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Significance is determined by comparision to normal predicted values based o

Reference values based on male/female, height, weight, age and ethnicity.

(Various ref systems in use e.g. Wright scale UK. Now use European Scale)
Traffic Light System
Green = 80-100% of predicted = Good control.
Yellow = 50-79% = Caution, review therapies.
Red Zone = <50% = Possible medical emergency.
Used to track asthma recover and monitor managment at home (regular peak

PEFR

Steps
1. Ensure the PEFR meter is set to zero
2. Sit up straight or stand
3. Take a deep breath (as deep as you can possibly manage)
4. Place your mouth around the mouthpiece of the PEFR meter, ensuring a tig
5. Exhale as forcefully as you possibly can manage
6. Note the PEFR reading
7. Repeat this process a further 2 times
8. The highest reading of the 3 should be taken as the overall result

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Ensure patient is using correct inhaler.
Steps

1. Assesss
Introduce etc.
Assess patients understanding of inhaler and assess use.
Depending on above explain the inhalers (preventer/beclomethasone, reliever
With steroid/combination inhalers remind patient to rinse-out mouth after to av
Assess the patients inhaler technique if follow-up appointment.

2. Demonstrate
Prepare inhaler (take of lid, shake MDI, insert capsule if handihaler)
Load Dose (Handihaler=press once puncture, Accuhaler = lever once, Turboha
Breath out Gently as far as possible
Tightly seal Lips arount Mouthpiece
Breate in (DPI = Quick and Deep, MDI/SMI slow+deep)
Remove inhaler from mouth
Hold Breathe for as long as is comfortable
Repeat as directed.
3. Assess/Re-Assess Inhaler Technique
Ask patient to carry out procedure themselves whilst obsever
Consider using trainer e.g. Whistle inhaler to assess.
Tweek techniquw.
Point out positives (feedback sandwhich)
Repeat As Neccessary

4. Spacer Device
Improve lung deposition in patients who cannot use/master aerosol inhaler tec
Reduce side effects of high-dose inhalder corticosteroids by minimising mouth
Common Types: Volumetric and Aerochamber.
1. Prepare inhaler (shake aerosol inhaler)
2. Attach inhaler mouthpiece to the spacer device
3. Breathe out gently as far as is comfortable
4. Seal lips around the spacer mouthpiece
5. Release 1 dose into the spacer device
6. Breathe in and out through the spacer mouthpiece several times
7. Administer second dose if needed and finish
5. Close
Questions/concerns
Provide information leaflet
Safety net by urging contact if difficulties.
Thank Patient.

Inhaler Technique

Nebuliser Technique

Common Inhalers
Dry Powder: Turbohaler, Accuhaler, Easyhaler, Handihaler
Metered Dose Inhalers: Evohaler, Easibreathe
Soft Mist Inhalers: Respimat
Squeezed Nebs into drug chamber
Close
Place mask over patient
Check Size+Seal (protects eyes)
Connect tubing to comp/O2 @ 6-8l/min
Ask patient to breathe normally.
When nebule fully nebulised turn of and remove.

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Rules
Prescriptions in ink
Signed and Dated
Prescribers name+address+MCN
Statement of profession
Name and address of patient
State if patient is <12/
Name of Drug
Dose and Freq, Duration, Directions.

Writing a Prescription.

Additionally for Controlled Substance

Prescribers contact number
Name, Form, Strenght, Dose.
Total quantity to be dispensed in words and numbers.

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normal predicted values based on measurements fromt eh general population.

ght, weight, age and ethnicity.

UK. Now use European Scale)

ency.

nagment at home (regular peak flow monitoring).

ssibly manage)
f the PEFR meter, ensuring a tight seal with your lips
anage

n as the overall result

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assess use.
venter/beclomethasone, reliever/salbutamol, or symbicort/dual).
ent to rinse-out mouth after to avoid candiasis.

w-up appointment.

capsule if handihaler)
Accuhaler = lever once, Turbohaler = Twist once)

ow+deep)

whilst obsever
assess.

ot use/master aerosol inhaler technique.

icosteroids by minimising mouth deposition.
r.

vice

thpiece several times

h

, Handihaler
e

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