Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1....
Transcript of Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1....
![Page 1: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/1.jpg)
Jon BellJon BellDirector,Director, CandayCanday Medical Ltd.Medical Ltd.
©© Canday Medical Ltd.Canday Medical Ltd. 20112011
Inhaler TechniqueInhaler Technique
![Page 2: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/2.jpg)
Belgian Chocolate, French Champagne andBelgian Chocolate, French Champagne andInhaled Medication:Inhaled Medication:
Too Good To Waste ?Too Good To Waste ?
Jon BellJon BellDirector,Director, CandayCanday Medical Ltd.Medical Ltd.
![Page 3: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/3.jpg)
DisclosureDisclosure
Jon Bell:
Director of a commercialorganisation that investigatesinhaler devices and their use.
(Canday Medical Ltd.)
Jon Bell / Canday Medical Ltd. do notreceive any remuneration or commission
based on the use of productsmanufactured by other companies.
Jon Bell and Canday MedicalLtd. have received sponsorshipto research and/or lecture oninhaler devices from:
GlaxoSmithKlineTEVAPfizerBoehringer IngelheimChiesiAltanaMerck GenericsNeolabKnowledgeworks Ltd.AstraZenecaClement Clarke InternationalNovartis
![Page 4: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/4.jpg)
Pearce L. Do Health Professionals Have Sufficient Knowledge And Skill To Teach OptimumInspiratory Flow (OIF)? A Study Using The In-Check Dial ™ (ICD) To Evaluate InspiratoryTechnique Poster: C1 ATS Meeting, Atlanta, May 2002
……… in 2002……… in 2002
![Page 5: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/5.jpg)
Baverstock M, Woodhall N & Maarman V. Do Health Care Professionals have sufficientknowledge of inhaler techniques in order to educate their patients effectively in their use?Poster presented at Winter Scientific Meeting British Thoracic Society 2010
……… in 2010……… in 2010
![Page 6: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/6.jpg)
From the hit TV Series House MD on Fox NBC.Video clip from Season 5 Episode 11 - when Dr. House asked a patient how she uses her inhaler.http://www.youtube.com/watch?v=dMAS2S51bM8
![Page 7: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/7.jpg)
“Poor Technique”“Poor Technique”
Target site
Unnecessary Waste
1. Lower than expected deliveryto target site
2. Reduced benefits3. Increased deposition in regions
outside target site4. Increased risk of side-effects
![Page 8: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/8.jpg)
“Poor Technique”“Poor Technique”
…. But very happy to practice technique
![Page 9: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/9.jpg)
UK: MDI and DPI Inhalation technique:UK: MDI and DPI Inhalation technique:inhalationinhalation too fast fortoo fast for pMDIpMDI, or too slow for DPI, or too slow for DPI
Al-Showair R, Tarsin W, Assi K, Pearson S, Chrystyn H Can patients with COPD use thecorrect inhalation with all inhalers and does training help ? Res Med 2007: 101, 2395-2401
163 COPD patientsaverage age 72.5 years
FEV1 47.8% predicted
MDI
Accuhaler
Turbohaler
59.5 %
HandiHaler
4.9 %
57.0 %
14.2 %
Too Fast
Too Slow
Too Slow
TooSlow
Initial presentation – before training
![Page 10: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/10.jpg)
Results later …….
“How you would instruct the patient to inhale” using that type of inhaler
Single measurement
“How would“How would youyou inhale” challengeinhale” challenge
Quick test of how you wouldinhale through commonly-useddevices
•pMDI measurement first•DPI measurement second
Need to:1. Simulate resistance of device2. Measure speed of inhalation
![Page 11: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/11.jpg)
What type of Inhaler is this ?What type of Inhaler is this ?
How does the aerosol get made ?How does the aerosol get made ?
![Page 12: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/12.jpg)
How does the aerosol get made ?How does the aerosol get made ?
What type of Inhaler are these ?What type of Inhaler are these ?
![Page 13: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/13.jpg)
What type of Inhaler is this ?What type of Inhaler is this ?
How does the aerosol get made ?How does the aerosol get made ?
![Page 14: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/14.jpg)
What type of device are these ?What type of device are these ?
How does the aerosol get made ?How does the aerosol get made ?
![Page 15: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/15.jpg)
What type of Inhaler are these ?What type of Inhaler are these ?
How does the aerosol get made ?How does the aerosol get made ?
![Page 16: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/16.jpg)
Aeroliser Accuhaler Turbohaler Clickhaler Twisthaler Easyhaler
Resistance in (cmH2O)½Lmin-1
Mean resistance of variousMean resistance of various DPIsDPIs
Assi KH, Chrystyn H. The different resistance of dry powder inhalers (DPIs).Am. J Respir. Crit. Care Med. 2001;163(5): A443 (Adapted from)
MDI /Spacer
![Page 17: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/17.jpg)
Fate of inhaled drugsFate of inhaled drugs –– Good TechniqueGood Technique
Swallowed
GI tractGI tract
Deposited in lung
Lungs
Metabolism or absorptionfrom the lung
Liver
Oralbioavailability
Absorptionfrom gut
First-passmetabolism
SystemicCirculation
Mouthpharynx
mucociliaryclearance
80%
20%
Schematic representation of potential dose distributionA Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for Respiratory Care.1st Edition. Page 1. Webpage: http://www.aarc.org/education/aerosol_devices/
Adapted from Barnes et al. AJRCCM 1998;157:S1-S53
![Page 18: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/18.jpg)
Swallowed
GI tractGI tract
Deposited in lung
Lungs
Metabolism or absorptionfrom the lung
Liver
Oralbioavailability
Absorptionfrom gut
First-passmetabolism
SystemicCirculation
Mouthpharynx
mucociliaryclearance
95%
5%
Fate of inhaled drugsFate of inhaled drugs –– PoorPoor TechniqueTechnique
Schematic representation of potential dose distributionA Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for Respiratory Care.1st Edition. Page 1. Webpage: http://www.aarc.org/education/aerosol_devices/
Adapted from Barnes et al. AJRCCM 1998;157:S1-S53
![Page 19: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/19.jpg)
• Design of inhalers vary• Formulation of drug• Mechanical activation
(passive MDI vs active DPI)• Internal resistance to airflow
• Patients vary• Pulmonary function
(reversible Vs irreversible disease )• Ability to learn / be taught the correct
technique• Physical size of lungs (child vs adult)• Effort varies from dose to dose
Why are there problems ?Why are there problems ?
inappropriateselection
and/orincorrectinhaler
technique
![Page 20: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/20.jpg)
How changes in inspiratory flow affectHow changes in inspiratory flow affect outputoutput
HighInspiratory flow
Low
Inhalation createsaerosol (e.g. DPI)
Aerosol made for you(e.g. MDI)
Lactose (in some DPIs)
Drug
![Page 21: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/21.jpg)
Aerosol Deposition at varying Particle SizeAerosol Deposition at varying Particle Size
0
Micron size
0.5
2
5
10DepositionDeposition
Pharynx, larynx &Pharynx, larynx &Upper respiratoryUpper respiratorytracttract
OptimalOptimaltracheobronchialtracheobronchialdepositiondeposition
Optimal alveolarOptimal alveolardepositiondepositionParticles exhaled if <0.5 micronParticles exhaled if <0.5 micron
![Page 22: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/22.jpg)
FacioFacio--MaxillaryMaxillaryView (lateral)View (lateral)
n.b. note the angles in the airways
RightRight BronchogramBronchogram
![Page 23: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/23.jpg)
Trachea
Bronchi
Bronchioles
IMPACT
IMPACT
Direction of flow
IMPACT
Particle Deposition In Respiratory TractParticle Deposition In Respiratory TractThree mechanisms of aerosol kinetics govern the majority of
particle deposition within the respiratory tract.
1. Inertial impaction 2. Sedimentation 3. DiffusionMost important Least Important
![Page 24: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/24.jpg)
Particle Deposition In Respiratory TractParticle Deposition In Respiratory Tract
Speed
Gravity
Brownian motion*
* Whitley Bay SmokeChamber
Mass
Three mechanisms of aerosol kinetics govern the majority ofparticle deposition within the respiratory tract.
1. Inertial impaction 2. Sedimentation 3. DiffusionMost important Least Important
![Page 25: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/25.jpg)
ImplicationsImplications
Metered Dose InhalersMetered Dose Inhalers
![Page 26: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/26.jpg)
Lung deposition fromLung deposition from pMDIspMDIs isisinfluenced by inspiratory flowinfluenced by inspiratory flow
Newman S et al, Eur J Respir Dis 1982;63: Suppl 119 57-65
30L/min
Total lungdeposition
(% of inhaleddose)
0
5
10
15
90L/min10 second breath hold
20%
VC
50%
VC
80%
VC
Metered DoseInhaler (MDI)
20%
VC
50%
VC
80%
VC
![Page 27: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/27.jpg)
ImplicationsImplications
Spacer DevicesSpacer Devices
![Page 28: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/28.jpg)
Metered DoseInhaler (MDI)
Spacer DevicesSpacer Devices –– How they helpHow they help
Drug
1. Capture aerosol avoiding coordination problems2. Reduces particles deposited in oropharynx
Leach, C. L., P. J. Davidson and R. Boudreau: HFA-Beclomethasone Provides Equivalent LungDeposition with or without Add-on Spacers. Eur. Res. J. 10(25): P1522, p. 236S, 1997.
![Page 29: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/29.jpg)
ImplicationsImplications
Dry Powder DevicesDry Powder Devices
![Page 30: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/30.jpg)
Total emitted dose at different flow ratesTotal emitted dose at different flow rates
Malton et al, J Pharm Med 1996:6:35-48 (In-vitro data - laboratory analysis)This does not necessarily correlate with clinical effectiveness
30 60 900
20
40
60
80
100 Salbutamol Accuhaler
Terbutaline Turbohaler
% oflabel claim
Flow (L/min)
![Page 31: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/31.jpg)
Aerosol produced for you –
inhale GENTLY
Please tell me the right inhalation techniquePlease tell me the right inhalation techniquefor each of the inhalers below……for each of the inhalers below……
![Page 32: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/32.jpg)
You create aerosol –
inhale FORCEFULLY
Please tell me the right inhalation techniquePlease tell me the right inhalation techniquefor each of the inhalers below……for each of the inhalers below……
![Page 33: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/33.jpg)
Assessment & Training DevicesAssessment & Training DevicesMonitoring inspiratory flow rate through the device
(www.2ToneTrainer.com)
Fyne Dynamic’sMagFloClement Clarke’s In-Check
and In-Check DIAL
Schering-Plough’sTwisthaler Trainer
Vitalograph’sAerosol Inhalation
Monitor (AIM)
60 L/min
CandayMedical’s
“2-Tone” Trainer
AstraZeneca’s TurbohalerUsage Trainer & Turbutesters
35 L/min
Allen & Hanburys’Accuhaler Trainer
![Page 34: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/34.jpg)
Isle of Wight Inhaler Technique ProjectIsle of Wight Inhaler Technique Project ––
StrategyStrategy1. Patients to receive consistent inhaler technique training from GPs,
Nurses, Pharmacists etc.2. HCPs to MEASURE patients ability to use inhaler (In Check DIAL)3. Targeted patients for maximum early benefit4. Following training, MDI patient to be supplied with a free 2Tone5. Strategy employed across primary and secondary care6. Directed MURs for CPs7. Enhanced service (MUR plus) for children offered by CPs8. Train a trainer, including outside NHS9. Extend to Schools, care homes, housebound etc.
![Page 35: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/35.jpg)
BaselineBaseline –– Respiratory Medication statusRespiratory Medication status
Expenditure:RespiratoryMedicines(overall)
YTD 2007
IOW Medicines Management Data ; Data on file 20th November 2008
Short-actingbeta agonists
+ 5%
+10%
-5%
> +11%
> +6%
+20%
Inhaledcorticosteroids
+ 15%
+20%
2007 2007 2007
•Annual spend: Inhaled corticosteroids > £1.7M•Highest in Southern England•Trend increasing
NationalAverage
![Page 36: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/36.jpg)
OutcomesOutcomes –– Respiratory Medication statusRespiratory Medication status
Expenditure:RespiratoryMedicines(overall)
YTD 2007Vs 2008
IOW Medicines Management Data ; Data on file 20th November 2008
Short-actingbeta agonists
+ 5%
+10%
-5%
> +11%
> +6%
+20%
Inhaledcorticosteroids
+ 15%
+20%
NationalAverage
2007 2007 2007
< +2% NationalAverage
+15%
20082008 2008
•2007 - Annual spend: Inhaled corticosteroids > £1.7M
•2007 - Highest in Southern England•2007 - Trend increasing
•Data collected over 9 month period•No other interventions took place in Respiratory Medicine
![Page 37: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/37.jpg)
OutcomesOutcomes –– Effects on patientsEffects on patients9 months data 2008 vs 2007
IOW Medicines Management Data ; Data on file 20th November 2008
Emergencyadmissions tohospital due to
asthma( n=20 Vs 41) Asthma related
deaths (n=2 Vs 8)
Hospitallength of
stay due toasthma
- 50%
0
+ 25%
-25%
-50%
-75%
•Data collected over 9 month period•No other interventions took place in Respiratory Medicine
![Page 38: Inhaler Technique - MSW...2013/09/25 · Isle of Wight Inhaler Technique Project – Strategy 1. Patients to receive consistent inhaler technique training from GPs, Nurses, Pharmacists](https://reader030.fdocuments.in/reader030/viewer/2022013021/5f01d52b7e708231d40142a0/html5/thumbnails/38.jpg)
1. Internal resistance affects speed of inhalation
2. Speed of inhalation affects DPI device efficacy (little effect on MDI)
3. Speed of inhalation and particle size affect how much drug is depositedin the lungs – and how much in the mouth and throat
4. Before initiating a new therapy, practitioners should check inhalertechnique. Inhalation should be:GENTLE for a device that creates the aerosol for you (e.g. MDI),butFORCEFUL for those that rely on the energy of inhalation (e.g. DPI)
5. NMR / CDS / MURs and Asthma Reviews present unique opportunity toidentify poor inhaler technique – but HCPs need to know good techniquefirst !
6. Evidenced by IOW project: NICE reference: http://tinyurl.com/6j9s5zv
Points to take awayPoints to take away