8.5 Inhaler Devices and Technique

Inhaler Devices

 

There are many types of inhaler devices, and each device has advantages and disadvantages.  Patients need an individualised assessment that considers factors such as the patient’s inspiratory flow rate and volume, dexterity, inhaler regimen complexity and environmental impact before an inhaler device is chosen and prescribed.  The following algorithm is taken from an Australian Prescriber article and can be used by prescribers to assist in choosing an inhaler device.  The article can be found here: p140-Rigby

This table provides additional considerations for choice of inhaler device type when prescribing inhaled medicines.  It’s good to know as you may need to suggest an inhaler device to a prescriber. Or, you may be prescribing inhaled medicines as an accredited pharmacist in the North Queensland Community Pharmacy Full Scope of Practice Pilot!

Clinical Situation

Consideration

Acute Asthma

Recommend use of spacer when using reliever pMDI for acute asthma

Any patient using a pMDI for an inhaled corticosteroid

Recommend use of a spacer every time (except for breath-acuated pMDIs)

Infants and small children

Use a spacer with a facemask

Poor manual dexterity (e.g. weak hands or arthritis)

Consider either of:

> a Haleraid device with relevant pMDIs (available for salbutamol, fluticasone, fluticasone/salmeterol)

> a breath-actuated inhaler

Difficulty connecting spacer to pMDI (e.g. elderly patient with weakness or poor coordination)

Leave spacer connected: pharmacist can attach spacer to inhaler each time canister is replaced, and leave attached until medicine is used up. (If patient uses more than one pMDI, provide a separate spacer for each device

Consider a breath-actuated inhaler.

Inability to form a good seal around the mouthpiece of the inhaler or spacer (e.g. person with cognitive impairment or facial weakness)

Consider a spacer plus age-appropriate facemask

Difficulty speaking or reading English

Give a physical demonstration

Use videos

Use an interpreter or provide written instructions in the person’s first language

Using multiple inhalers

Choose the same type for each medicine, if possible, to avoid confusion

If not possible, train person in the correct inhaler technique for each of their devices, emphasizing any key differences (e.g. speed of inhalation, shake pMDIs but not dry-powder inhalers)

Inhaler Technique 

Up to 90% of Australians do not use correct inhaler technique.  Poor inhaler technique results in poor control and flare-ups.  Repeated hands-on training in correct inhaler use should be emphasised at every interaction with patients.  If patients require multiple inhaled drugs, combination inhalers should be prescribed to reduce errors in inhaler technique and improve adherence. 

 

Use this link to access a library of videos published by the National Asthma Council which demonstrate correct inhaler technique: https://www.nationalasthma.org.au/living-with-asthma/how-to-videos

We will review the use of these in devices in the GLS so you can become familiar with them, but you will need to practice, practice, practice at every opportunity on the use of:

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