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11/13/24, 8\:18 PM Guide | Inhaler explanation

Inhaler explanation

Table of contents

Introduction

Explaining e
skill. This step-by-step guide describes how to explain inhaler technique in an OSCE setting.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Check the patient's current understanding of inhaler technique, allowing you to better tailor your explanation.
Position the patient so that they are sitting comfortably.
Ask the patient if they have any pain or shortness of breath before beginning your explanation of inhaler technique.

Explanation

Overview

Provide a general overview of the patient's inhaler\:
" Y o u h a v e b e e n s t a r t e d o n ….( n a m e o f i n h a l e r ) …f o r y o u r a s t h m a .
"
" T h i s i s w h a t t h e i n h a l e r l o o k s l i k e .
"
" T h i s i s t h e m o u t h p i e c e , t h i s i s t h e c a n i s t e r c o n t a i n i n g t h e m e d i c a t i o n a n d t h i s i s t h e d o s e c o u n t e r .
"

Di

Reliever (e.g. salbutamol inhaler)
Explain what a reliever inhaler is and when it should be used\:
" ( N a m e o f i n h a l e r ) i s a r e l i e v e r . T h i s i s u s e f u l t o h e l p r e l i e v e s u d d e n a s t h m a a t t a c k s . I t w o r k s b y r e l a x i n g t h e a i r w a y s s o t h a t
y o u c a n b r e a t h e m o r e e a s i l y . Y o u s h o u l d n’ t n e e d t h i s m o r e t h a n t h r e e t i m e s a w e e k i f y o u r a s t h m a i s w e l l c o n t r o l l e d . A s k y o u r
G P f o r a r e v i e w i f y o u a r e u s i n g t h i s m o r e f r e q u e n t l y . I w o u l d l i k e y o u t o i n h a l e ( x p u
"
Preventer (e.g. beclomethasone inhaler)
Explain what a preventer inhaler is and when it should be used\:
" ( N a m e o f i n h a l e r ) i s a p r e v e n t e r - i t h e l p s t o r e d u c e t h e s w e l l i n g i n t h e a i r w a y s a n d s t o p s t h e m f r o m t i gh t e n i n g u p . Y o u u s e
t h i s i n h a l e r t o r e d u c e t h e r i s k o f h a v i n g a s t h m a a t t a c k s . I w o u l d l i k e y o u t o i n h a l e …( x p u
r e a l l y i m p o r t a n t t h a t y o u d o n' t m i s s d o s e s , a s r e gu l a r u s e i s k e y t o k e e p i n g y o u r a s t h m a u n d e r c o n t r o l .
"
Remind the patient to rinse their mouth after use due to the increased risk of oral candidiasis\:
" Y o u s h o u l d r i n s e y o u r m o u t h a f t e r y o u u s e t h i s i n h a l e r a s o t h e r w i s e , y o u m i g h t d e v e l o p a s o r e a n d i n
"
SMART (Single Maintenance and Reliever Therapy) regime (e.g. Symbicort, Fostair, Duoresp, Spiromax)
Explain what a SMART inhaler is and when it should be used\:
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" S y m b i c o r t i s u s e d a s b o t h a p r e v e n t e r a n d a r e l i e v e r . Y o u n e e d t o u s e t h i s r e gu l a r l y …( x p u
s y m p t o m s a n d …( x p u
"
Remind the patient to rinse their mouth after use due to the increased risk of oral candidiasis\:
" Y o u s h o u l d r i n s e y o u r m o u t h a f t e r y o u u s e t h i s i n h a l e r a s o t h e r w i s e , y o u m i g h t d e v e l o p a s o r e a n d i n
"

Check the patient's understanding

Ask the patient to summarise the key points back to you to check their understanding\:
" T o m a k e s u r e y o u' v e u n d e r s t o o d e v e r y t h i n g I' v e s a i d c o u l d y o u t e l l m e w h a t t y p e o f i n h a l e r y o u h a v e a n d w h e n i t s h o u l d b e
u s e d ? D o n' t w o r r y i f y o u c a n' t r e m e m b e r e v e r y t h i n g r i g h t a w a y , w e c a n a l w a y s go b a c k o v e r t h e i m p o r t a n t i n f o r m a t i o n .
"

Demonstration

The guide below focuses on correct inhaler technique using a pressurised metered-dose inhaler (pMDI), which is most
commonly used in OSCE scenarios.
2
Ensure you clearly explain and demonstrate each of the following steps to the patient using a dummy inhaler.

Things to do before using the inhaler

There are several things you should advise the patient to do before they begin to use their inhaler.
Device test
If the inhaler hasn't been used for 5 days or more, the patient should be advised to test the device before using it\:
1. Remove the cap and shake the inhaler well.
2. Point the mouthpiece away from you and press the canister to release a pu
Dose counter
Some pMDI's have a dose counter which shows the number of remaining doses left in the inhaler. Advise the patient to check
the inhaler is not empty and to seek a replacement whilst they still have several doses left.
Expiry date
The expiry date shows when the medication within the inhaler will expire and no longer be e
typically located on the metal canister of the inhaler. Advise the patient to seek a replacement in advance of their inhaler
expiring and to avoid using it after the expiry date.

Procedure

Preparation
1. Hold the inhaler upright.
2. Remove the cap from the inhaler and inspect to make sure there is nothing inside the inhaler mouthpiece.
3. Shake the inhaler well.
Inhalation
4. Sit or stand up straight and slightly tilt your chin up. This position helps the medication to better reach the lungs.
5. Breathe out gently and slowly away from the inhaler until your lungs feel empty.
6. Put your lips around the mouthpiece of the inhaler to create a tight seal.
7. Start to breathe in slowly and steadily whilst at the same time pressing the canister on the inhaler once.
8. Continue to breathe in slowly until your lungs feel full.
9. Remove the inhaler from your mouth and seal your lips.
10. Hold your breath for 10 seconds, or as long as you are comfortably able to.
11. Breathe out gently, away from your inhaler.
Final steps
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12. Once you have
with water to reduce the chance of side e
Multiple doses
If you've been prescribed a second pu

Assess inhaler technique

Ask the patient to use their own inhaler as demonstrated and observe their technique.
Provide feedback based on what you observe to allow the patient to re
Point out the positives...
" Y o u a r e d o i n g X & Y v e r y w e l l"
… then introduce room for improvement …
i n h a l e r s w o r k m o r e e
"
" b u t d o i n g A & B m a y h e l p y o u r
Continue to repeat the cycle of observation and feedback until the patient is able to use their inhaler e

Spacer devices

Spacers are used to improve drug deposition in the lungs. They are also useful for reducing the side e
inhaled corticosteroids by decreasing the amount of drug deposited in the mouth. Commonly used spacers include Volumatic
and AeroChamber.
Ensure you clearly explain and demonstrate each of the following steps for e
1. Prepare the inhaler as previously explained.
2. Attach the inhaler mouthpiece to the spacer device.
3. Breathe out gently and slowly away from the spacer until your lungs feel empty.
4. Place your lips around the spacer mouthpiece to create an e
5. Release one dose of the inhaler into the spacer device.
6. Breathe deeply, both in and out, through the spacer mouthpiece several times.
7. Administer a second dose if required.

Spacer device care instructions

The spacer device should be washed with detergent (washing up liquid is
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.

Closing the consultation

Check if the patient has any questions regarding inhaler technique.
Advise the patient to use their inhalers as directed.
Explain the potential side e
Palpitations and tremor\: salbutamol can cause tachycardia and tremor, particularly at higher doses.
Oral thrush\: steroid inhalers can cause candidiasis, particularly if the patient doesn't wash their mouth out e
each use.
Advise that if the patient has an asthma attack that does not respond to their salbutamol inhaler after 10 pu
seconds between each pu
Provide an information lea
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Arrange a follow-up appointment to re-assess the patient's inhaler technique.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.

References

1. James Heilman, MD. Adapted by Geeky Medics. Oral candidiasis. Licence\: CC BY-SA. Available from [LINK].
2. Asthma UK. How to use a pMDI inhaler. Accessed on 12th June 2020. Available from\: [LINK].
3. Tradimus. Adapted by Geeky Medics. Spacer device. Licence\: CC BY-SA. Available from\: [LINK].
Source\: geekymedics.com
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