Wash hands; Introduce self; ask Patientβs 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 patientβs 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 β 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 thepatient 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!