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Practice review

Checking inhaler technique

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Inhaler technique should be assessed regularly and devices are available to help with assessment

 

Author

Ram Gulrajani, BSc, Asthma Dip, COPD Dip, RSCN, RGN, is respiratory nurse consultant, West Essex PCT.

 

Abstract

Gulrajani, R. (2009) Checking inhaler technique. Nursing Times; 105: online publication.

Inhaler technique checks are an essential procedure in assessing patients with respiratory disease, but the process can be extremely subjective. This article describes the use of devices to check technique.

Keywords: Inhaler technique, Inspiratory flow rate, Respiratory care

 

 

The process of checking inhaler technique in treating asthma and COPD should be carried out during consultations with healthcare professionals.

Quality and Outcomes Framework (QOF) standards include checking patients’ inhaler technique during asthma or COPD reviews.

When selecting an aerosol delivery device for patients with asthma and COPD, the following should be considered:

  • Device/drug availability;
  • Clinical setting;
  • Patients’ age;
  •  Ability to use the device correctly (Dolovich et al, 2005).

 

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Problems with inhaler technique

The aim of checking patients’ technique is to ensure they maximise the availability of inhaled drugs in the lungs to control their condition and symptoms. Poor asthma control may result from selecting an inappropriate device or incorrect use of the right device (National Respiratory Training Centre, 1998). This is also applicable to patients with COPD.

Hesselink et al (2001) found that over 24% of patients made at least one essential mistake in their inhalation technique.

Dry powder inhaler devices (DPI) require less coordination than a pressurised metered dose inhaler and can improve the delivery of the drug to the lungs. However, patients who use a DPI need to be able to inhale adequately through the device.

Many people with poor inhaler technique are unaware of this problem. Older people and children in particular have problems coordinating breathing in and actuating (triggering) the inhaler. Other problems include:

  • Actuating (triggering) the device before breathing in (inspiration);
  • Actuating the device while breathing out (expiration);
  • Actuatingthe device after breathing in so no air is taken in to inhale the medication;
  • Breathing in through the nose instead of the mouth;
  • Taking more than one dose in a single inspiration.

Devices for checking technique

This process of checking inhaler technique is subjective and depends on healthcare practitioners’ own experience and training. It is essential that patients’ technique is checked as objectively as possible.

There are several aids that can be used to check and improve inhaler technique and increase the delivery of drugs to the lungs. Use of these devices should result in better control and minimise the amounts of medication used.

The development of the In-check Dial, manufactured by Clement Clarke International, is an invaluable tool used to check patients’ inspiratory flow rate when using breath-actuated pressurised metered dose inhalers (BApMDI) and dry powder inhalers (DPI).

The In-Check Dial is a hand held low range inspiratory flow measurement device with a dial top. The dial has been designed to accurately simulate the resistance of popular inhaler devices. These include Turbohalers, Accuhalers and Easi-Breathe.

This enabled clinicians to train patients to use the correct inspiratory flow rate to optimise deposition of the drug in the lungs.

Although useful, the In-Check Dial is not used with an inhaler. It allows patients to achieve an appropriate inspiratory flow rate but as the actual inhaler is not used it is not possible to check individual inhaler technique at the same time.

MAG-FLO device

This device measures patients’ ability to actuate their DPI inhaler device and their sustained inspiratory volume to enhance deposition of the inhaled drug in the lungs.

MAG-FLO has an optimum flow signal that patients can see while using their inhaler. They see a green light when the inhalation is within the optimum range – if it is too fast or too slow, the light goes out.  More importantly, it is a useful tool to help patients maintain their inspiratory flow rate once their device has been actuated. The device switches itself off after use.

The MAGFLO can be used with all dry powder devices including Turbohalers, Accuhalers, Handihalers and Novolizers.

In practice I have found it is ineffective when used with the Autohaler and a pressurised metered dose inhaler, but is effective when used to check inhaler technique with pMDI and a spacer device and with the Easi-Breathe system.

Conclusion

It is important that patients’ inhaler technique is measured and can be quantified, allowing for objectivity and a rationale for changing therapy. The MAG-FLO allows this to be achieved in a simple and easy way.

 

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