Inhalation Techniques

Patient Education on
Environmental Control
Basma Y. Kentab
Inhalation Techniques
The following are all real
examples !!
A man was asked to demonstrate his
inhaler technique.

He pointed the inhaler at his chest

and sprayed
An elderly man complained that his inhaler
was not relieving his wheeziness.

He was asked to demonstrate his technique.

He asked for a tablespoon.

He shook his inhaler, sprayed two

doses onto the spoon then licked it off!
 A patient had been using excessive
Salbutamol inhaler quantities

When asked to demonstrate his technique,

He stood up, sprayed the inhaler around
the room, just like an air freshener, and
sat down again
 Nebulizer
A nebulizer uses forced air to turn asthma
medication into a fine mist so that it can easily be
breathed into the lungs.

For some peopleand with some medications

nebulizers are the most effective way of
delivering inhaled medications.
 Facemask
Medication cup

Plastic tubing Compressed air machine

Inhalers
Inhalers are hand-
held portable
devices that deliver
medication directly
to the lungs.
 Types of Inhalers
Metered Dose Inhalers
(MDI)
These inhalers use a
chemical propellant to force
a measured dose of
medication out of the
inhaler.
It may be easier to use a
MDI with a spacer (a short
tube that attaches to the
inhaler )
Dry Powder Inhalers
(DPI)
No chemical propellant.
Medication released by
breathing in more quickly
with a traditional MDI
easier to use than the
conventional pressurized
MDI because hand-lung
coordination isn't required
Spacers shouldn't be used
with dry powder inhalers.
 Medications Delivered through
Inhalers
Short-acting bronchodilators : Provide immediate relief of asthma
symptoms. E.g. albuterol (Ventolin).

Long-acting bronchodilators : Relieve asthma symptoms for

longer periods of time. E.g. salmeterol (Serevent) and formoterol
(Foradil).

Corticosteroids : Used long term to prevent asthma attacks. E.g.

budesonide (Pulmicort), triamcinolone acetonide (Azmacort)

Cromolyn or nedocromil : nonsteroidal medications are used long

term to prevent inflammation.

Corticosteroid plus long-acting bronchodilator : This medication

combines a corticosteroid and a long-acting bronchodilator
(Symbicort).
MDI
Using MDI without Spacer
 Using MDI without Spacer
Shake the inhaler well before use (three or four shakes)
Remove the cap
Breathe out, away from your inhaler
Bring the inhaler to your mouth. Place it in your mouth between your
teeth and close your mouth around it.
Start to breathe in slowly. Press the top of your inhaler once and
keep breathing in slowly until you've taken a full breath
Remove the inhaler from your mouth, and hold your breath for about
ten seconds, then breathe out
If you need a second puff, wait 30 seconds, shake your inhaler
again, and repeat steps 3-6.
Always write down the number of puffs you've taken so that you can
anticipate when you need to refill your prescription.
Store all MDIs at room temperature.
MDI with Spacer
 Using MDI with Spacer
A spacer is a tube that MDI is placed into and it
holds the medication that is released (with
activation of the MDI) until patient can breathe it
in.

The spacer can be cleaned by soaking in a

solution of mild detergent and water for 15
minutes. Shake out the excess water and allow to
air dry. Replace the device after 24 months of
continuous use.
Using MDI with Spacer
 Using MDI with Spacer
Shake the inhaler well before use (three or four shakes)
Remove the cap from your inhaler, and from your spacer,
if it has one
Put the inhaler into the spacer
Breathe out, away from the spacer
Bring the spacer to your mouth, put the mouthpiece
between your teeth and close your lips around it
Press the top of your inhaler once
Breathe in slowly until you've taken a full breath. If you
hear a whistle sound, you are breathing in too fast.
Slowly breathe in.
Hold your breath for about ten seconds, then breathe out
DPI - Turbuhaler
Using Turbuhaler
 Using Turbuhaler
Unscrew the cap and take it off. Hold the inhaler upright
Twist the coloured grip of your Turbuhaler as far as it will go, then
twist it all the way back. You've done it right when you hear a "click"
Breathe out away from the device
Put the mouthpiece between your teeth, and close your lips around
it. Breathe in forcefully and deeply through your mouth
Remove the Turbuhaler from your mouth before breathing out
Always check the number in the dose counter window under the
mouthpiece to see how many doses are left. For the Turbuhalers
that do not have a dose counter window, check the window for a red
mark, which means your medication is running out. When finished,
replace the cap
Do not use a spacer with the DISKUS, Turbuhaler or any
other dry powder inhaler
DPI - Diskus
Using Diskus
 Using Diskus
Open your DISKUS hold it in the palm of your hand, put the thumb
of your other hand on the thumb grip and push the thumb grip until it
clicks into place
Slide the lever away from you as far as it will go to get your
medication ready
Breathe out away from the device
Place the mouthpiece gently in your mouth and close your lips
around it
Breathe in deeply until you've taken a full breath
Remove the DISKUS from your mouth
Hold your breath for about ten seconds, then breathe out slowly
Always check the number in the dose counter window to see how
many doses are left.
Do not use a spacer with the DISKUS, Turbuhaler or any
other dry powder inhaler
Patient Education
on
Environmental
Control
 Exposure of asthma patients to irritants or
allergens to which they are sensitive has been
shown to increase asthma symptoms and
precipitate asthma exacerbations.

Patients with asthma at any level of severity

should avoid:
Exposure to allergens to which they are sensitive.
Exposure to environmental tobacco smoke
Exertion when levels of air pollution are high.
 Environmental Factors that may
Exacerbate Asthma
Inhalant allergens:
Animal allergens
House-dust mites
Cockroach allergens
Indoor fungi (molds)
Outdoor allergens
Occupational exposures
Irritants:
Tobacco smoke
Indoor/outdoor pollution and irritants
 Inhalant Allergens
Reduce or eliminate exposure to the allergen(s)
the patient is sensitive to, including:

Animal dander:
- Remove animal from house or
- at a minimum, keep animal out of patients
bedroom
 Inhalant Allergens
House-dust mites:

- Essential: Encase mattress in an allergen

impermeable cover; encase pillow in an allergen-
impermeable cover or wash it weekly; wash
sheets and blankets on the patients bed in hot
water weekly (water temperature of 130 F is
necessary for killing mites).

- Desirable: Reduce indoor humidity to less than

50 percent; remove carpets from the bedroom;
avoid sleeping or lying on upholstered furniture;
remove carpets that are laid on concrete.
 Inhalant Allergens
Cockroaches:
- Use poison bait or traps to control.
- Do not leave food or garbage exposed.

Pollens (from trees, grass, or weeds) and outdoor

molds:
To avoid exposures, adults should stay indoors with
windows closed during the season in which they have
problems with outdoor allergens, especially during the
afternoon.

Indoor mold:
Fix all leaks and eliminate water sources associated
with mold growth; clean moldy surfaces. Consider
reducing indoor humidity to less than 50 percent.
 Irritants
Tobacco Smoke:
Advise patients and others in the home who smoke to
stop smoking or to smoke outside the home.
Discuss ways to reduce exposure to other sources of
tobaccosmoke, such as from day care providers and
the workplace.

Indoor/Outdoor Pollutants and Irritants:

Discuss ways to reduce exposures to the following:
Wood-burning stoves or fireplaces
Unvented stoves or heaters
Other irritants (e.g., perfumes, cleaning agents,sprays)
 Devices That May Modify Indoor Air
Vacuuming carpets once or twice a week is essential to reduce
accumulation of house dust.

Humidifiers are not recommended for use in the homes of house-

dust mite-sensitive patients with asthma.

Air conditioning during warm weather is recommended for asthma

patients because it allows windows and doors to stay closed

Use of a dehumidifier will reduce house-dust mite levels in areas

where the humidity of the outside air remains high for most of the
year

Air-duct cleaning of heating/ventilation/air conditioning systems has

been reported to decrease levels of airborne fungi in residences
 Occupational Exposure
Work-aggravated asthma:
Work with onsite health care providers or
managers/supervisors.
Discuss avoidance, ventilation, respiratory protection,
tobacco smoke-free environment.

Occupationally induced asthma:

Recommend complete cessation of exposure to
initiating agent.