Analysis

Top five tips on inhaler use and technique

Inhaler treaatment for patients with chronic obstructive pulmonary disease may appear straightforward, but nurses need to keep close tabs on those in their care to ensure they achieve the best possible results, argues practice nurse Aud-Marit Walker.

Inhaler treaatment for patients with chronic obstructive pulmonary disease may appear straightforward, but nurses need to keep close tabs on those in their care to ensure they achieve the best possible results, argues practice nurse Aud-Marit Walker.

Ms Walker, a practice nurse in Yealmpton, Devon with a special interest in respiratory care, has five tips for trying to make things run as smoothly as possible.

1. Check that patients don’t put up with an inhaler they find difficult to use
2. Don’t prescribe multiple inhaler types
3. Make sure you know how to demonstrate the correct techniques
4. Use visual prompts and refer to websites and apps
5. Give regular reminders about technique

‘You need to get the right inhaler for the right patient,’ says Ms Walker. ‘Some patients don’t have the strength of breath to effectively inhale and some inhalers require dexterity involving opening the inhaler, releasing a capsule from the packaging and piercing it, and inhaling in a specific way. For some this is too complicated and they give up.’

Spacer

Ms Walker recommends using a spacer for these patients. This eases the passage of medication and guards against medication being deposited in the mouth and throat, where it can lead to irritation and mild infections.

Ms Walker takes the view that ‘less is more’ regarding the prescription of inhalers. ‘We should avoid prescribing multiple types for one patient. This can cause confusion and errors and can lead to poor technique,’ she says.

‘Nurses need to ensure that the inhaler techniques they demonstrate to patients are correct,’ she adds.

Demonstration video

‘Health professionals need to know their onions. Many nurses, GPs and pharmacists show people incorrect techniques. Some websites for supporting patients show most inhalers, but there are more and more coming on to the market so it is worth checking the manufacturer’s website for a demonstration video. Some videos are available via a smartphone – AirFluSal Forspiro is a good app for this’ (tinyurl.com/z8jcm86).

Another tip is for nurses to use visual prompts to help patients’ improve their inhaler techniques. ‘You need to make sure you have time to go through this with a patient, and allow them to demonstrate their technique in front of you. Show them the correct technique using a placebo inhaler,’ says Ms Walker.

‘Manufacturer leaflets and management plans are useful, but tell the patient how to do it, too. It doesn’t have to be face-to-face as evidence shows that patients using an inhaler for the first time are more likely to show the correct technique even after watching videos.’

Bigger picture

‘Also, don’t be afraid to give the patient the bigger picture. People are more likely to stick to their medication if they understand exactly what it is and what it does when they take it.’

Another tip is to routinely remind patients about good technique. Ms Walker explains: ‘Techniques can slip over time, and bad habits can come back. Most bad habits usually occur in connection with metered-dose inhalers. These require a very long and slow inhalation, and patients need to hold their breath at the end of the inhalation but lots of people get this wrong,’ she adds.

‘People tend to make a quick, sharp inhalation, which you often see in films when someone uses an inhaler. But the patient does not get the optimal dose if they do this.’

Bad habits

Ms Walker says that in addition to poor technique, patients often fall into bad habits over adherence. ‘They stop using the inhaler because they are feeling better, or reduce their use because they are worried about the steroid content or side effects,’ she says.

‘After the initial consultation, it’s important to review it a month later. After that, build time into routine appointments to ask the patient to demonstrate their techniques. Use phrases such as: “Can you show me how you use your inhaler?” And for those prescribed a spacer, ask them: “Do you use your inhaler alone?” It’s important to get this right.’

Christian Duffin is a freelance health writer

 

 

 

 

This article is for subscribers only

Jobs