Remote Primary Health Care Manuals

Inhalation devices for respiratory medicines

Well lit area.
Wear gloves.

Only common delivery devices are included here — see supporting resources for other devices and for videos and guides demonstrating the use of devices

Attention

  • Help person become familiar with their own medicine
  • Always check package insert for specific instructions about person's device
  • Make sure your clinic has emergency supply of extra inhalation devices for people living and travelling in remote and rural communities
  • If person’s condition doesn't improve with normal medicine — follow asthma or COPD action plan
    • If they don't have plan — talk with health team about developing one

Puffer (metered dose inhaler/MDI)

  • Aerosol inhaler that gives medicine straight to airways as fine mist — Figure 6.28. Many different medicines in aerosol form

Figure 6.28  

Puffer.

Attention

  • Best if used with a spacer
  • Tell person — when device empty
    • Throw away in sealed bag or container
    • Do not throw on fire. Pressurised — could explode
  • To clean — take metal canister out. Wash plastic holder/mouthpiece in warm soapy water, rinse, air dry. Put canister back

What you do

Using without a spacer

  • Take cap off mouthpiece, shake inhaler for 10 seconds
  • Check dose counter if it has one
  • Breathe out completely, tilt head back slightly
  • Put mouthpiece between teeth without biting, close lips to form good seal
  • Put finger on top of canister, press once firmly and at the same time take a slow deep breath all the way in
  • Hold breath for 5 seconds or as long as comfortable, hold breath while taking mouthpiece out of mouth
  • Breathe out slowly away from mouthpiece
    • If another dose (puff) needed — wait 1 minute then repeat
  • Put mouthpiece cap back on, store inhaler in cool place

Using with a spacer

Turbuhaler

Figure 6.29  

Turbuhaler

Attention

  • Do not shake
  • Do not get Turbuhaler wet — to clean use dry clean cloth to wipe device and mouthpiece 
  • Do not blow into Turbuhaler. Breathe out away from mouthpiece

What you do

  • Remove cover, check dose counter
  • Hold Turbuhaler upright while priming — twist grip right around and then back until click heard
  • Breathe out away from mouthpiece
  • Put mouthpiece between teeth without biting, close lips to feel good seal
  • Breathe in strongly and deeply
  • Breathe out gently away from mouthpiece, replace cover

Nebuliser

  • Used in clinic with oxygen for severe and life threatening asthma — Figure 6.30

Figure 6.30  

Nebuliser and face mask.

Attention

  • Nebulisers carry a high risk of transmitting infection because they generate aerosol droplets and should only be used if absolutely necessary. Wear full PPE
  • Bronchodilators (relievers) work as well with puffer and spacer as with nebuliser. Only use nebuliser for severe cases
    • 12 puffs salbutamol = 5mg salbutamol

What you do

  • Check strength of medicine in nebule to be used with nebuliser — most come in more than one strength
  • Different nebuliser solutions can be mixed in bowl (eg salbutamol with ipratropium)
  • Dilute with normal saline if needed

HandiHaler

  • Used to deliver tiotropium powder from capsule — Figure 6.31

Figure 6.31  

Handihaler.

Attention

  • Do not swallow capsules. Breathe in contents using HandiHaler — Figure 6.31
  • Do not breathe into device
  • To clean — wipe daily with clean dry cloth. Wash whole device as needed, allow to air dry

What you do

  • Open cap, open mouthpiece, put fresh capsule in chamber
  • Close mouthpiece until it clicks, to pierce capsule
  • Press green piercing button in once only and release (do not shake)
  • Breathe out gently away from mouthpiece
  • Put mouthpiece between teeth without biting and close lips to form good seal
    • Breathe in slowly and deeply, so capsule vibrates
    • Keep breathing in as long as comfortable
    • Hold your breath while taking mouthpiece out of your mouth
    • Breathe out gently away from mouthpiece
  • Put mouthpiece back into mouth and repeat 
  • Open mouthpiece, remove used capsule, close mouthpiece and cap

Accuhaler

Figure 6.32  

Accuhaler.

Attention

  • Hold accuhaler horizontally when loading and taking dose, or medicine may be dislodged
  • Do not shake
  • Do not breathe into device or leave cover open — moisture will get in
  • Do not get wet — to clean use dry clean cloth to wipe device and mouthpiece

What you do

  • Check dose counter
  • Open using thumb grip
  • Holding horizontally, load dose by sliding lever until it clicks
  • Breathe out gently away from mouthpiece
  • Put mouthpiece in mouth and seal lips, breathe in steadily and deeply
    • Hold breath for about 5 seconds or as long as comfortable
    • While holding breath, remove inhaler from mouth
    • Breathe out gently away from mouthpiece
  • Close cover to click shut

Ellipta

Figure 6.33  

Ellipta.jpg

Attention

  • Every time you slide cover down a dose is loaded
    • Dose is lost if you open and close cover without inhaling the medicine
  • Do not shake
  • Do not breathe out into device
  • Dispose of device 6 weeks after opening
  • Do not get wet — to clean use dry clean cloth to wipe device and mouthpiece

What you do

  • Check dose counter
  • Slide cover down to see the mouthpiece. Should hear a click
  • Breathe out gently — away from inhaler
  • Close your lips firmly around mouthpiece so lips fit over curved shape of mouthpiece
    • Don't block air vents with your fingers
  • Take 1 long, steady, deep breath in through mouth
    • Remove inhaler from your mouth and hold your breath for 5 seconds or as long as comfortable
    • Breathe out slowly and gently away from mouthpiece
  • Slide cover up over the mouthpiece
  • If another dose (puff) needed — wait 30 seconds then repeat
  • After use — rinse mouth thoroughly with water then spit out

Supporting resources