Inhaled Therapies Devices
The choice of inhaler should consider the ability of the person to use correctly and will depend on age, coordination, dexterity and inspiratory flow. For optimal drug delivery when using inhalers, it is important the correct technique is used, (this also minimises side-effects). The technique needed varies depending on the device used (see below).
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Other than poor technique co-existing problems can lead to inhalers being used incorrectly e.g. around 75% of COPD patients have difficulty using metered dose inhalers. One solution for this is to use a spacer device which will improve drug deposition in the lungs as they required less coordination. Patients would need to be taught how to used these correctly along with cleaning monthly (not more frequently as this causes static to build up) and allowing to air dry. It has been recommended that spacers are used by everyone on high dose ICS and by most elderly people, however, they are useful for anyone with poor inhaler technique.
Nebulisers can be beneficial for those with distressing or disabling breathlessness even though they are on maximal drug treatment. They may also be useful for those on large doses of bronchodilators. They require no coordination as a mouthpiece is used (preferably over a mask). Nebulisers should only be continued if:
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Symptoms are reduced
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Increased exercise capacity
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Improved lung function
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Increased ability for undertaking activities of daily living
Metered Dose Inhaler (MDI):
Sometimes known as Evohalers, MDI’s have been used for over 40 years for various brands and types of medication. They are quick to use and small making them convenient to carry around. However, to use correctly good coordination is needed in order to press the canister down and breathe in at the same time. Errors that commonly occur when using these include not shaking it before use, inhaling too sharply and not holding their breath long enough after using.
Dry powder inhalers:
These inhalers require less coordination as they are activated by breathing in at the mouthpiece making them ideal for those who struggle with the MDI. However, to get the powder from the device into the lungs you have to breath in fairly hard, this can be difficult if the person is already struggling to breathe or is breathless. These include Accuhalers, Diskhalers, Easyhalers, Turbohalers and Clickhalers.
Accuhaler:
Diskhaler:
Turbohaler:
Easyhaler: