How a spacer works
- Shake the canister
- Take the cap off – check there is nothing inside; the opening is clear
- The patient does a normal expiration (not a full expiration)
- Put the nozzle in your mouth, and at the same time as breathing in, press down on the top
- Do a full inhalation
- Hold your breath for 10 seconds
- Even with a very good technique, only 15% of the drug reaches the lungs – the other 85% is deposited on the wall of the pharynx and ultimately swallowed
- Lots of others!
With a spacer
- Need to be replaced every couple of months
- Need to be washed every day in soapy warm water, and only let them dry by evaporation (drip drying) – do not wipe it dry! – this causes build up of static electricity
- They reduce the velocity of the drug particles, and thus reduce the number of particles being deposited on the mouth and pharynx
- To use the spacer – put one end in your mouth, and activate the drug. Then take 5 normal sized breaths very gently in and out. Do this twice – one for each ‘puff’ of the drug.
Washing the mouth
- Often no dose counter
- Requires co-ordination of breathing and pressing – can be difficult for the very young and very old, or those with arthritis, or other problems with the hands
- When experiencing SOB / other symtoms
- Before an event that you know often causes symptoms – e.g. exercise in execise induced asthma
Breath Actuated Inhaler
- Shake the device
- Remove the cap
- Prime the device – pull the red lever up so that it clicks
- Whilst sat upright, take a normal breath out.
- Inhale slowly and deeply – don’t be put off by the click. Keep breathing in to a full inspiration, and then hold your breath for 10 seconds
- Push the red lever back down. Replace the cap
- Remember the tell the patient they wont feel the spraying sensation at the back of the throat and that this is normal. They may still be able to taste the drug though.
- Patient may not remember to ‘prime’ it before each use
- Can be difficult for some people to prime; it is possible to press up the red lever using the edge of a table.
- It makes a loud clicking noise when you inhale, which can be offputting
- Shake it
- Hold it upright, and open the cap, to prime the device
- Sit upright, do a normal breath out
- Seal lips tightly around mouthpiece. Be careful not to block the holes on top with your fingers.
- Inhale slowly and deeply. Do not stop breathing in when you hear the inhaler puff. At the end of the breath, hold your breath for 10 seconds
- Close the cap, with the inhaler upright
- Repeat if you require another dose
- Patients can forget that the cap needs to be closed between doses.
- Patient has a tendency to put their finger over the top of the device (like with an MDI), and here at the top there are vents to allow air in – so you mustn’t cover them!
- Some patients like to take the top off and use it like an MDI – tell them not to do this!
- Seretide (salmeterol and fluticasone)
- Has a bit of a complicated method of priming
Quick drug summary
MDI, inhalation solution (nebulizer)
MDI, DPI inhalation solution, tablet
Brethine, Bricanyl, Brethaire
- Can breathe slightly harder – but still need to take a full long breath!This is necessary to separate the particles out, and allows for better absorption
- Take a very gentle long deep breath in – the particles are dispersed by the device itself, you don’t want to breathe in too hard, as you will end up with them all sticking to the back of your throat!