Inhaler Technique

Question 1

Poor inhaler technique leads to what?

Answer 1

Less drug deposition in the lungs
Wastes medication
Poor disease control
Reduced quality of life
Increased emergency hospital admissions
Higher treatment costs

Question 2

What does the correct use of pMDIs require?

Answer 2

Good coordination and timing on behalf of the patient
Good breathing technique
Inhaler maintenance

Question 3

What is essential for chronic pMDI use?

Answer 3

Accurate consultations for new patients
Regular reviews of inhaler technique

Question 4

What should be considered in patients that are unable to achieve correct pMDI use?

Answer 4

A spacer

Question 5

Common inhaler mistakes

Answer 5

Slouching
Using an empty inhaler
Not shaking or priming the inhaler
Using an MDI inhaler without a spacer
Spraying several pulls into a spacer
Holding the head too far forward or backward
Tongue or teeth in the way of spacer/inhaler opening
Mouth not tight enough around spacer/inhaler
Directing spacer/inhaler at tongue or roof of mouth
Inhaling medicine too fast

Question 6

A patient using an pMDI should be aware of what?

Answer 6

Prime a new or not-recently used inhaler
Breathe out initially
Don’t breathe out too quickly

Question 7

How and why should an inhaler be primed?

Answer 7

Spray 4 times with a 5 second shake in between each pump
Ensures correct mixing of the propellant and the medication within the melting chamber

Question 8

When should an inhaler be primed?

Answer 8

A new inhaler
Not been used in a two week period or more
The inhaler has been dropped

Question 9

Why should a patient breathe out initially before using a pMDI?

Answer 9

Efficient introduction of inhaled medication requires lungs to be clear of air and for the drug particles to be carried by inspiration into the alveolar and bronchial spaces

Question 10

Why should a patient not breathe out too quickly after using a pMDI?

Answer 10

It is likely the majority of the medication is removed from the bronchial and alveolar space before it can initiate its pharmacological effect

Question 11

What should a patient do to get the full therapeutic effect of medication after taking a dose from a pMDI?

Answer 11

Hold breath for about 10 seconds

Question 12

Advice for a patient using a DPI

Answer 12

Take a fast, deep, forceful breath in through the mouth, taking as big a breath as possible since delivery is not aided by a propellant
Multiple doses? Wait 1 minute between doses
ICS? Rinse mouth with water and spit

Question 13

Where should DPIs be stored?

Answer 13

In a cool dry place to avoid caking of the dry powder

Question 14

SMIs have a mechanical spring in their structure, what does mean?

Answer 14

Doesn’t require strong inspiration by the patient
Present with low degree of buccal deposition - require lower administrative dose

Question 15

How to prime an SMI

Answer 15

Point towards the ground
Press the dose-release button below the mouthpiece
A visible release of mist should occur
Must be re-primed if unused for 21 days or longer

Question 16

What to do if no visible mist shows when priming?

Answer 16

Close the cap
Turn the base
Open the cap
Prime again until mist visible

Question 17

How long to wait between doses with SMI

Answer 17

1 minute