Improving Chronic Inhaler Adherence in Adolescent Populations
Improving Pharmacist Inhaler Devices and …...2019/12/06 · Improving Pharmacist Inhaler Devices...
Transcript of Improving Pharmacist Inhaler Devices and …...2019/12/06 · Improving Pharmacist Inhaler Devices...
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An initiative of
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Improving Pharmacist
Inhaler Devices
Technique and Patient
Counseling
Sarah Y. Hur, Pharm.D.
Kaiser Permanente
Ambulatory Care Services
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Disclosures
The speaker has no actual or potential conflicts of
interest in relation to this program
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Learning Objectives
At the end of this session, the participant will be able to:
Demonstrate understanding of inhaler devices and their proper use and care
Compare and contrast the various inhaler devices by reviewing features of each devices that are relevant for optimal delivery and patient response
Identify poor inhaler technique and how to coach patients to improve their use of respiratory delivery devices
Describe specific examples of communication strategies to use with patients on inhaler technique and improve adherence to therapy
Describe the role of the pharmacists in helping patients with asthma or COPD achieve optimal results
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How well do you know your
inhalation devices?
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Remembering Information A reported 40% to 80% of medical information
that patients receive is forgotten immediately(1)
Up to 50% of the information retained is recalled
incorrectly(2)
Only about 46-59% subjects able to demonstrate
proper ICS inhaler technique(3)
Systemic review reported that 4%-94% of patients
did not use DPI inhalers correctly (4)
Kessels RP. J R Soc Med. 2003;96:219-22.
Anderson JL et al. Rheumatology. 1979;18:18-22.
Cochrane MG et al. Chest 2000;117: 542-50
Lavorini F et al. Respir Med. 2008; 102: 593-604.
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Patient Counseling for
Inhalation Devices
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Why use Inhalation Devices?
Targeted delivery
Lower doses can be used
Less risk for systemic side effects and
adverse reactions
Faster onset of action in many cases
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Types of Inhalation DevicesA. pMDI – Pressurized Metered Dose Inhalers
Medication delivered in an aerosol
Can be used with spacer
B. Soft Mist Inhalers
Respimat – Uses interval spring to generate
aerosol and doesn’t require propellant or
inspiratory flow rate
C. DPI – Dry Powder Inhalers
Multiple dose: Diskus, Turbuhaler, Flexhaler,
Twisthaler, Pressair
Capsules devices: Handihaler, Aerolizer
D. Jet or ultrasonic Nebulizers
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Breathing In: FAST or SLOW?
MDI or soft spray inhalers –Breathe in SLOWLY
DPI – Breathe in FAST
If breathing in too slow,
medication may end up in the
mouth, not in the lungs
If breathing in too fast,
medication may end up in the
throat, not in the lungs
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Question 1A rapid and forceful inhalation effort is optimal
when using a:
a. Metered Dose Inhaler
b. Metered Dose Inhaler with spacer
c. Dry Powder Inhaler
d. Jet nebulizer device
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Most Common Mistakes
Failure to exhale
Failure to correctly hold device
Unable to coordinate pressing and breathing
Failure to generate adequate inspiratory flow
rate (too fast or too slow)
Failure to hold breath
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Pressurized Metered Dose Inhaler
(pMDI)
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Pressurized Metered Dose Inhaler
(pMDI)
Poor inhalation technique associated with marked decrease in lung
deposition
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pMDI: Priming
1. Prime the MDI (spraying 2-4 puffs into the air before
use) as instructed on package insert
pMDI Prime
Atrovent HFA 2 puffs if new or not used for 3 days
Advair HFA 4 puffs if new, 2 puffs if not used for <4wks or dropped
Flovent HFA 4 puffs if new, 1 puff if not used for >7days
Proair HFA 3 puffs if new or not used for 2wks
Proventil HFA 4 puffs if new or not used for 2wks
QVAR HFA 2 puffs if new or if not used for >10 days
Symbicort HFA 2 puffs if new or not used for 7 days or dropped
Ventolin HFA 4 puffs if new or not used for 14 days, 1 puff if dropped after washing
Xopenex HFA 4 puffs if new or not used for 3 days
Dulera HFA 4 puffs if new or not used for 5 days, do not remove the canister from
the actuator
Alvesco 3 puffs if new or not used for 10 days
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pMDI: Preparation2. Remove the cap from the MDI and shake well for 5
seconds
3. Breathe out all the way
4. Keep your chin up
5. Use one of the 3 techniques
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pMDI: Inhalation6. As you start to breathe in slowly, press down on the
canister one time
7. Keep breathing in slowly to completely fill your
lungs. (It should take about 5 -7 seconds to
completely breathe in)
8. Hold your breath for 10 seconds (count to 10
slowly) to allow the medication to reach the airways
of the lung
9. Repeat the above steps for each puff ordered by
your doctor. Wait about 1 minute between puffs
10.Replace the cap on the MDI when finished
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pMDI: Counseling Tips
Inhale SLOWLY and steadily
A few devices have dose counter but not all.
Count each doses or use dose counter to keep
track of remaining doses
Do not float the canister in water
Recommend to use with spacer
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pMDI: Cleaning
Remove the metal canister by pulling it out. Never wash the metal
canister or put it in water
Wash the actuator through the top with warm running water for 30
seconds. Then wash the actuator again through the mouthpiece
May use mild soap and water
Shake off water then let the plastic parts dry in the air
Clean regularly (weekly is best). Buildup may actually affect
delivery
Exception: Alvesco, Dulera, Symbicort, Advair – do not remove
canister. Clean opening and mouthpiece with dry swab or tissue
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Question 2Which counseling point is incorrect for MDIs:
A. When inhaling dose, patient should breathe in
slowly and steadily
C. Clean regularly since buildup may actually affect
delivery
B. When inhaling dose, patient should inhale dose
quickly and forcefully
D. All must be primed before first use, approximately
2-4 times depending on product
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Spacers Spacers and holding chambers provides reservoir
for medication in aerosol and reduces
oropharyngeal deposition
Valved holding chambers help with actuation and
inhalation coordination
Can reduce ADR with ICS
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pMDI with Spacer1. Remove the cap from the MDI and Spacer
2. Insert the MDI into the open end of the spacer (opposite the
mouthpiece)
3. Shake well for 5 seconds
4. Breathe out all the way
5. Place the mouthpiece of the chamber between your teeth
and seal your lips tightly around it
6. Spray 1 puff into the spacer by pressing down the inhaler
7. Breathe in SLOWLY through your mouth to completely fill
your lungs. You’re breathing too quickly if you hear a "horn-
like" sound
8. Hold breath for 10 seconds (count to 10 slowly)
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Spacer (w/ or w/o Facemask) Spacer (without Facemask)
Inhale up to 5 seconds
1 actuation into chamber for each inhalation
Spacer (with Facemask)
5 inhalations per actuation
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Spacer: Cleaning Remove back piece (colored rubber ring)
Mix soap with lukewarm water. Place spacer/VHC
in the soapy water for 15 minutes (this helps to
cover up static charge). Agitate slowly
Rinse with running water & air dry (standing
vertically)
Most are dishwasher safe: place in top rack ONLY,
avoid in heat >158*F. Do not boil or sterilize
Wash prior to first use and then weekly. Replace
after 12months of use
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Soft Mist Inhalers:
Respimat
Spiriva Respimat Combivent Respimat Striverdi Respimat
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Soft Mist Inhalers:
Respimat
Uses spring mechanism to release the medication, does not contain
propellants
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Respimat: Preparation (1st Use)
1. Press safety catch while pulling off clear base
2. Write discard by date on back label (Discard 3 months after cartridge is inserted)
3. Push narrow end of cartridge into inhaler (Use hard surface to push cartridge completely in, when correctly inserted 1/8” of the cartridge will remain visible)
4. Replace the clear base, do not remove clear base or cartridge after assembled
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Respimat: Priming (1st use)1. Hold top of inhaler and TWIST clear base 180* in
the direction of the white arrows (on back label)
until “click” (Ensure orange cap is closed to avoid
accidental release of dose)
2. Flip open orange cap
3. Press dose release button
4. Close orange cap
5. Repeat above steps until spray is visible
Prime 3 puffs if new or if not used for >21 days
Prime 1 puff if not used for >3 days
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1. Turn the base, open the cap
2. Close your lips around the mouthpiece
3. Press the dose-release button
4. Inhale
Respimat: Inhalation
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Respimat: Inhalation1. Hold top of inhaler and twist clear base 180* in the
direction of the white arrows (on back label) until “click” (Ensure orange cap is closed to avoid accidental release of dose)
2. Flip open orange cap
3. Exhale completely, out of mouth
4. Seal lips around mouthpiece without covering air vents, hold inhaler horizontally
5. As you begin to inhale SLOWLY, press the dose release button to release a puff
6. Continue to inhale SLOWLY and fully
7. Hold breath for 10 seconds or as long as possible
8. Exhale SLOWLY
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Respimat: Counseling Tips
1. No need to shake the inhaler before use
2. No need to use spacer
3. Do not remove the cartridge once it has been
inserted into the inhaler
4. When closed, the cap helps prevent you from
accidentally pressing the button. The protective
lid also helps keep the mouthpiece clean
5. If Respimat hasn’t been used for >3 days, release
1 puff toward the ground to prepare for use. If
hasn’t been used for >21 days, release 3 puffs to
prepare for use
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Dose indicator shows approximately how much medicine is left
When it reaches the RED zone, there’s enough medicine for 7 days (30 dose product) or 3 days (14 dose product)
• Discard 3 months from the date the cartridge is
inserted
• Automatic Lock: The inhaler locks when there’s
no more medicine left
Respimat: When to Replace
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Respimat: Cleaning & Storing
Clean the mouthpiece, including the metal
part inside the mouthpiece, with a damp
cloth or tissue only, at least once a week
If the outside of the inhaler gets dirty, wipe
it with a damp cloth
Store at room temperature, do not freeze
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Diskus (DPI)
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Diskus (DPI): Preparation
1. No need to prime
2. Hold the diskus horizontally like a
hamburger
3. Slide open the diskus until “click”
to expose mouthpiece and lever
4. Slide lever until “click”. This
action loads the dose of
medication. You will see the dose
counter decrease by one. Do not
shake.
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Diskus: Inhalation5. Exhale away from the diskus
6. Place the diskus mouthpiece in your mouth
and breathe in rapid, strong and steady, and
fill your lungs completely. If too slow, med
ends up in mouth. If too fast, med ends up
in throat
7. Hold your breath for up to 10 seconds
4. Remove the diskus from your mouth and
exhale slowly
5. Close the diskus
6. Rinse mouth with water “Swish and Spit” if
using ICS
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Diskus: Inhalation
1. Open
2. Click
3. Exhale
4. Inhale
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Diskus: Counseling Tips Breath-activated. Inhale rapidly
Cannot be used in children under 6 years, elderly, unconscious patient, in presence of severe airflow obstruction (undergoing mechanical ventilation)
No need to prime or use spacer
You may not taste, smell, or feel the dry powder
If using ICS, rinse mouth and gargle after use. Do not swallow rinsed water.
Cleaning: If residue powder in the diskus, open and tap to remove powder
Storing: Protect from moisture. Store in a dry place at room temperature
Dispose 30 days after opening pouch or when 60 blisters used, whichever comes first
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Flexhaler
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Flexhaler: Priming (1st Use)
The only DPI that requires priming
1. Hold the Flexhaler upright (brown grip at bottom).
2. Twist and remove the cover
3. Holding it in the middle, twist the brown grip on
the bottom in one direction until it stops and then
fully back again. You will hear a click. It does not
matter which direction you twist first
4. Repeat a second time
5. No need to prime again even if you do not use it
for a long period of time
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Flexhaler: Inhalation
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Flexhaler: Inhalation1. Twist the cover and lift it off
2. Twist the brown grip fully in one direction as far as it
will go and then fully back again. You will hear a click.
The Flexhaler is now loaded with a dose
3. Turn your head away from the inhaler and breathe out
4. Place the device in your mouth and breathe in FAST
and forcefully
5. Hold your breath for 10 seconds
6. Take the Flexhaler away from your mouth and exhale
slowly
7. Replace the white cover and twist it completely to close
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Flexhaler: Counseling Tips Do not use for sudden, severe symptoms of
asthma
The only DPI that requires priming at FIRST
use
No need to use spacer
You may not taste, smell, or feel the dry
powder or there may be a slight sweet taste
Store in a dry place at room temperature.
Never place the DPI in water or increased
humidity. Never shake or breathe into the
DPI
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Flexhaler: When to Replace
• Dose indicator shows how many doses are left
in the inhaler
• Look at the middle of the window
• Dose indicator usually moves each time you
use about 5 doses
• Inhaler is empty when the number “0” on the
red background reaches the middle of the
dose indicator window
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Twisthaler (DPI)
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Twisthaler: Preparation1. While holding the
Twisthaler upright, twist
the white cap counter
clockwise
2. As you twist and lift off the
cap, the dose counter will
decrease by one and the
dose will be loaded. The
medicine is now ready to
be inhaled
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Twisthaler: Inhalation1. Exhale completely away from Twisthaler
2. Hold horizontally and place the
mouthpiece between your teeth sealing
your lips tightly around the mouthpiece
3. Breathe in rapidly and deeply
4. Hold breath for 10 seconds
5. Replace the cap and twist clockwise.
Make sure it CLICKS to completely close
it. (This must be done to properly load
the next dose)
6. Rinse your mouth and gargle (do not
swallow)
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Twisthaler: Counseling Tips DO NOT LOSE THE CAP. Dose counter automatically
counts down the dose when the cap is removed. This
action also loads the dose of medication
No need to prime or use spacer
Never shake or breathe into the DPI
You may not taste, smell, or feel the dry powder or
there may be a slight sweet taste
Do not use for sudden, severe symptoms of asthma
or if you have allergy to milk proteins
Store in a dry place at room temperature. Never
place the DPI in water or increased humidity
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Twisthaler: When to Replace The Twisthaler will need to be thrown out
45 days after removal from foil pouch or
when the dose counter reads "00”
When the counter reads "00" there is no
medicine left in the Twisthaler
Cap will lock automatically after the last
dose
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Ellipta
Arnuity Ellipta
Fluticasone (ICS)
Anoro Ellipta
Umeclidinium (Ich)
+
Vilanterol (LABA)
Incruse Ellipta
Umeclidinium
(Ich)
Breo Ellipta
Fluticasone (ICS)
+
Vilanterol (LABA)
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Ellipta: Preparation1. Wait to open the cover until you are ready to take
your dose
2. Before the inhaler is used for the first time, the
counter should show the number 30. This is the
number of doses in the inhaler
3. Open the cover of the
inhaler. Slide the cover
down to expose the
mouthpiece. You should
hear a CLICK
4. The counter will count
down by 1 number
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Ellipta: Inhalation1. Exhale away from the inhaler
2. Put the mouthpiece between your lips and close your lips firmly around it. Your lips should fit over the curved shape of the mouthpiece
3. Take one long, steady, deep breath in through your mouth. Do not breathe in through your nose
4. Do not block the air vent with your fingers
5. Remove the inhaler from your mouth and hold your breath as long as comfortable for you (3-4 secs)
6. Breathe out slowly and gently
7. Close the inhaler by sliding the cover up
8. Rinse mouth if ICS (Arnuity or Breo)
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Ellipta: Counseling Tips
If you open and close the cover
without inhaling the medicine,
you will lose the dose
Do not block the air vent with
your fingers
Clean the mouthpiece if needed using a dry tissue
before closing the cover
You may not taste of feel the medicine, even when
you are using the inhaler correctly
Do not take another dose from the inhaler even if you
do not feel or taste the medicine
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Ellipta: When to Replace When you have less than 10
doses remaining in your
inhaler, the left half of the
counter shows RED as a
reminder to get a refill
After you have inhaled the
last dose, the counter will
show “0” and will be empty
Discard 6 weeks after the
date you opened the tray
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Pressair
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Pressair: Preparation (1st Use)
1. Remove the protective cap
2. Hold the green button facing straight up, do not tilt
3. Before you put the inhaler into your mouth, press
the green button all the way down. Then release
the green button. Do not continue to hold the
green button down
4. Stop and check the control window to make sure
the dose is ready for inhalation
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Stop and check the Control
Window to make sure your dose if
ready for inhalation
Look to see if the colored control
window has changed from RED to
GREEN
If the control window stays red,
repeat the Press and Release
actions until the control window is
green
Pressair: Priming (1st Use)
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Pressair: Inhalation1. Breathe out completely away from the
inhaler
2. Put your lips tightly around the mouthpiece of the Pressair inhaler
3. Breathe in QUICKLY and deeply through your mouth
4. Breathe in until you hear a “click” sound. Keep breathing in, even after you have heard the inhaler “click” to be sure you get the full dose
5. Do not hold down the green button while you’re breathing in
6. Hold breath for as long as is comfortable then breathe out slowly
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Pressair: Inhalation7. Check the control window to see if
it has turned to RED (from green).
If the window is red, you have
inhaled your full dose of medicine
correctly. If still green, repeat
breathing in or check to make sure
green button released properly
8. Dose indicator counts down in
intervals of 10: 60, 50, 40, 30, 20,
10, 0
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Pressair: Counseling Tips Do not hold the green button down while you’re
inhaling
When you press and release the green button, the
colored control window will change from RED to
GREEN. Once you inhale, the colored control
window changes from GREEN to RED
No need to clean Pressair other than wipe the
outside of the mouthpiece with a dry tissue or
paper towel
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Pressair: When to Replace RED band will begin to appear within the dose indicator
when you’re nearing your last dose
The marking “0” with the red background shows in the middle of the dose indicator
The device locks out
45 days have passed since the inhaler was taken out of the sealed pouch
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DPI – Capsule Devices Handihaler, Aerolizer, Neohaler
Do not remove a capsule from the blister card until
you are ready for a dose
Throw away any capsule that is not used right away
after it’s taken out of the blister package
Do not swallow capsules. The contents of the
capsule should only be inhaled through the
appropriate device (Aerolizer, Handihaler, Neohaler)
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Handihaler (DPI - Capsule)
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Handihaler – Inhalation1. Open the HandiHaler device. Separate only one of the
blisters from the blister card; then open the blister
2. Insert the SPIRIVA capsule and close the mouthpiece firmly against the gray base until you hear a click
3. Press the green piercing button once until it is flat (flush) against the base, then release
4. Breathe out completely
5. Then, with the HandiHaler in your mouth, breathe in deeply until your lungs are full. You should hear or feel the SPIRIVA capsule vibrate (rattle)
6. Remember, to take your full daily dose, you must inhale twice from the same SPIRIVA capsule
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Neohaler (DPI - Capsule)
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Neohaler: Preparation1. Pull off cap
2. Tilt the mouthpiece to open inhaler
3. Remove a capsule from the blister. Only remove immediately before use
4. Insert capsule into the capsule chamber
5. Close the inhaler. You should hear a CLICK as it fully closes
6. Hold the inhaler upright. Pierce the capsule by pressing both buttons fully one time. You should hear a CLICK as the capsule is being pierced. Do not pierce more than once. Release the buttons fully
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Neohaler: Inhalation1. Breathe out fully away from the mouthpiece
2. Place the mouthpiece in your mouth and close your lips around the mouthpiece. Hold the inhaler with the buttons to the left and right
3. Inhale FAST and steadily, as deeply as you can
4. As you breathe in through the inhaler, the capsule spins around in the chamber and you should hear a WHIRRING noise
5. If you do not hear a whirring nose, capsule may be stuck so open the inhaler and carefully loosen the capsule by tapping. Do not pierce buttons to loosen the capsule
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Neohaler: Inhalation6. Continue to hold breath as long as comfortably
possible while removing the inhaler from your
mouth. Then breathe out
7. Open the inhaler to see if any powder is left in the
capsule. If there is powder left in the capsule,
close the inhaler and repeat process
8. Remove the empty capsule by tipping it out and
discarding it
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Asthma Medication Overview
Short Acting “Rescue” Long Acting “Control”
Used only as needed Used daily, regularly
Short Acting B2 Agonists
(SABA)
Inhaled Corticosteroids
(ICS)
Anticholinergics ICS + LABA Combination
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COPD Medication Overview
COPD Medications
Short Acting B2 Agonists (SABA)
Long Acting B2 Agonists (LABA)
Anticholinergics (Ich)
Combination:
Albuterol + Ipratropium: SABA + Ich
Umeclidinium + Vilnaterol:
Fluticasone + Vilanterol
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Short Acting B2 Agonist (SABA)
Generic Brand
Albuterol Proventil HFA
Ventolin HFA
Proair HFA
Proair RespiClick
Levalbuterol Xopenex HFA
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SABA SABA is a quick-relief (rescue) inhaler. It will
work within minutes to help breathing easier
It relaxes muscles around your airways to
prevent or treat shortness of breath
If more than 1 puff needs to be inhaled,
separate puffs by 1 minute (vs. no wait for
ICS)
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Anticholinergic
Generic Brand
Ipratropium Atrovent HFA
Tiotropium Spiriva Handihaler
Spiriva Respimat
Aclidinium Tudorza Pressair
Umeclidinium Incruse Ellipta
Glycopyrrolate Seebri Neohaler
Glycopyrrolate Lonhala Magnair
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Anticholinergic Do not let the powder from the capsule get into your
eyes. Your vision may get blurry and the pupil in your eye may get larger (dilate). If this happens, call your doctor
If you have vision changes or eye pain or if you have difficulty passing urine or painful urination, stop taking the medication and call your doctor right away
Inform your doctor if you have glaucoma, problems passing urine or an enlarged prostate as those may worsen with an anticholinergic medication. Tell your doctor if you have kidney problems or are allergic to milk proteins
Most common side effect is dry mouth. Others include constipation and trouble passing urine
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Inhaled Corticosteroid (ICS)
Generic Brand
Beclomethasone QVAR HFA
QVAR Redihaler
Budesonide Pulmicort Flexhaler
Pulmicort Respules
Ciclesonide Alvesco HFA
Flunisolide Aerospan HFA
Fluticasone Flovent HFA
Arnuity Ellipta
ArmonAir RespiClick
Mometasone Asmanex Twisthaler
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ICS Should be used regularly and at the same time each
day, as prescribed by your provider. Regular use decreases airway swelling and opens small airways. Not used to treat acute symptoms
Patient may not get the most benefit for 1-2 wks or longer after using ICS
No need to wait between ICS puffs
Separate different types of inhalers (for eg. SABA vsICS) by 5-10 minutes. Use bronchodilator first, then maintenance inhalers
Rinse with water “swish and spit” after use to decrease oral thrush. If using face mask, rinse face with water
Safe for use, even in children. Corticosteroids do not produce the same effect as anabolic steroids
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Question 3What do you advise an asthmatic patient taking
albuterol and beclomethasone?
A. Take albuterol first then immediately take
beclomethasone
B. Take albuterol every day routinely
C. Take albuterol then wait 1 minute to take
beclomethasone
D. Take beclomethasone first then take albuterol
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Question 4When a patient is using QVAR MDI 1 puff BID and
Xopenex 2 puffs q3-4h PRN for wheezing?
A. Wait 1 minute between the QVAR and Xopenex HFA
B. Use QVAR first then Xopenex HFA
C. Wait 15 minutes between Xopenex HFA puffs
D. Rinse mouth with water after using QVAR
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Question 5Which of the following consultation information is
correct for a patient who starts using fluticasone
(Flovent) inhaler?
A. This medication will need to be shaken prior to
administration
B. This medication should be taken as needed for
asthma symptoms
C. This medication will quickly alleviate symptoms
of asthma
D. This medication may cause diarrhea during the
first week of therapy
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Long Acting B2 Agonist (LABA)
Generic Brand
Formoterol Perforomist
Nebulizer
Indacaterol Arcapta Neohaler
Salmeterol Serevent Diskus
Arformoterol Brovana Nebulizer
Olodaterol Striverdi Respimat
Contraindicated for use as monotherapy in asthma
SMART trial
Showed increase in asthma-related deaths
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LABA Do not use for relief of acute symptoms.
Concomitant SABA can be used as needed for
acute relief
All LABA are contraindicated in patients with
asthma without use of a long-term asthma
control medication. Monotherapy is not
indicated for the treatment of asthma
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Combination (ICS + LABA)Generic Brand
Budesonide + formoterol Symbicort
Mometasone + formoterol Dulera
Fluticasone + salmeterol Advair HFA/Diskus
Fluticasone + vilanterol Breo Ellipta
Combination (Anticholinergic + LABA)
Generic Brand
Umeclidinium + vilanterol Anoro Ellipta
Glycopyrrolate + Formoterol Bevespi Aerosphere
Combination (LABA + LAMA)Generic Brand
Indacaterol + glycopyrrolate Utibron Neohaler
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Importance of Patient Education
about Inhalation Devices
Manufacturers’ instructions are not adequate
Verbal instruction improves technique
Group or individual instruction is effective
Devoted time is important; and reinforcement is
necessary
Training aids for specific devices are useful
Lavorini F et al. Prim Care Respir J. 2010; 19:335-41
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The Role of the Pharmacist Provide Education
Device training – medication type and technique
Avoidance of triggers and exacerbators: Tobacco
smoke, dust mites, pets, etc
Vaccines:
Anual flu vaccine for all asthmatic patients
Pneumococcal vaccine x1 at 19-64yo and revaccinate at
65yo or older with at least 5 years between doses
Monitor medication
Importance of adherence, especially for asthma
Overuse and underuse
Device training via “teach back therapy”
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Teach-Back Explain
Demonstrate
Discuss
Summarize key points
Quiz key points
Request patient to repeat
Observe
Congratulate!
Clarify and emphasize
Reinforce and assess periodically
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Examples of Teach-Back “I want to be sure that I explained this correctly.
Can you tell me how you will use this inhaler?”
“We discussed a lot of details about your lung
condition today. Let’s review a few important
points. What are three things for you to do at home
to control your asthma?”
“How will you use your inhaler when you wake up in
the morning?”
“Please show me how you will use your inhaler.”
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Question 6Describe the role of the pharmacists in helping
patients with asthma or COPD achieve optimal
results?
A. Provide device training
B. Monitor medication overuse and underuse
C. Provide education on medication type and
technique
D. All of the above
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Question 7The “teach-back” method of patient instruction
involves:
A. Summarizing the key points of instruction at the end of the session
B. Providing a quiz to the patient about the
key points
C. Asking the patient to repeat the
instructions in his or her own words
D. All of the above
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Summary Inhalation therapies are central in the
management of common lung diseases
Good inhalation technique is essential for optimal benefit from pharmacotherapy
All patients should receive education and training regarding use of prescribed inhalation devices
Individual delivery devices have specific instructions regarding use
Patients should undergo periodic assessments regarding use of prescribed inhalation devices
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ResourcesThese are excellent resources to review and use when developing
plans for educating and advising patients about the use of
inhalation devices
MDI: http://www.youtube.com/watch?v=Rdb3p9RZoR4
Spacer: http://www.youtube.com/watch?v=a54MAjo_xXQ
Respimat: http://www.youtube.com/watch?v=U1NV10RuV6Y
Diskus: https://youtu.be/_Sc7j9iW9TM
Flexhaler: https://youtu.be/kD4CdrT-l84
Twisthaler: https://youtu.be/E9OAWEjPmZo
Ellipta: https://youtu.be/l-ac6lRu7kE?t=10s
Pressair: https://youtu.be/NJlbN_kJ7gM?t=10s
Handihaler: https://youtu.be/KYS3-Kp672Y
Aerolizer: https://youtu.be/VvKi7OEKQYk
Neohaler: https://youtu.be/D3DeShJhdyQ?t=5s
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Please Do Not Take the Devices!Contact list to obtain demo devices
Manufacturer
Demo Devices Contact
Astra Zeneca Flexhaler, Pressair http://www.astrazeneca-
us.com/contact-us-hcp-
request-for-pharmaceutical-
samples
Boehringer
Ingelheim
Handihaler,
Respimat
1-800-243-0127
GSK Ellipta, Diskus 1-888-825-5249
Merck Aerolizer, Twisthaler 1-908-740-4000
Novartis Neohaler 1-888-669-6682
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Questions?
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An initiative of