Check patient’s understanding of their inhaler – allowing you to tailor your explanation to the patient’s level of knowledge
Explain what the inhaler device is…
“You have been started on ….(name of inhaler)…for your asthma/COPD“ – show 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.
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
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