Asthma and Respiratory B2 agonist (Adrenergic Bronchodilators) medication

Figure 1. How to use a metered dose inhaler (MDI)

ILLUSTRATION BY JAVIER TRIGO

1: Cap should be removed and inhaler shaken to ensure consistent delivery of dose. Device should be primed if patient is using for the first time, or if not used for a while.
2: Patient should breathe out fully.
3: Patient should breathe in slowly and steadily and press down on the inhaler device.
4: On inhalation, the patient should hold their breath for a count of ten.
5: Patient should slowly breathe out, repeat dose (if applicable), and replace mouthpiece cover. Clean device if necessary after use.

Common errors in technique made by patients:

• Not shaking the aerosol inhaler before use
• Not priming the aerosol inhaler before first use
• Failing to detect an empty inhaler before use
• Failing to breathe out fully before inhaling
• Incorrect coordination of MDI and pMDI actuation with inspiration
• Incorrect inspiration flow rate (breathing in too fast or too slow)
• Failing to hold breath after inhalation

For solutions to these common errors, please see table 2.

Figure 2. How to use a metered dose inhaler (MDI) with spacer

ILLUSTRATION BY JAVIER TRIGO

1: Cap should be removed and the patient should check to see if the mouthpiece is clean. Inhaler should be shaken to ensure consistent delivery of dose. Device should be primed if patient is using for the first time, or if not used for a while.
2: The inhaler mouthpiece should be inserted into the end of the spacer device.
3: Patient should breathe in, and then breathe out fully.
4: The inhaler and spacer device should be held between the index finger and thumb. The spacer mouthpiece should be placed in the mouth, above the tongue. The patient should close their lips around the spacer device.
5: The patient should tilt their head back slightly toward the ceiling. The top of the inhaler device should be pressed to release a single dose of medicine. The patient should slowly breathe in all of the air and hold breath for ten seconds.
6: Patient should open mouth, remove spacer device and breathe out slowly. Patients could also use the tidal breathing technique, where they breathe slowly and steadily in and out four to five times.

Common errors in technique made by patients:

• Not shaking the aerosol inhaler before use
• Not priming the aerosol inhaler before first use
• Failing to detect an empty inhaler before use
• Failing to breathe out fully before inhaling
• Delay in inhaling drug through a holding spacer device
• Incorrect inspiration flow rate (breathing in too fast or too slow)
• Failing to hold breath after inhalation
• Poor maintenance of inhaler or spacer device

For solutions to these common errors, please see table 2.

Figure 3: How to use an Accuhaler

ILLUSTRATION BY JAVIER TRIGO

1: Holding the device horizontal or upright, the patient should open the inhaler by moving sliding lever in the correct direction.
2: Patient should breathe out fully but not into the Accuhaler.
3: Patient should place the inhaler device in the mouth, with the lips forming a tight seal over the mouthpiece, before breathing in quickly and deeply through the inhaler device.
4: On inhalation, the patient should hold their breath for a count of ten.
5: Patient should slowly breathe out.
6: Inhaler should be closed correctly by moving sliding lever in the correct direction. The inhaler should be cleaned as necessary.

Common errors in technique made by patients:

• Failing to breathe out fully before inhaling
• Incorrect positioning/holding of device
• Not breathing in quickly and deeply at the start of inhalation
• Failing to hold breath after inhalation
• Poor maintenance of inhaler

For solutions to these common errors, please see table 2.

Figure 4: How to use a turbohaler

SOURCE: ILLUSTRATIONS BY JAVIER TRIGO

1: The patient should unscrew the cap (turning anticlockwise) and remove. Holding the inhaler upright, the dose can be loaded by turning the coloured base to the right, as far as it will go.
2: Then twist it back to the left until it clicks. It is now loaded.
3: The patient should breathe out gently, away from the device. Holding the device without covering the air inlets, the tip of the mouthpiece should be placed between the lips and a good seal made.
4: The patient should breathe in quickly and deeply and hold their breath for 5–10 seconds. Remove the device before breathing out fully. Clean the device as necessary, replace the cap and screw it shut.

Common errors in technique made by patients:

• Incorrect positioning/holding of the device
• Incorrect inspiration flow rate (breathing in too fast or too slow)
• Poor maintenance of inhaler

For solutions to these common errors, please see table 2