How To Use Inhaler

How to Use Inhalers
Workshop
Dr Riham Hazem Raafat

Lecturer of Chest Diseases
Module 1
Introduction
• Inhalation therapy refers to the delivery of a drug
to the body via the airways by delivering it in an
aerosol (spray) form.
Advantages of inhalation therapy:

• Direct delivery to the site of action.
• Small quantity of drug.
• Rapid onset of action.
• Minimal systemic absorption → decreases

systemic side effects.
Disadvantages of inhalation therapy:

• Time and effort consuming
History of Inhalers
Pharmacokinetics of Inhaled Drugs
So for Successful Drug Delivery:
• Particle Size of the Aerosol
(1) Physical factors
• Design of the Device
(2) Ventilatory factors
• Inspiratory Flow & Breath Hold
(3) Anatomic factors
• Airway Caliber & Disease Distortion
(4) Patient-related factors
• Correct Technique
SO TO SUMMERIZE:
Lung Deposition of Different Inhalers
Module 2
Types of Inhalers
1- Metered Dose Inhalers
(With or W/O Spacer)
2- Dry Powder Inhalers

(Single/ Multiple Dose)
3- Nebulizers
(Jet/Ultrasonic/Mesh)
Poor Technique
SO,
Since 2010
More lung
deposition
(No cold Freon effect)
(Gas at lower temp)
Tail Off Effect More consistent

(near empty) even near empty
Technique of MDIs:
Care and Maintenance: Priming and Wasting Doses:
N.B.
Factors Affecting Performance: Advantages & Disadvantages:
counter
• Disadvantages:
How to Know it’s Empty:
(OLD METHOD) If No Counter

Autohaler - Breath Actuated MDI Inhaler (BA – MDI)
- Consists of a pressurized canister of medication in a plastic case with a mouthpiece.
- Is breath activated. This means when you inhale, the Autohaler automatically
releases a mist of medication.

Aero-chamber
Adv/Disadv. of MDI with Spacer:
Technique of MDI with Spacer:
Care and Maintenance:
Advantages: Disadvantages:
AEROLIZER & BREEZHALER HANDIHALER
o Formoterol o Indacetrol
o Budesonide o Glycopyronium
o Indac/Glyco
Tiotropium Bromide
Spiriva (18ug)
Foradil (12ug) Onbrez (150-300 ug)

Miflonide Seebri (44ug)
(200-400mg) Ultibro (110/50 – 85/43)
Soft Mist Inhalers (SMI)
RESPIMAT
Some inhalers
require
forceful/strong and
deep inhalation
while others require
calm/slow and deep
inhalation
depending on the
internal inhaler
resistance
Technique of Diskus:
Technique of Turbohaler:
Technique of Aerolizer:
Technique of Handihaler:
Technique of Respimat (SMI):
NEBULIZERS (mist inhalation form)
using
compressed gas
Conventional Pneumatic (JET)

Advantages: Disadvantages:
• Useful in children , • Bronchospasm
• Handicapped persons ,
• Over hydration
• Seriously ill patients Ventilated patients
• Delivery of contaminated aerosols
• Elderly individuals
• Tubing condensation
• High doses can be given
• Combination drugs can be given • Swelling of retained secretions
• Enhancement of secretion clearance

• Sputum induction (physiotherapy)
• Humidification of respired gases
• Prevent dehydration
• Prevent or relieve bronchospasm
• Plenty of drugs can be used
Technique:
1. Measure correct amount of saline solution using a clean dropper. Put the saline into the nebulizer cup.
2. Measure correct amount of medicine using a clean dropper and add it to nebulizer cup containing the saline.
3. If you are using a premixed medicine, add the correct amount.
4. Attach mouthpiece to T-shaped part. Fasten this unit or mask to the cup.
5. Turn on air compressor. - If connected to ventilator: to inspiratory limb with airflow 6-8 L/min
6. Put mouthpiece in mouth, between teeth and seal lips tightly around it.
7. Take slow, deep breaths in through the mouth
8. If you are unable to take slow, deep breaths, breathe normally into mask.
9. Hold each breath for 1 -2 sec before breathing out or hold each breath for 1-5 sec every 3-5 inhalations.
10. Continue breathing this way until medicine is gone from the cup (about 5-15 minutes).
Technique of Nebulizer:
Crucial Errors Nebulizers
 Incorrect size for child
 Not fitting tightly on face/mouth/nose
 Not holding nebulizer upright
 Stopping too early, before dose done

Module 3
Drugs Used for Inhalation
Distilled Water / NS
Available Devices in Egypt
Decision Tree
•Efficacy and safety
•Availability (and affordability) of prescribed drug in certain device
•Patient’s ability to use the device correctly
•Patient preferences
•Preferably prescribe same type of device (with comparable instruction) in
individuals if using several inhaled drugs

Age Requirements for Use of Inhalers

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How to Use Inhalers

Dr Riham Hazem Raafat

Advantages of inhalation therapy:

• Small quantity of drug.

• Rapid onset of action.

• Minimal systemic absorption → decreases

Disadvantages of inhalation therapy:

2- Dry Powder Inhalers

(Gas at lower temp)

Tail Off Effect More consistent

(OLD METHOD) If No Counter

- Consists of a pressurized canister of medication in a plastic case with a mouthpiece.

releases a mist of medication.

Foradil (12ug) Onbrez (150-300 ug)

Conventional Pneumatic (JET)

• Enhancement of secretion clearance

3. If you are using a premixed medicine, add the correct amount.

7. Take slow, deep breaths in through the mouth

 Incorrect size for child

 Not fitting tightly on face/mouth/nose

 Not holding nebulizer upright

 Stopping too early, before dose done

•Availability (and affordability) of prescribed drug in certain device

•Patient’s ability to use the device correctly

•Preferably prescribe same type of device (with comparable instruction) in

individuals if using several inhaled drugs

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