Introduction
- Wash hands; Introduce self; ask Patient’s name, DOB and what they like to be called; Explain what you propose to do
- Check what patient already knows regarding condition (asthma/COPD), inhaler treatments and technique
Asthma/COPD review
- Review patient’s asthma/COPD control
- How often they require salbutamol or experience symptoms
- When they use their preventer
- Number of exacerbations
- Exercise tolerance
- Peak flow measurements (for asthma)
- Check understanding of inhalers, technique, and compliance
- Explain type of inhaler, its purpose, and when to use it
Inhaler technique explanation
Initial information giving
- Inhaler contains a set dose of medication
- The aim is to get it into the lungs
- Drug released by pressing canister or twisting/clicking device – demonstrate
Steps for Metered dose inhaler use
- Check date of expiration
- Shake vigorously
- Remove cap and check the inside is clean
- Stand or sit up straight
- Hold inhaler upright with index finger on top and thumb at the bottom
- Breathe out completely
- Seal mouth well around mouthpiece
- Press firmly down on the canister and simultaneously breathe in slowly and deeply (aim for back of throat)
- Hold breath for 10 seconds or as long as possible
- Breathe out slowly
- Replace cap
- Repeat after 1 minute if required
- Wash mouth out afterwards (if using steroid inhaler)
Demonstration and observation
- Demonstrate it yourself
- Clean the mouthpiece of a different placebo inhaler (with an alcohol 70%/chlorhexidine 2% device disinfection wipe)
- Ask the patient to demonstrate how they would use it
- Observe the patient and correct any mistakes
- Get the patient to repeat until they do it correctly
Other advice
- Seek emergency help if symptoms are severe or not relieved by inhaler
- See GP or specialist nurse if suffering with side effects or using reliever inhaler more than 3 times per week
- Ask the patient if they have any questions or concerns
Use of a spacer device
Spacers may be used in children, those experiencing side effects from steroid inhalers, or people having difficulty with inhaler technique. Usage steps:
- Assemble spacer
- Shake inhaler and then remove cap
- Attach it to the spacer
- Breathe out completely
- Seal mouth around spacer mouthpiece
- Press on the canister to release drug
- Breathe in slowly and deeply for 3-5 seconds and then hold for 10 seconds (or, alternatively, take five normal breaths from the spacer in and out through the mouth)
- Repeat if required after 1 minute
- NB: if the device whistles they are breathing in too quickly.
Looking after the spacer:
- Wash spacer with warm water and soap
- Always leave to drip dry
- Replace every 6-12 months
Learn more about inhalers…
The asthma and COPD prescription ladders and more about inhalers is covered here!