RESP - A. INHALERS-COVERED

Question 1

spacers

Answer 1

• removes need for coordination
• improves drug delivery
• reduce risk of oral infection from inhaled steroid
• children, pMDI and spacer for beta2 agonists and ICS
• face mask required until child can breathe using spacer facemask
• if breathing in too fast, whistling sound (with small volume spacers)

Question 2

choosing an inhaler

Answer 2

• assess inhaler
• choose
• train

Question 3

in-check dial

Answer 3

• coach patients to use their inhalers correctly
• assesses peak inspiratory flow rate
• stimulates resistance characteristics of specific inhalers
• patient can be trained to inhale at a flow rate known to be suitable for their DPI or pMDI
• 6 resistance groups (5 - DPIs, 1 - pMDI)

Question 4

peak flow meters

Answer 4

• can help identify changes: improvement or deterioration
• can change doses if on MART regime

Question 5

how to use peak flow meters

Answer 5

1. pull counter (red arrow) back as far as it will go to top near mouthpiece
2. stand/sit upright
3. take deepest breath
4. make sure mouth makes tight seal around mouthpiece
5. blow as hard and fast as can into meter
6. write down score
7. do 3 times in a row, short rest in between
8. use highest to fill into peak flow diary

Question 6

peak flow scores

Answer 6

• ‘best score’ = normal for patient - usual
• 80% of best score - all good
• 50-80% - GP or asthma nurse
• 50 or less - 999

Question 7

steroid inhalers

Answer 7

• preventers
• 2x daily, morning and night
• can deposit in mouth or throat
• oral thrush
• rinse mouth after use
• spacer can help
• high dose for longer periods = steroid card
• wash spacer every week or so
• dry in air

Question 8

nebulisers

Answer 8

• distressing breathlessness despite inhaler use
• asthma attack
• COPD exacerbations
• mainly in hospital
• low efficiency (10% drug reached lungs)
• microbiological contamination can occur
• glaucoma risk with nebulised ipratropium