Inhaler technique

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: symptoms frequency; when they use their preventer; how often they need their reliever; 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 small dose of medication
• The inhaler aims to deliver it directly deep into the lungs
• Drug released by pressing canister or twisting/clicking device – demonstrate

Steps for Metered dose inhaler use

1. Check date of expiration
2. Shake inhaler
3. Remove cap and check the inside is clean
4. Stand or sit up straight
5. Hold inhaler upright with index finger on top and thumb at the bottom
6. Breathe out completely
7. Seal mouth well around mouthpiece
8. Press firmly down on the canister and simultaneously breathe in slowly and deeply (aim for back of throat)
9. Hold breath for 10 seconds or as long as possible
10. Breathe out slowly
11. Replace cap
12. Repeat after 1 minute if required
13. 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 any side effects or concerns around control or technique
• Ask the patient if they have any questions or concerns

Use of a spacer device

Spacers may be used in children, patients with thrush related to 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