single breath: Breathe in slowly and deeply and hold breath for around 5 seconds or as long as comfortable. Take spacer out of mouth while holding breath
OR
Tidal breath:** Breathe in and out normally for 3 or 4 breaths before removing spacer from the mouth - Breathe out gently
- Remove inhaler from spacer
- Ifanextradoseisneeded,repeat steps3to9
- Replace cap on inhale
Accuhaler
- Open cover using thumb grip
- Hold horizontally, load dose by
sliding lever until it clicks - Breathe out gently, away from the inhaler
- Place mouthpiece in mouth and close lips to form a good seal, keep inhaler horizontal
- Breathe in steadily and deeply
- Hold breath for about 5 seconds
or as long as comfortable - While holding breath, remove inhaler from mouth
- Breathe out gently, away from the inhaler
- If an extra dose is needed repeat steps2to8
- Closecovertoclickshut
Autohaler
- Remove cap
- Hold inhaler upright and shake
well - Push lever up
- Breathe out gently, away from the inhaler
- Put mouthpiece between teeth without biting and close lips to form good seal
- Breathe in slowly and deeply. Keep breathing in after hearing click
- Hold breath for about 5 seconds or as long as comfortable
- While holding breath, remove inhaler from mouth
- Breathe out gently, away from the inhaler
- Pushleverdown
- If an extra dose is needed,
repeat steps 2 to 10 - Replacecap
Breezhaler
- Remove cap
- Flip the mouthpiece to open
- Remove the capsule from blister and place in chamber
- Close the mouthpiece until it clicks
- Press side buttons in ONCE and
release (do not shake) - Breathe out gently, away from inhaler
- Put mouthpiece between teeth without biting and close lips to form good seal
- Breathe in quickly and steadily, so capsule vibrates
- Hold breath for about 5 seconds, or as long as comfortable
- While holding breath,remove inhaler from mouth
- Breathe out gently, away from inhaler
- Openmouthpieceandremove capsule
- If more than one dose is needed. repeat steps 3 to 12
- Close mouthpiece and cap
Ellipta
- Slide the cover down until you hear a click (do not shake)
- Breathe out gently, away from the inhaler
- Place mouthpiece in mouth and close lips to form a good seal. Do not cover air vent
- Breathe in steadily and deeply
- Hold breath for 5 seconds
or as long as comfortable - While holding breath, remove inhaler from mouth
- Breathe out gently, away from the inhaler
- Slide the cover upwards as far as it will go, to cover the mouthpiece
Genuair
. Remove cap by squeezing arrows and pulling
2. Hold inhaler so large coloured button is facing straight up
3. Without tilting inhaler, press and release the button
4. Check control window has changed to green
5. Breathe out gently, away from inhaler
6. Place mouthpiece in mouth and close lips to form a good seal. Keep inhaler horizontal
7. Breathe in strongly and deeply. Keep breathing in after click is heard
8. Hold breath for about 5 seconds or as long as comfortable
9. While holding breath, remove inhaler from mouth.
10. Breathe out gently, away from inhaler.
11. Check control window has changed to red.
12. Replace cap
Handihaler
- Open cap
- Flip open mouthpiece
- Remove capsule from blister and place in chamber
- Close mouthpiece until it clicks 5. Press green piercing button in
once and release (do not shake) - Breathe out gently, away from inhaler
- Place mouthpiece between teeth without biting and close lips to form a good seal
- Breathe in slowly and deeply, so capsule vibrates
- Keep breathing in as long as comfortable
- While holding breath, remove inhaler from mouth
- Breathe out gently, away from inhaler
- Repeat steps 7 to 11 to take the full dose
- Open mouthpiece and remove capsule
- Close mouthpiece and cap
Respimat
- Hold inhaler upright with the cap closed
- Turn base in direction of arrows until it clicks (half a turn)
- Open the cap until it snaps fully open
- Breathe out gently, away from inhaler
- Place mouthpiece in mouth and close lips to form a good seal. Do not cover air vents
- Breathe in slowly and deeply through mouth and, at the same time, press down on the dose button
- Keep breathing in slowly and deeply
- Hold breath for 5 seconds or as long as comfortable
- While holding breath, remove inhaler from mouth
- Breathe out gently, away from inhaler
- Click cap shut
- Repeat from step 1 to get the full dose (as two inhalations is the usual dose for medicines used with Respimat)
prime before using for first time
Spiromax
- Hold inhaler upright with mouthpiece cover at the bottom
- Open the mouthpiece cover downwards until it clicks
- Breathe out gently, away from inhaler
- Place mouthpiece between teeth without biting and close lips to form a good seal. Do not cover air vents
- Breathe in strongly and deeply 6. While holding breath, remove
inhaler from mouth - Hold breath for 5 seconds or as long as comfortable
- Breathe out gently, away from inhaler
- Close mouthpiece cover
- If an extra dose is needed, repeat
steps1to9
Turbuhaler
- Unscrew and remove cover 2. Keep inhaler upright while
twisting grip - Twist around and then back until click is heard
- Breathe out gently, away from the inhaler
- Place mouthpiece between teeth without biting and close lips to form a good seal. Do not cover air vents
- Breathe in strongly and deeply 7. Hold breath for about 5 seconds
or as long as comfortable - Remove inhaler from mouth
- Breathe out gently away from the inhaler
- If an extra dose is needed, repeat steps2to9
- Replace cover
Spacers
what is a spacer?
how do you use it?
pMDI plus a spacer
A spacer is an attachment that can help increase the amount of medicine that reaches the lungs compared to using a pMDI on its own.
Some people find they can use a pMDI easier with a spacer.
pMDI plus a spacer
Breathe in through your
mouth, slowly and steadily
over 4 to 5 seconds or, breathe in and out through your mouth, slowly and steadily.
- Spacers should NOT be regarded as interchangeable: consult the Summary of Product Characteristics (where specified by name).
- Patients whose asthma is well-controlled and who are using a spacer should always use the same type of spacer and not switch between
spacers. Different spacers may deliver different amounts of ICS, which may have implications for both safety and efficacy
what are some examples of spacers?
Spacers include: A2A
spacer®, Able Spacer®,
Antistatic Space Chamber
Plus® devices, DispozABLE,
OptiChamber® Diamond,
Pocket Chamber®, Space
Chamber Plus® devices,
Vortex AeroChamber Plus ®,
Volumatic
How do you clean a spacer? (exam q)
Spacer cleaning: If you keep
your spacer clean it will last
longer and be more effective.
Clean the spacer regularly. The instruction leaflet tells you how often to clean it. Use warm water and mild detergent, such as washing up liquid. Rinse and
allow to air dry. Do not dry with a cloth or towel
Peak Flow Test and Diary
How do you measure peak flow?
To measure your peak flow:
* Find a comfortable position, either sitting or standing – do this the same way every time
* Push the pointer back to the first line of the scale nearest the mouthpiece
* Hold the peak flow meter so it’s horizontal and make sure that your fingers are not obstructing the measurement scale
* Breathe in as deeply as you can and place your lips tightly
around the mouthpiece
* Breathe out as quickly and as hard as you can
* When you’ve finished breathing out, make a note of your reading
* This should be repeated 3 times, and the highest of the 3 measurements should be recorded as your peak flow score.
- If you’re monitoring your asthma at home, you may have a diary or chart to record your score.
Steroid Cards
Which patients should you issue one to?
- Consider issuing a steroid treatment card [MHRA, 2006] to:
- People using prolonged high doses of ICS.
- People taking inhaled corticosteroids plus drugs that inhibit their metabolism (for example cytochrome P450 inhibitors, such as HIV protease inhibitors)
- Support early recognition and treatment of adrenal crisis in adults
What 3 things determine asthma?
- Waking up during the night at least 1x or more a week
- Asthma symptoms at least 3x or more (exacerbations)
- Using salbutamol or rescue inhaler (reliever)at least 3x or more a week
How to diagnose asthma:
Spirometry test and BDR test= Assesses lung function and level of obstruction
Baseline, measure spirometry, give bronchodilator and wait 15 minutes, measure again for inc lung function no then diagnose asthma
Why is ICS not given in COPD but Asthma?
COPD is not an eosinophilic disease (count is around 300 cells/ul) so many not be effective
Inc risk of pneumonia in COPD patients
What 2 things in an asthma review do you confirm before inc dose?
Inhaler technique
Adherence
