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PROPER USE OF INHALERS

By: Angela Kate Uy
Kriztelle Magnaye
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What Is an Asthma Inhaler?

An asthma inhaler is a handheld
device that delivers asthma
medication straight into the airways.
While asthma medications can be
taken orally and intravenously, with
an asthma inhaler more of the
medication is delivered directly into
the lungs to help relieve asthma
symptoms faster and with fewer side
effects. Also, some asthma
medications are effective only when
inhaled.

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How Are Drugs Delivered in an
Asthma Inhaler?

Metered dose inhalers
(MDIs):
A metered dose inhaler
(MDI) delivers asthma
medication through a small,
handheld aerosol canister.
The metered dose inhaler
gently puffs the medicine
into your mouth when you
press down on the inhaler,
and you breathe the
medicine in.

Dry powder inhalers (DPIs):
Dry powder asthma inhalers
require you to breathe in deeply
as the drug enters your lungs.
These asthma inhalers may be
difficult to use, especially during
an asthma attack when you
cannot fully catch a deep breath.
Read the instructions carefully for
each dry powder inhaler because
they vary considerably. The
technique you learned for one
type of inhaler often does not
apply to others.

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What Types of Drugs Are Used in
Asthma Inhalers?

Corticosteroids including Advair,
Aerobid, Asmanex, Azmacort,
Dulera, Flovent, Pulmicort,
Symbicort, Qvar
Mast cell stabilizers, which may
prevent allergic reaction,
including Intal and Tilade

HFA, AccuNeb), Alupent, Maxair,
Xopenex
Long-acting beta-agonists,
including Serevent (salmeterol)
and Foradil (formoterol).
Combivent and DuoNeb inhalers
contain both albuterol and
ipratropium (an anticholinergic
bronchodilator). This combination
of albuterol and ipratropium may
also be given using a nebulizer.


Anti-inflammatory asthma
inhalers


Bronchodilator asthma inhalers

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Different types of Inhaler

1.Metered dose inhaler
A metered-dose inhaler (MDI) is a device that
delivers a specific amount of medication to the lungs,
in the form of a short burst of aerosolized medicine
that is inhaled by the patient. It is the most commonly
used delivery system for treating asthma, chronic
obstructive pulmonary disease (COPD) and other
respiratory diseases. The medication in a metered
dose inhaler is most commonly a bronchodilator,
corticosteroid or a combination of both for the
treatment of asthma and COPD. It contains a
pressurized inactive gas that propels a dose of drug
in each 'puff'. Each dose is released by pressing the
top of the inhaler. This type of inhaler is quick to use,
small, and convenient to carry. It needs good co-
ordination to press the canister, and breathe in fully at
the same time.
Aerosol
How to use
Shake the canister
- Take the cap off check there is nothing inside; the opening is clear
- The patient does a normal expiration (not a full expiration)
- Put the nozzle in your mouth, and at the same time as breathing in, press down on the top
- Do a full inhalation
- Hold your breath for 10 seconds
o Even with a very good technique, only 15% of the drug reaches the lungs the other 85% is
deposited on the wall of the pharynx and ultimately swallowed
Drugs used:
- Salbutamol
- salmeterol
- Beclomethasone
With a spacer
These reduce the risk of thrush (candidiasis) as well as alleviating the need for synchronized
breathing and activation of the inhaler. Newer spacers are smaller, and also make a musical note
when you are breathing too hard to tell you to reduce the strength of breaths.
- Need to be replaced every couple of months
- Need to be washed every day in soapy warm water, and only let them dry by evaporation
(drip drying) do not wipe it dry! this causes build up of static electricity
- They reduce the velocity of the drug particles, and thus reduce the number of particles being
deposited on the mouth and pharynx
- To use the spacer put one end in your mouth, and activate the drug. Then take 5 normal
sized breaths very gently in and out. Do this twice one for each puff of the drug.

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2.Breath-activated inhalers
These are alternatives to the standard MDI. Some are
still pressurised MDIs, but don't require you to press a
canister on top. The autohaler shown on the left is an
example. Another example of a breath-activated MDI is
the easi-breathe inhaler.

Other breath-activated inhalers are also called dry
powder inhalers. These inhalers do not contain the
pressurised inactive gas to propel the drug. You don't
have to push the canister to release a dose. Instead,
you trigger a dose by breathing in at the mouthpiece.
Accuhalers, clickhalers, easyhalers, novolizers,
turbohalers, diskhalers and twisthalers are all breath-
activated dry powder inhalers. You need to breathe in
fairly hard to get the powder into your lungs.
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This is a breath activated device, and thus had the advantage
that breathing and pressing dont need to be co-ordinated.
HOW TO USE
- Shake the device
- Remove the cap
- Prime the device pull the red lever up so that it clicks
- Whilst sat upright, take a normal breath out.
- Inhale slowly and deeply dont be put off by the click.
Keep breathing in to a full inspiration, and then hold your breath for
10 seconds
- Push the red lever back down. Replace the cap
- Remember the tell the patient they wont feel the spraying
sensation at the back of the throat and that this is normal. They
may still be able to taste the drug though.
Which medications come in an Autohaler?
Autohalers include Airomir (reliever medication) and Qvar
(preventer medication).
- Salbutamol
- Beclomethasone
Disadvantages
- Patient may not remember to prime it before each use
AUTOHALER
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TURBUHALER

A Turbuhaler is a dry-powder inhaler available in
an easy-to-use format.

Which medications come in a Turbuhaler?
Turbuhalers include Pulmicort (preventer),
Symbicort (combination medication) and Oxis
(symptom controller) and Bricanyl (reliever).

How to use a Turbuhaler
Unscrew the cap and take it off. Hold the inhaler upright
Twist the coloured grip of your Turbuhaler as far as it will go. Then twist
it all the way back. You have done it right when you hear a "click"
Breathe out away from the device
Put the mouthpiece between your teeth, and close your lips around it.
Breathe in forcefully and deeply through your mouth
Remove the Turbuhaler from your mouth before breathing out
Always check the number in the side counter window under the
mouthpiece to see how many doses are left. For the Turbuhalers that do
not have a dose counter window, check the window for a red mark, which
means your medication is running out. When finished, replace the cap.

ACCUHALER
Accuhalers are a type of dry powder inhaler, which means
the medication is inside them in the form of a dry powder.
Accuhalers are round plastic devices that usually have
two colours on them. The device is breath activated
which means the dry powder medication is sucked from
the device rather than fired like in some other types of
puffers.
Which medications come in an Accuhaler?
Flixotide (preventer medication), Serevent
(symptom controller medication) and Seretide
(combination medication) are all available in Accuhaler
form.
Disadvantages
- Has a bit of a complicated method of priming


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SPACER DEVICE

Spacer devices are used with pressurized
MDIs. There are various types - an example
is shown opposite. The spacer between the
inhaler and the mouth holds the drug like a
reservoir when the inhaler is pressed. A
valve at the mouth end ensures that the
drug is kept within the spacer until you
breathe in. When you breathe out, the valve
closes. You don't need to have good co-
ordination to use a spacer device.

A facemask can be fitted on to some types
of spacers, instead of a mouthpiece. This is
sometimes done for young children and
babies who can then use the inhaler simply
by breathing in and out normally through the
mask.
Tips on using a spacer device
These have a valve at the mouth end - the spacer in the picture above is an
example:
Shake the inhaler before firing each puff.
Start breathing in from the mouthpiece as soon as possible after firing the
puff into the device.
Try to hold your breath for a few moments when you have breathed in.
Breathe in and out a few times before firing the next puff. Try to hold your
breath for a few moments each time you breathe in.
Check that the valve opens and closes with each breath.
A facemask can be put on to the valve end for babies and young children.
They just breathe normally with their face against the mask. The valve
opens and closes with each breath in and out. Hold the spacer slightly
tilted with the inhaler end uppermost to help the valve open and close
easily.
Static charge can build up on the inside of the plastic chamber. This can
attract particles of drug, and reduce the output when the spacer is used.
To prevent this, wash the plastic spacer as directed by the maker's
instructions. This is usually before first use, and then about once a month
with washing up liquid and water. Let it dry in air without rinsing or wiping.
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THANK YOU