SPRIOMETRY, INHALERS AND INHALER TECHNIQUES Adarsh Shah

1. SPRIOMETRY, INHALERS AND INHALER TECHNIQUESAdarsh Shah

2. Learning Objectives Understand basic respiratory physiology. Understand rationale for performing spirometry and its diagnostic value. Know the principles of inhaler technique. Be able to explain inhaler technique to patients. Be aware of the common inhaler devices currently available, and few advantages and disadvantages of each.

3. EXPLAINING ANY PROCEDURE.. Introduce self – name, role Check patient’s name and DOB Gauge level of patients understanding regarding procedure Evaluate ideas, concerns and expectations Name of procedure, indications and proposed benefits What it involves – preparation before, during and after procedure, both for patient and family/friends Risks and complications of the named procedure Availability of results / follow up Supporting information leaflet

4. TYPES OF INHALERS AND DEVICES METERED DOSE INHALER (MDI) AUTOHALER EASIBREATHE ACCUHALER TURBOHALER HANDIHALER SPACER DEVICE / AEROCHAMBER

5. METERED DOSE INHALER (MDI) Remove cap & shake MDI Sit up and exhale all the way out Tightly seal lips around mouthpiece & tilt head back slightly Start to breathe in slowly & deeply At same time as breathing in, press down on canister to actuate one puff Continue to breathe in as much as possible Hold breath for 10 seconds Breathe out slowly If 2nd dose required, repeat above Ventolin (green) = salbutamol Seretide (purple) = fluticasone + salmeterol

6. METERED DOSE INHALER (MDI) - MAINTENANCE Clean at least once a week Remove metal canister & mouthpiece cover Rinse plastic casing under warm running water Dry thoroughly Replace the metal canister & mouthpiece cover DO NOT PUT METAL CANISTER IN WATER – pressurized container!!! When new canister inserted, shake inhaler and spray twice in the air before first use. MDI not suitable for very young, elderly, or those with Arthritis or ailments affecting hands.

7. AUTOHALER ‘breath actuated’ inhaler. Eliminates need for hand coordination. Warn patient of taste disturbance! Shake device and then push lever right up to prime it Ensure hands do not cover vents at bottom of device Sit up and exhale all the way out Start to breathe in slowly & deeply by tightly sealing lips around mouthpiece - click & whoosh noise indicates dose released, but continue to breathe in Hold breath for 10 seconds then breathe out slowly If 2nd dose required, return lever to downward position then push back up and repeat steps 3-6. Return lever to downward position when done.

8. EASIBREATHE breath actuated’ inhaler Warn patients of taste disturbance Shake device and then open cap to prime it Ensure hands do not cover vents at bottom of device Sit up and exhale all the way out Start to breathe in slowly & deeply by tightly sealing lips around mouthpiece – puff indicates dose released, but continue to breathe in Hold breath for 10 seconds then breathe out slowly If 2nd dose required, return close cap and re-open, then repeating steps 3-6. Close cap when done.

9. ACCUHALER ‘dry powder’ inhaler Warn patient of lack of ‘spray’! 1. Hold outer casing and push thumb grip away from you – exposes mouthpiece and hear a click. 2. Holding mouthpiece towards you, slide lever back until it clicks. 3. Sit upright, head held up and breathe out. 4. Holding lever, seal lips around mouth piece. 5. Inhale deeply and steadily. 6. Remove inhaler and hold breath for 10 seconds. 7. Breathe out slowly. 8. For second dose, slide lever back and forth until click heard and repeat steps 3-7. 9. Close inhaler by sliding thumb grip towards you.

10. TURBOHALER ‘dry powder’ inhaler Warn patient there is no dose counter – when window turns red, device is empty. 1. Unscrew and remove white cover. 2. Holding inhaler upright, twist grip clockwise and then anticlockwise until it clicks. 3. Sit upright, head held up and breathe out. 4. Seal lips around mouth piece. 5. Inhale deeply and steadily. 6. Remove inhaler and hold breath for 10 seconds, then breathe out. 7. For second dose, repeat steps 2-6. 8. Close inhaler by replacing white cover.

11. HANDIHALER ‘dry powder’ inhaler – needs low inspiratory flow rate Warn patient that it requires capsule insertion and dexterity. 1. Expose mouthpiece by pulling cap upwards. 2. Pull mouthpiece upwards exposing chamber. 3. Take 1 capsule from pack and insert into chamber 4. Replace mouthpiece (should click) but leave cap open. 5. Press side button 3-5 times to pierce & crush capsule. 6. Sit upright, head held up and breathe out. 7. Seal lips around mouth piece, then inhale deeply & steadily. 9. Remove inhaler and hold breath for 10 seconds. 10. Breath out slowly. 11. Remove capsule, replace cap.

12. SPACER DEVICES Use with MDI: requires less coordination Shake inhaler & insert it into spacer Tightly seal lips around mouthpiece Actuate MDI Slow deep inhalation from spacer Breathe in & out normally through the spacer for 30 seconds If a second dose is required, repeat above. NB- Large volume spacers are more efficient than small volume spacer, but bulky to carry.

13. BTS ASTHMA GUIDELINES FOR ADULTS

14. NICE GUIDELINES FOR DIAGNOSIS OF COPD

15. Conclusion Well done on making it so far… See you at a tutorial soon Get in touch if you have any ideas, concerns or expectations… Include your id and / hk508/ …@ic.ac.uk