Asthma INHALER DEVISES.

There is no evidence to dictate an order in which devices should be tested for those patients who cannot use pMDI.

In the absence of evidence, the most important points to consider are patient preference and local cost.

The choice of device may be determined by the choice of drug.
ƒ If the patient is unable to use a device satisfactorily an alternative should be found.
ƒ The patient should have their ability to use an inhaler device assessed by a competent healthcare professional .
ƒ The medication needs to be titrated against clinical response to ensure optimum efficacy.

ƒ Reassess inhaler technique as part of structured clinical review .

In children aged 0-5 years,

pMDI and spacer are the preferred method of delivery of ?2 agonists or inhaled steroids.

A face mask is required until the child can breathe reproducibly using the spacer mouthpiece. Where this is ineffective a nebuliser may be required.

USE AND CARE OF SPACERS FOR ALL AGES.
ƒ
The spacer should be compatible with the pMDI being used.

ƒ The drug should be administered by repeated single actuations of the metered dose inhaler into the spacer, each followed by inhalation.
ƒ There should be minimal delay between pMDI actuation and inhalation.
ƒ Tidal breathing is as effective as single breaths.

ƒ Spacers should be cleaned monthly rather than weekly as per manufacturer’s recommendations or performance is adversely affected.
They should be washed in detergent and allowed to dry in air.
The mouthpiece should be wiped clean of detergent before use.

ƒ Drug delivery may vary significantly due to static charge. Metal and other antistatic spacers are not affected in this way.
ƒ Plastic spacers should be replaced at least every 12 months but some may need changing at six months.

Dr G Mohan- UK-LECTURE SERIES TO SPECIALIST RESPIRATORY NURSES.