Inhaler Devices Administration Guide

Why are inhaler devices prescribed? An inhaler is a device holding a drug that you take by breathing in (inhaling). This allows the drug to be delivered directly into the lungs where it is needed, meaning that people need much smaller doses than if the drug was taken by mouth. This helps to reduce the incidence of side-effects. Inhalers are prescribed for people with asthma or chronic obstructive pulmonary disease (COPD). There are different classes of inhaled drugs: Short-acting beta2 agonists e.g. salbutamol, terbutaline These are often called ‘reliever’ inhalers and are mostly blue in colour. They work by relaxing the muscles in the airways, which opens the airways wider to help ease symptoms quickly. Reliever inhalers are used ‘as required’ to ease symptoms of breathlessness, wheeze or a tight chest. These inhalers should only be used when required to relieve symptoms. Long-acting beta2 agonists e.g. salmeterol, formoterol The drugs in these inhalers work in a similar way to relievers, but work for up to 12 hours after taking each dose. Long-acting beta2 agonists may be used in addition to a corticosteroid inhaler if symptoms are not fully controlled by a corticosteroid inhaler alone. These inhalers should be used regularly. Corticosteroids e.g. beclometasone, fluticasone, budesonide These are often called ‘preventer’ inhalers and are mostly brown in colour. Some corticosteroid drugs are combined with long-acting beta2 agonist drugs, and these inhalers are often purple or red in colour. Corticosteroids are usually used regularly twice daily to reduce inflammation in the airways, meaning that airways are less likely to become narrow and cause symptoms such as wheezing. These inhalers should be used regularly. Antimuscarinic bronchodilators e.g. ipratropium, tiotropium These work by relaxing the muscles in the bronchi in the lungs. This helps to opens the airways wider, which eases symptoms of breathlessness, wheeze or tight chest. These inhalers should be used regularly.

There are different types of inhaler devices available, including: Metered dose inhaler Easi-breathe Autohaler Easyhaler Accuhaler Turbohaler Handihaler Respimat

Why is it important to use the correct inhaler technique? When the correct inhaler technique is used, more of the drug is able to reach the lungs where it is needed. Generally, about 20% of the drug reaches the lungs and the remaining 80% hits the back of the throat and gets swallowed. But if inhalers are used incorrectly, as little as 5% of the drug can reach the lungs. This means that residents receive suboptimal benefit from their inhalers and are at risk of asthma symptoms or worsening of their COPD. This reduces quality of life and puts residents at risk of hospital admissions. It is therefore extremely important that all nursing home staff who assist residents in using their inhalers ensure that the correct inhaler technique is used. Examples of incorrect inhaler technique include: Not shaking the device before use Inhaling too fast or too slow Poor coordination and actuation of the canister Not holding your breath for 5-10 seconds after inhaling the drug Inhaling though the nose rather than the mouth

What is the correct inhaler technique of each inhaler device?

Metered dose inhaler 1. Remove the cap and shake the inhaler. 2. Breathe out gently. 3. Put the mouthpiece in your mouth and as you begin to breathe in (which should be DEEP and SLOW) press the canister down and continue to inhale steadily and deeply. 4. Hold your breath for 10 seconds (or as long as is comfortable) and remove the inhaler from your mouth. 5. For a second dose wait for approximately 30 seconds before repeating steps 1-4. 6. Replace the cap.

Easi-breathe 1. Shake the inhaler, hold it upright and open the cap. 2. Breathe out gently. 3. Hold the canister upright, put the mouthpiece in your mouth and close your lips and teeth around it. Do not block the air holes on top. 4. Breathe in STEADILY and DEEPLY through the mouthpiece. Do not stop inhaling when the inhaler ‘puffs’ but continue taking a deep breath. 5. Hold your breath for 10 seconds (or as long as is comfortable) and remove the inhaler from your mouth. 6. After use, hold the inhaler upright and immediately close the cap. 7. For a second dose, wait approximately 30 seconds before repeating steps 1-5.

Autohaler 1. Remove the cap. Hold the inhaler upright and push the lever up on top of the inhaler. Shake the inhaler. 2. Breathe out gently. 3. Keeping the inhaler upright, put it in your mouth and close you lips around it (the air holes at the bottom must not be blocked by your hand). 4. Breathe in STEADILY and DEEPLY through the mouthpiece. Do not stop inhaling when the inhaler ‘clicks’ – continuing taking a deep breath. 5. Hold your breath for 10 seconds (or as long as is comfortable) and remove the inhaler from your mouth. 6. Lower the lever at the top of the inhaler. 7. For a second dose, wait for approximately 30 seconds before repeating steps 1-6 8. The lever must be pushed up (‘on’) before each dose, and pushed down again (‘off’) afterwards.

Easyhaler 1. Remove the protective cover and the dust cap that covers the mouthpiece. 2. Shake the inhaler vigorously up and down 3-5 times. 3. Holding the inhaler in the upright position, press the inhaler ONCE between your finger and thumb until you hear a click, and let it click back again. 4. Breathe out gently away from the inhaler 5. Holding the inhaler in the upright position, place the mouthpiece in your mouth between your lips and teeth and seal tightly around it. 6. Take a STRONG and DEEP breath through the inhaler. Remove the inhaler from your mouth. 7. Hold your breath for at least 5 seconds, and then exhale gently. 8. Put the dust cap back onto the inhaler mouthpiece.

Accuhaler 1. Hold the outer casing of the inhaler in one hand while pushing the thumb grip away with the thumb of your other hand until a click is heard. 2. Holding the inhaler with the mouthpiece towards you, slide the lever away until it clicks. This makes the dose available for inhalation. 3. Breathe out gently. 4. Holding the inhaler horizontally, put the mouthpiece in your mouth and suck in QUICKLY and DEEPLY. 5. Remove the inhaler from your mouth and hold your breath for about 10 seconds or as long as is comfortable. 6. To close the inhaler, slide the thumb grip back towards you as far as it will go until it clicks. 7. For a second dose, repeat steps 1-6.

Turbohaler 1. Unscrew and lift off the cover. 2. Hold the inhaler upright and twist the grip once to the left as far as it will go, and then once to the right. You should hear a click. 3. Breathe out gently. 4. Put the inhaler in your mouth and breathe in as DEEPLY as possible. Even when the full dose is taken there may be no taste. 5. Remove the inhaler from your mouth and breathe out slowly. 6. Replace the cover. To take another dose repeat steps 1-5.

Handihaler 1. 2. 3. 4.

Open the dust cap by pressing the green piercing button. Pull the dust cap upwards to expose the mouthpiece. Open the mouthpiece by pulling the mouthpiece ridge upwards away from the base. Before removing a Spiriva capsule from the blister, separate one of the blisters from the blister card by tearing along the perforation. 5. Insert the Spiriva capsule in the centre chamber of the Handihaler. 6. Close the mouthpiece until you hear a click, but leave the dust cap open. Be sure that the mouthpiece sits firmly against the base of the Handihaler. 7. Hold the Handihaler with the mouthpiece upright and press the piercing button until it is flat against the base, and then release. Do NOT press the piercing button more than once. 8. Breathe out gently (but not into the mouthpiece of the Handihaler). 9. Raise the Handihaler device to your mouth and close you lips tightly around the mouthpiece. Do not block the air vents. 10. Keeping the Handihaler in a horizontal position, breathe in SLOWLY and DEEPLY so that you hear or feel the Spiriva capsule vibrate. 11. Hold your breath for 10 seconds (or as long as is comfortable) 12. Remove the Handihaler from your mouth and breathe out slowly. 13. Open the mouthpiece and tip out the used Spiriva capsule and throw it away. 14. Close the mouthpiece and dust cap.

1. 2. 3. 4. 5. 6. 7.

Dust cap Mouthpiece Mouthpiece ridge Base Green piercing button Centre chamber Air intake vents

Respimat Inserting the cartridge and preparing for use: The following steps are necessary before first use: 1. With the green cap (A) closed, press the safety catch (E) and pull off the clear base (G). 2. Take the cartridge (H) out of the box. Push the narrow end of the cartridge into the inhaler until it clicks into place. The cartridge should be pushed gently against a firm surface to ensure that it has gone all the way in. Do not remove the cartridge once it has been inserted into the inhaler. 3. Replace the clear base (G). Do not remove the clear base again. To prepare the inhaler for first-time use: 1. Hold the inhaler upright, with the green cap (A) closed. Turn the base (G) in the direction of the red arrows on the label until it clicks (half a turn). 2. Open the green cap (A) until it snaps fully open. 3. Point the inhaler towards the ground. Press the dose release button (D). Close the green cap (A). 4. Repeat steps 4, 5 and 6 until a cloud is visible. Then repeat steps 4, 5 and 6 three more times to ensure the inhaler is prepared for use. The inhaler is now ready to use. Using the inhaler: 1. Hold the inhaler upright, with the green cap (A) closed. Turn the base (G) in the direction of the red arrows on the label until it clicks (half a turn). 2. Open the green cap (A) until it snaps fully open. Breathe out slowly and fully, and then close your lips around the end of the mouthpiece without covering the air vents (C). Point the inhaler to the back of your throat. 3. While taking in a SLOW, DEEP breath through your mouth, press the dose release button (D) and continue to breathe in slowly for as long as you can. Hold your breath for 10 seconds or for as long as is comfortable. 4. Repeat steps 1-3 so that you get the full dose. 5. Close the green cap.

Don’t forget!

  

Residents should always be sitting upright or standing when using their inhaler devices. This allows more of the drug to deposit into the lungs. Use a spacer device if possible: this may increase the amount of drug that gets deposited into the residents’ lungs After using corticosteroid inhalers, residents should rinse their mouth out with some water. Corticosteroids can sometimes cause oral thrush and rinsing the mouth out with water after use reduces the risk of this.

For an animated video demonstration of how to use inhalers devices correctly, visit the Asthma UK website at www.asthma.org.uk

Author: Jenny Gibbs, Medicines Management Dept., NHS Bristol. 2011.