Inhaler Devices

Question 1

What is an inhaler?

Answer 1

Medical device

Delivers medicine quickly to the lungs

Available in many device types based on the patients requirements eg. Dpi - dry powder inhaler

Question 2

Benefits of inhalers?

Answer 2

Drug delivered to the patients lungs

Higher bioavailability = smaller dose needed than by giving by mouth (can use salbutamol corticosteroid if needed)

Less side effects using inhalers

Question 3

Device types

Answer 3

DPI - Dry powder
PMDI - pressured metered device inhaler
SMI- Soft mist inhaler

Different device types = different techniques

Question 4

Need to consider

Answer 4

Not all pts have the same inspiratory flow( how well they breathe)

Question 5

Not all patients are able to do what?

Answer 5

• follow the correct instructions without the correct guidance
• patients may struggle with coordinating pressing inhaler and breathing

Question 6

Adherence

Answer 6

Try and give most suitable - OD dose rather than BD with a spacer

So ask daily habits and a pic of the patients and give advice

Question 7

Different types of devices

Answer 7

• inhalers
• nebulisers
  -parenetrals (IV/IM)
• Spacers
• Peak flow

Question 8

SABA

Answer 8

Short acting beta agonist

Question 9

ICS

Answer 9

Inhaled corticosteroid

Question 10

LABA

Answer 10

Long acting Beta agonist

Question 11

LTRA

Answer 11

Leukotriene Receptor antagonist

Question 12

LAMA

Answer 12

Long acting muscarinic antagonist

Question 13

Mart

Answer 13

Maintenance and reliever

(ICS and LABA) - in one device

Question 14

Examples of MART

Answer 14

• Fostair - inhaler
• Symbicort - Dry powder
• Duoresp - Breathe actuated powder
• Fobumix = Powder

Question 15

PMDI - more effective when used with a spacer

Answer 15

Inhale slowly and deeply (RIGHT BREATHE website), coordinating inhalation with the spray

If you inhale too quickly, back of throat = thrush

Question 16

Who can use PMDI

Answer 16

All ages, especially children
- encourage spacer

Question 17

PMDI - Tips to optimise treatments

Answer 17

Young children, elderly, arthritis

Spacers ensure good technique, especially those under 5, struggling with technique and anyone who might need it

Question 18

Breath actuated PMDI inhalers

Answer 18

Easy breathe!!!!!

Question 19

Breath actuated inhalers - PMDI

Answer 19

-Lift the cap down
-hold inhaler upright from the dishes (don’t block the top valve)
- inhale slowly and deeply, devise will detect breathing and deliver the dose

Question 21

Who can use Breathe actuated PMDI?

Answer 21

Suitable 12 and above

Question 22

PMDI Breathe actuated - optimising treatment

Answer 22

• top of inhaler has vents - vital for it to work
• Advise patients to hold the inhalers so they don’t block the vents
• device delivers drug on breathing in so no need to coordinate breathing
• spacers are incompatible here

Question 23

DPIs

Answer 23

• acuhaler
  Turbohaler

They need priming and click

Question 24

DPI

Answer 24

• big particles, inhale quickly and deeply through the mouth

Too slow = not effective
Too Fast = hits the back of the throat

Question 25

DPI - drink water

Answer 25

Need to rinse or drink water to avoid thrush

Question 26

Accuhalers - how to use

Answer 26

Twist to open the inhaler, dose counter will go down to show that the inhaler is ready Hold up horizontally Big deep breath to inhale medicine

Question 27

Who can use DPI aculaher

Answer 27

4 Y/O and above

Question 28

Tips to optimise DPI - accuhaler/turbohaler

Answer 28

- Easier to use, less coordination needed and includes a doses - no need for spacer - dry powder patient may feel the difference than when switching from pMDI to DPI - eg. Lack of feeling in mouth - Cough and oral thrush

Question 29

Dry powders - turbohaler

Answer 29

Take lid off Twist cap/browm/red - hold horizontally - breathe in big breath and inhale medicine

Question 30

DPI - Turbohaler age?

Answer 30

6 years and above

Question 31

Examples of Turbohaler

Answer 31

Pulmicort - budesonide Symbicort - budesonide/formeterol

Question 32

What can we give for thrush

Answer 32

Daktarin oral gel of Nystatin

Question 33

Soft mist

Answer 33

Respimat

Question 34

How do soft mist work?

Answer 34

Turn the base until it clicks (make sure that the cap is closed) - push open the cap - breathing in whilst pressing the button

Question 35

Soft mist age licensing

Answer 35

6 years and above

Question 36

Tips to optimise soft mist treatment

Answer 36

- inhalers need to be primed when new, this is done by inserting the cartridge into inhaler and pressing until you see a mist - need new device after 6 cartridges - works with a spacer