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Respiratory devices
Dr Ahmed Sayeed, MD,MRCP(UK)
Case scenario
 30 year School teacher was diagnosed to have asthma since
the age of 15 years.
 She is currently on
Sere...
INHALER TECHNIQUE
Objectives of the workshop
 To know different types of inhalers
 To know the uses of inhalers
 To learn techniques of i...
The quality of inhaler
teaching provided to
patients as self-
assessed by physicians
before (grey bars) and
after (black b...
Evaluation of Inhaler Techniques Among Asthma
Patients Seen in Nigeria
Study to assess inhaler technique in Saudi
hospitalized patients with asthma & COPD
Saudi Medical Journal, smj.2016.
INTRODUCTION
INHALER DEVICES ARE THE MAJOR METHOD FOR
DELIVERY OF ASTHMA MEDICATION
 EFFECTIVENESS CAN BE COMPROMISED IF...
Drugs used in inhaler devices
Inhaled beta agonist and anticholinergic bronchodilators for chronic obstructive
lung diseas...
Drugs used in inhaler devices
Inhaled glucocorticoids for
 Asthma,
 Eosinophilic bronchitis,
 COPD
Drugs used in inhaler devices
 Airway secretion modifying agents for cystic fibrosis- acetylcysteine, DNase
 Inhaled pul...
TYPES OF INHALER DEVICES
 The pressurized metered dose
inhaler (MDI),
 The dry powder inhaler (DPI),
 The soft mist inh...
Metered dose inhalers
Dry powder inhalers
 Breath-actuated devices that deliver
micronized drug particles
 Drug is delivered to the airways by...
Soft mist inhalers
 Release the medication in a soft mist,
 Respimat SMI have a mean aerodynamic
diameter ≤5.8 µm
 The ...
SPACERS AND HOLDING CHAMBERS
 Allows the velocity of particles to
decrease before reaching the mouth.
 Use of a valved h...
COMMON PROBLEMS WITH INHALER
DEVICES
 Upper airway deposition
 Actuation-inhalation
coordination
 Insufficient breath-h...
TEACHING INHALER USE SKILLS
 The clinician should first demonstrate the steps on
the checklist.
 The patient then practi...
MDI TECHNIQUE
MDI inhalers must be cleaned
 Do not wash the canister or immerse it in water.
 Clean the top and bottom of the plastic ...
MDI WITH SPACER
DPI technique
DPIs come in two main types
 https://youtu.be/bXHHFmZ_DRI
 https://youtu.be/Kr02is6jVUk
SINGLE DOSE DPI
MULTI DOSE DPI
Turbohaler
 https://www.youtube.com/watch?v=r-
wUuf1mODg&index=2&list=FLheMeQDqGiXQW-SshP3Fyhg&t=0s
Soft mist inhaler technique
 SMIs release the medication in a soft mist, which lasts in the air
about six times longer th...
SOFT MIST INHALER
Use of Respimat® Soft Mist™ Inhaler in COPD
patients
Int J Chron Obstruct Pulmon Dis. 2006
Common errors while using inhaler devices
Determining when an inhaler device is
empty
 Some MDIs are have integrated dose counters.
 Electronic dose counters such...
Patients with tracheostomy
Two systems for delivery of nebulized medication.
 Either a mask can be placed over the trache...
Mechanically ventilated patients
 Humidification of inhaled gas decreases aerosol
deposition by approximately 40 %.
 Inc...
INFORMATION FOR PATIENTS
Two types of patient education
"The Basics"
 "Beyond the Basics."
Other devices
Incentive spirometry involves
deep breathing facilitated by a
simple mechanical device to
provide visual fe...
The peak flow meters
 The peak expiratory flow is the
maximal rate that a person can
exhale during a short maximal
expira...
Cough assist device
Patients with an ineffective cough due to
 muscular dystrophy,
 myasthenia gravis,
 poliomyelitis,
...
Take home messages
 Common problems with inhaler usage are
deposition of medication in the oropharynx, poor
coordination....
References
 Up-to-date 2018
 YouTube for inhaler technique videos
Respiratory  devices 4 december 2018(21 nov)
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how can we improve the technique of inhaler devices?
what is the impact of conducting a workshop and educating health care professionals

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Respiratory devices 4 december 2018(21 nov)

  1. 1. Respiratory devices Dr Ahmed Sayeed, MD,MRCP(UK)
  2. 2. Case scenario  30 year School teacher was diagnosed to have asthma since the age of 15 years.  She is currently on Seretide 2 puffs twice a day Salbutamol MDI 2 puffs PRN  Her symptoms are still not controlled  https://youtu.be/zG2DVoRP86g
  3. 3. INHALER TECHNIQUE
  4. 4. Objectives of the workshop  To know different types of inhalers  To know the uses of inhalers  To learn techniques of inhaler use  To know briefly about other devices
  5. 5. The quality of inhaler teaching provided to patients as self- assessed by physicians before (grey bars) and after (black bars) the inhaler education.
  6. 6. Evaluation of Inhaler Techniques Among Asthma Patients Seen in Nigeria
  7. 7. Study to assess inhaler technique in Saudi hospitalized patients with asthma & COPD Saudi Medical Journal, smj.2016.
  8. 8. INTRODUCTION INHALER DEVICES ARE THE MAJOR METHOD FOR DELIVERY OF ASTHMA MEDICATION  EFFECTIVENESS CAN BE COMPROMISED IF THE PATIENT USES THE INHALER DEVICE INCORRECTLY
  9. 9. Drugs used in inhaler devices Inhaled beta agonist and anticholinergic bronchodilators for chronic obstructive lung diseases.  Asthma,  COPD,  Bronchiectasis,  Bronchiolitis.
  10. 10. Drugs used in inhaler devices Inhaled glucocorticoids for  Asthma,  Eosinophilic bronchitis,  COPD
  11. 11. Drugs used in inhaler devices  Airway secretion modifying agents for cystic fibrosis- acetylcysteine, DNase  Inhaled pulmonary vasodilators for pulmonary hypertension- ileoprost  Aerosol delivery of drugs (eg, opiates) may be used to treat some nonrespiratory diseases.
  12. 12. TYPES OF INHALER DEVICES  The pressurized metered dose inhaler (MDI),  The dry powder inhaler (DPI),  The soft mist inhaler (SMI)
  13. 13. Metered dose inhalers
  14. 14. Dry powder inhalers  Breath-actuated devices that deliver micronized drug particles  Drug is delivered to the airways by the inhalation of air over a punctured capsule, blister, or reservoir  https://youtu.be/bXHHFmZ_DRI
  15. 15. Soft mist inhalers  Release the medication in a soft mist,  Respimat SMI have a mean aerodynamic diameter ≤5.8 µm  The lower velocity of the aerosol decreases oropharyngeal deposition.
  16. 16. SPACERS AND HOLDING CHAMBERS  Allows the velocity of particles to decrease before reaching the mouth.  Use of a valved holding chamber also allows sequential actuation and inhalation.
  17. 17. COMMON PROBLEMS WITH INHALER DEVICES  Upper airway deposition  Actuation-inhalation coordination  Insufficient breath-hold
  18. 18. TEACHING INHALER USE SKILLS  The clinician should first demonstrate the steps on the checklist.  The patient then practices in front of the clinician so that errors may be corrected.  The patient's technique should be evaluated periodically & corrections made as necessary.  Patients should be positively reinforced for correct inhaler technique.
  19. 19. MDI TECHNIQUE
  20. 20. MDI inhalers must be cleaned  Do not wash the canister or immerse it in water.  Clean the top and bottom of the plastic mouthpiece by running warm tap water through them for 30 to 60 seconds.  Shake off excess water and allow the mouthpiece to dry completely.  Replace the canister in the mouthpiece when dry.  Release one puff from the inhaler into the air away from the patient’s face.
  21. 21. MDI WITH SPACER
  22. 22. DPI technique DPIs come in two main types  https://youtu.be/bXHHFmZ_DRI  https://youtu.be/Kr02is6jVUk
  23. 23. SINGLE DOSE DPI
  24. 24. MULTI DOSE DPI
  25. 25. Turbohaler  https://www.youtube.com/watch?v=r- wUuf1mODg&index=2&list=FLheMeQDqGiXQW-SshP3Fyhg&t=0s
  26. 26. Soft mist inhaler technique  SMIs release the medication in a soft mist, which lasts in the air about six times longer than the aerosol from an MDI.  Respimat SMI have a mean aerodynamic diameter ≤5.8 µm.  Particles less than 1 µm tend to be exhaled, rather than impacting on the airway.  https://youtu.be/NfI1ogOyWLE
  27. 27. SOFT MIST INHALER
  28. 28. Use of Respimat® Soft Mist™ Inhaler in COPD patients Int J Chron Obstruct Pulmon Dis. 2006
  29. 29. Common errors while using inhaler devices
  30. 30. Determining when an inhaler device is empty  Some MDIs are have integrated dose counters.  Electronic dose counters such as the 3M Integrated Dose by Dose Counter.  Maintain a log of the number of actuations.  DPI devices have counters that display the number of puffs remaining.
  31. 31. Patients with tracheostomy Two systems for delivery of nebulized medication.  Either a mask can be placed over the tracheostomy opening.  The nebulizer chamber can be attached to the tracheostomy tube using a T-piece made of ventilator tubing and a connector.
  32. 32. Mechanically ventilated patients  Humidification of inhaled gas decreases aerosol deposition by approximately 40 %.  Increased dosage of medication is often required.  Inhaled medications can be delivered using either an MDI or a nebulizer.  MDI may deliver a more consistent dose than a nebulizer.
  33. 33. INFORMATION FOR PATIENTS Two types of patient education "The Basics"  "Beyond the Basics."
  34. 34. Other devices Incentive spirometry involves deep breathing facilitated by a simple mechanical device to provide visual feedback  https://www.youtube.com/wat ch?v=uqwCZdXdDrI&list=FL heMeQDqGiXQW- SshP3Fyhg&index=2
  35. 35. The peak flow meters  The peak expiratory flow is the maximal rate that a person can exhale during a short maximal expiratory effort after a full inspiration.  https://www.youtube.com/w atch?v=055fSYXgNKU&ind ex=4&list=FLheMeQDqGiX QW-SshP3Fyhg
  36. 36. Cough assist device Patients with an ineffective cough due to  muscular dystrophy,  myasthenia gravis,  poliomyelitis,  https://www.youtube.com/watch?v=oUMy b9h2-2w
  37. 37. Take home messages  Common problems with inhaler usage are deposition of medication in the oropharynx, poor coordination.  Use of a spacer device reduces oropharyngeal deposition and improves coordination.  MDI can be used in mechanically ventilated patients.
  38. 38. References  Up-to-date 2018  YouTube for inhaler technique videos
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    May. 3, 2019
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    Apr. 29, 2019

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