OSCE inhaler technique PDF

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Summary

OSCE inhaler technique...

Description

OSCE – Inhaler station Introduction  Introduce yourself  State you have washed hands  Confirm patient’s details  Check patient’s understanding of their inhaler – ask what they know about it Explanation  Explain what the inhaler device is, what drug it contains, what is used for  Explain when the inhaler should be used – state whether it is a preventer or reliever Demonstration  Demonstrate how to use the inhaler depending on type  If it is an ICS tell them to rinse mouth after using the inhaler  Common side effects they may encounter Closure  Ask patient if they have any questions or concerns and advise them to get in touch if they have any questions  Thank the patient  Wash hands

SABA

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LABA

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LAMA

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Reliever Salbutamol, fenoterol, terbutaline sulphate It works by relaxing the airways to facilitate breathing Inhale 2 puffs when feeling wheezy or short of breath If patient needs their SABA more than twice a week or more than once a week, they need to be reviewed by GP/practice You should contact your doctor immediately if your breathing gets worse after inhaling this medicine Side effects include muscle tremors, palpitations and headaches but they are more likely to occur if you overuse the medicine Try to always keep this inhaler with you and ensure you have a spare one at home so that you never run out of inhalers Try to keep within the max dose stated on the label Preventer Salmeterol, formoterol It works by relaxing muscles around your airways so that you can breathe more easily Prevents development of asthma and COPD symptoms when taken regularly and it should be taken everyday You won’t see an immediate effect as it is a preventer inhaler, regular use will lead to better control of asthma/COPD Generally, taken twice daily and often given in a combined inhaler with an inhaled corticosteroid Preventer

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ICS

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No immediate effect, regular use will lead to better control Tiotropium Inhale contents of ONE capsule ONCE daily at the same time everyday Do not use more than once daily Use one blister of capsules at a time, if you have used one capsule from a blister continue to use it before opening another Side effects may include dry mouth, taste disturbances, headache, cough or constipation Advice patient on how to clean their inhaler and explain this should be done once a month Contact GP immediately if breathing is worsening Preventer Should be taken regularly, usually twice daily State the importance of using correct inhaler technique Smoking may reduce the effectiveness of inhaled corticosteroids Ask patient if they smoke If they smoke encourage them to stop Patients with high doses ICS’s should carry a steroid card Use large-volume spacer with pMDIs if high doses are needed Tell patient to rinse mouth with water after use as this will reduce risks of oral candidiasis and systemic absorption Common side effects may include sore mouth, oral candidiasis and hoarseness

Different types of inhalers and their techniques Pressurised metred dose inhaler 1. Remove cap over the mouthpiece 2. Shake inhaler before use 3. Breathe out as far as you can 4. Bring inhaler to your mouth and close lips around the mouthpiece 5. Start to breathe in slowly and at the same time press down once on the canister 6. Continue to breathe in slowly for as long as you can and then remove inhaler, close your mouth and hold breath for at least 10 seconds 7. Breathe out slowly and gently 8. Replace cap over the mouthpiece or if you need another dose, wait a minute, shake the inhaler and repeat from step 3 9. Only use the inhaler for the total number of doses on the label, then start a new inhaler

Breath-actuated MDI (2 types)

Easi-breathe 1. Stand or sit upright when using inhaler 2. Shake inhaler before use. Hold inhaler upright and fold down the cap that covers the mouthpiece 3. Breathe out fully 4. Place the mouthpiece between your teeth without biting and form a seal around with your lips 5. Breathe in steadily through your mouth slowly and deeply 6. Continue to breathe in when you feel the puff of medication in your mouth 7. Carry on breathing in until you have taken a deep breath 8. Hold your breath for at least 10 seconds and remove inhaler from mouth 9. Breathe out gently 10. Close cap immediately after use 11. If you require another dose, wait for one minute and repeat procedure

Autohaler 1. Stand or sit upright when using inhaler 2. Remove the cover by pulling down the lip at the back and shake inhaler 3. Hold the inhaler upright and push the lever up 4. Breathe out fully 5. Place mouthpiece between teeth without biting and close lips around it 6. Breathe in slowly and deeply through your mouth 7. Continue to breathe in when you hear the click and feel the puff of medication in your mouth 8. Remove inhaler from mouth and hold breath for 10 seconds or as long as comfortable 9. Breathe out gently 10. Lower the lever after each puff 11. If you need another dose wait for at least a minute and repeat procedure 12. Replace mouthpiece cover after use Dry powder Accuhaler 1. Check the dose counter 2. Open the cover by using your thumb grip 3. To load dose, keep the device horizontal while sliding the lever until you hear a click 4. Breathe out gently away from inhaler 5. Place mouthpiece in mouth (without biting) and close lips to form a seal. Keep inhaler horizontal 6. Breathe in steadily and deeply 7. Hold breath for about 5 seconds or as long as comfortable 8. Remove inhaler from mouth while holding breath 9. Breathe out gently away from inhaler 10. Close cover until you hear a click

Turbohaler 1. Unscrew and lift off the cover

2. Hold the turbohaler upright and twist the coloured grip as far as it will go. Then twist it all the way back until you hear a click. 3. Breathe out as far as you can 4. Bring inhaler to your mouth and close lips around mouthpiece 5. Breathe in as deeply as possible (there may be no taste) 6. Remove the turbohaler from your mouth, close your mouth and hold breath for at least 10 seconds 7. Breathe out slowly and gently 8. Replace cover, if another dose is required wait for one minute and repeat procedure You may not taste or feel any medication when taking your dose. If the turbohaler contains a corticosteroid, rinse your mouth with water after your dose. Handihaler 1. To release the dust cap, press the piercing bottom completely in and let go 2. Open dust cap by pulling it outwards and then open mouthpiece by pulling it upwards 3. Remove capsule from the blister just before use and place it in the centre chamber 4. Close the mouthpiece until you hear a click leaving the dust cap open 5. Hold the device with the mouthpiece upwards and press piercing button completely in once and release 6. Breathe out fully (do not breathe into the mouthpiece at any time) 7. Bring inhaler to your mouth and close lips around the mouthpiece 8. Keep your head upright and breathe in slowly and deeply until you hear or feel the capsule vibrate 9. Breathe in fully and hold breath as long as comfortable while removing inhaler from mouth. Breathe out normally 10. To empty the capsule fully repeat from step 6 11. Open the mouthpiece, tip out the used capsule to dispose it and close the mouthpiece and dust cap before storing it 12. Clean the handihaler once a month To clean the inhaler, open the mouthpiece and the cap. Open the base by lifting piercing button and rinse the inhaler with warm water. Dry the device thoroughly by tipping excess water out and air-dry it afterwards by leaving the mouthpiece, cap and base open. It will take 24 hrs to dry so advice patient to clean it immediately after they’ve used it to prepare it for the next dose. If required, the outside of the mouthpiece may be cleaned with a moist (not wet) tissue....