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Inhaler technique is a common topic in information giving OSCE scenarios. This guide demonstrates a structured approach to explaining inhaler technique in an OSCE setting. Check out the inhaler technique mark scheme here.

Introduction

Introduce yourself

Wash hands

Confirm patient details – name / DOB

Check patient’s understanding of their inhaler – allowing you to tailor your explanation to the patient’s level of knowledge

Explanation

Explain what the inhaler device is…

“You have been started on ….(name of inhaler)…for your asthma/COPDshow the patient the inhaler device

Explain when the inhaler device should be used…

Preventer (e.g. beclomethasone inhaler)

(Name of inhaler) is a preventer – it helps to reduce the swelling in the airways and stops them from being so sensitive. You use this to lower the risk of severe attacks. I would like you to inhale …(x puff(s))…(x time(s) a day)…everyday. It’s really important that you don’t miss doses, as regular use is key to keeping your asthma/COPD under control  Remind the patient to rinse mouth after use if the inhaler contains a steroid due to risk of oral candidiasis.


Reliever (e.g. salbutamol inhaler)

(Name of inhaler) is a reliever. This is useful to help relieve immediate wheezing/asthma attacks. It works by relaxing the airways so that you can breathe more easily. You shouldn’t need this more than 3 times a week if your asthma is well controlled. Ask your GP for a review if you are using this more frequently. I would like you to inhale (x puff(s)) when you feel short of breath.

If prescribing SMART (Single Maintenance and Reliever Therapy) regime (e.g. Symbicort, Fostair, Duoresp, Spiromax)

Symbicort is used as both a preventer and a reliever. You need to use this regularly …(x puff(s))…twice a day to prevent symptoms and …(x puff(s))…each time you have an attack. Remind the patient to rinse mouth after use due to risk of oral candidiasis. 

Show patient the dose counter on the inhaler where applicable.  Ask the patient to summarise the key points back to you to demonstrate understanding.

Demonstration

Explain the steps below as you demonstrate

1. Prepare the inhaler (take off the lid / shake if MDI / insert capsule if handihaler)

2. Load the dose – (press button to puncture capsule if handihaler  press lever once if accuhaler/ twist bottom if turbohaler)

3. Breathe out gently as far as is comfortable

4. Tightly seal lips around the mouthpiece

5. Breathe in:

  • Dry powder inhalers (DPI) need to be breathed in quick and deep
  • Metered dose inhalers (MDI) need to be breathed in slow and deep
  • Soft mist inhalers (SMI) need to be breathed in slow and deep

6. Remove inhaler from mouth, hold breath for as long as is comfortable

7. Repeat procedure as directed

Assess inhaler technique

Ask the patient to carry out the procedure themselves whilst you observe.

Most patients’ techniques will require tweaking.

Point out the positives …You are doing X&Y very well… then introduce room for improvement …”but doing A&B may help your inhalers work more effectively for you

DEMONSTRATE > OBSERVE > FINE TUNE > REPEAT AS NECESSARY 

Spacer devices

Spacers are used to improve drug deposition to the lungs in patients who cannot master their aerosol inhaler technique. They are useful in reducing side effects of high dose inhaled corticosteroids by reducing the amount of drug deposited in the mouth. Commonly used spacers are Volumatic and AeroChamber.

1. Prepare inhaler (shake aerosol inhaler)

2. Attach inhaler mouthpiece to the spacer device

3. Breathe out gently as far as is comfortable

4. Seal lips around the spacer mouthpiece

5. Release 1 dose into the spacer device

6. Breathe in and out through the spacer mouthpiece several times

7. Administer second dose if needed and finish

The spacer device should be washed with detergent (washing up liquid is fine) once a month and left to air-dry. It should never be wiped dry as this can cause static within the device and drug particles will stick to sides of the spacer as a result. Spacers should be replaced at least once a year.

To close the consultation

Ask if the patient has any questions or concerns

Provide information leaflet if available

Advise the patient to get in touch should they have any more questions or concerns

Thank patient

Wash hands

Commonly used inhalers

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