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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 advan
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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