1. Inhalation Techniques Patient Education on Environmental Control
Basma Y. Kentab

2. Inhalation Techniques

3. The following are all real examples !!

4. A man was asked to demonstrate his inhaler technique.
He pointed the inhaler at his chest
and sprayed………

5. He was asked to demonstrate his technique. He asked for a tablespoon.
An elderly man complained that his inhaler was not relieving his wheeziness.
He was asked to demonstrate his technique.
He asked for a tablespoon.
He shook his inhaler, sprayed two
doses onto the spoon then licked it off!

6. A patient had been using excessive Salbutamol inhaler quantities
When asked to demonstrate his technique,
He stood up, sprayed the inhaler around the room, just like an air freshener, and sat down again

7. Nebulizer
A nebulizer uses forced air to turn asthma medication into a fine mist so that it can easily be breathed into the lungs.
For some people—and with some medications—nebulizers are the most effective way of delivering inhaled medications.

8. Facemask
Medication cup
Compressed air machine
Plastic tubing

16. Inhalers
Inhalers are hand-held portable devices that deliver medication directly to the lungs.

17. Types of Inhalers Metered Dose Inhalers (MDI)
These inhalers use a chemical propellant to force a measured dose of medication out of the inhaler.
It may be easier to use a MDI with a spacer (a short tube that attaches to the inhaler )
Dry Powder Inhalers (DPI)
No chemical propellant. Medication released by breathing in more quickly with a traditional MDI
easier to use than the conventional pressurized MDI because hand-lung coordination isn't required
Spacers shouldn't be used with dry powder inhalers.

19. Medications Delivered through Inhalers
Short-acting bronchodilators : Provide immediate relief of asthma symptoms. E.g. albuterol (Ventolin).
Long-acting bronchodilators : Relieve asthma symptoms for longer periods of time. E.g. salmeterol (Serevent) and formoterol (Foradil).
Corticosteroids : Used long term to prevent asthma attacks. E.g. budesonide (Pulmicort), triamcinolone acetonide (Azmacort)
Cromolyn or nedocromil : nonsteroidal medications are used long term to prevent inflammation.
Corticosteroid plus long-acting bronchodilator : This medication combines a corticosteroid and a long-acting bronchodilator (Symbicort).

20. MDI

21. Using MDI without Spacer

22. Using MDI without Spacer
Shake the inhaler well before use (three or four shakes)
Remove the cap
Breathe out, away from your inhaler
Bring the inhaler to your mouth. Place it in your mouth between your teeth and close your mouth around it.
Start to breathe in slowly. Press the top of your inhaler once and keep breathing in slowly until you've taken a full breath
Remove the inhaler from your mouth, and hold your breath for about ten seconds, then breathe out
If you need a second puff, wait 30 seconds, shake your inhaler again, and repeat steps 3-6.
Always write down the number of puffs you've taken so that you can anticipate when you need to refill your prescription.
Store all MDI’s at room temperature.

23. MDI with Spacer

24. Using MDI with Spacer
A spacer is a tube that MDI is placed into and it holds the medication that is released (with activation of the MDI) until patient can breathe it in.
The spacer can be cleaned by soaking in a solution of mild detergent and water for 15 minutes. Shake out the excess water and allow to air dry. Replace the device after 24 months of continuous use.
Many people do not use their inhaler correctly, or can not coordinate the MDI use, and the medication may collect in the mouth and/or throat.

25. Using MDI with Spacer

26. Using MDI with Spacer
Shake the inhaler well before use (three or four shakes)
Remove the cap from your inhaler, and from your spacer, if it has one
Put the inhaler into the spacer
Breathe out, away from the spacer
Bring the spacer to your mouth, put the mouthpiece between your teeth and close your lips around it
Press the top of your inhaler once
Breathe in slowly until you've taken a full breath.  If you hear a whistle sound, you are breathing in too fast. Slowly breathe in.
Hold your breath for about ten seconds, then breathe out

27. DPI - Turbuhaler

28. Using Turbuhaler

29. Using Turbuhaler
Unscrew the cap and take it off. Hold the inhaler upright
Twist the coloured grip of your Turbuhaler as far as it will go, then twist it all the way back. You've done it right when you hear a "click"
Breathe out away from the device
Put the mouthpiece between your teeth, and close your lips around it. Breathe in forcefully and deeply through your mouth
Remove the Turbuhaler from your mouth before breathing out
Always check the number in the dose counter window under the mouthpiece to see how many doses are left. For the Turbuhalers® that do not have a dose counter window, check the window for a red mark, which means your medication is running out. When finished, replace the cap
Do not use a spacer with the DISKUS®, Turbuhaler® or any other dry powder inhaler

30. DPI - Diskus

31. Using Diskus

32. Using Diskus
Open your DISKUS® hold it in the palm of your hand, put the thumb of your other hand on the thumb grip and push the thumb grip until it clicks into place
Slide the lever away from you as far as it will go to get your medication ready
Breathe out away from the device
Place the mouthpiece gently in your mouth and close your lips around it
Breathe in deeply until you've taken a full breath
Remove the DISKUS® from your mouth
Hold your breath for about ten seconds, then breathe out slowly
Always check the number in the dose counter window to see how many doses are left.
Do not use a spacer with the DISKUS®, Turbuhaler® or any other dry powder inhaler

33. Patient Education on Environmental Control

34. Patients with asthma at any level of severity should avoid:
Exposure of asthma patients to irritants or allergens to which they are sensitive has been shown to increase asthma symptoms and precipitate asthma exacerbations.
Patients with asthma at any level of severity should avoid:
Exposure to allergens to which they are sensitive.
Exposure to environmental tobacco smoke
Exertion when levels of air pollution are high.

35. Environmental Factors that may Exacerbate Asthma
Inhalant allergens:
Animal allergens
House-dust mites
Cockroach allergens
Indoor fungi (molds)
Outdoor allergens
Occupational exposures
Irritants:
Tobacco smoke
Indoor/outdoor pollution and irritants

36. Inhalant Allergens
Reduce or eliminate exposure to the allergen(s) the patient is sensitive to, including:
Animal dander:
- Remove animal from house or
- at a minimum, keep animal out of patient’s bedroom

37. Inhalant Allergens House-dust mites:
- Essential: Encase mattress in an allergen impermeable cover; encase pillow in an allergen- impermeable cover or wash it weekly; wash sheets and blankets on the patient’s bed in hot water weekly (water temperature of ≥130 °F is necessary for killing mites).
- Desirable: Reduce indoor humidity to less than 50 percent; remove carpets from the bedroom; avoid sleeping or lying on upholstered furniture; remove carpets that are laid on concrete.

38. Inhalant Allergens Cockroaches:
- Use poison bait or traps to control.
- Do not leave food or garbage exposed.
Pollens (from trees, grass, or weeds) and outdoor molds:
To avoid exposures, adults should stay indoors with windows closed during the season in which they have problems with outdoor allergens, especially during the afternoon.
Indoor mold:
Fix all leaks and eliminate water sources associated with mold growth; clean moldy surfaces. Consider reducing indoor humidity to less than 50 percent.

39. Irritants Tobacco Smoke: Indoor/Outdoor Pollutants and Irritants:
Advise patients and others in the home who smoke to stop smoking or to smoke outside the home.
Discuss ways to reduce exposure to other sources of tobaccosmoke, such as from day care providers and the workplace.
Indoor/Outdoor Pollutants and Irritants:
Discuss ways to reduce exposures to the following:
Wood-burning stoves or fireplaces
Unvented stoves or heaters
Other irritants (e.g., perfumes, cleaning agents,sprays)

40. Devices That May Modify Indoor Air
Vacuuming carpets once or twice a week is essential to reduce accumulation of house dust.
Humidifiers are not recommended for use in the homes of house-dust mite-sensitive patients with asthma.
Air conditioning during warm weather is recommended for asthma patients because it allows windows and doors to stay closed
Use of a dehumidifier will reduce house-dust mite levels in areas where the humidity of the outside air remains high for most of the year
Air-duct cleaning of heating/ventilation/air conditioning systems has been reported to decrease levels of airborne fungi in residences

41. Occupational Exposure
Work-aggravated asthma:
Work with onsite health care providers or managers/supervisors.
Discuss avoidance, ventilation, respiratory protection, tobacco smoke-free environment.
Occupationally induced asthma:
Recommend complete cessation of exposure to initiating agent.