II. Precautions
- Each Inhaler type has unique best usage recommendations
- Try to prescribe Inhalers with the same delivery methods to optimize compliance
- Inhaler Cleaning (prevent clogging)
- Clean Inhalers at least weekly
- Albuterol HFA
- Clogging may appear as white residue at MDI spray nozzle
- Remove Canister and avoid getting wet
- Rinse mouthpiece top and bottom under Running water for 30 seconds each, then dry
- Other Inhalers
- Discuss with pharmacist or follow manufacturer instructions
- Many of the devices (e.g. Symbicort) do not allow for removal of canister
- May wipe any mouthpiece with dry cloth to clean
- Avoid moisture around Dry Powder Inhalers
- References
- (2020) presc lett 27(9): 54
III. Technique: Aerosol Metered Dose Inhaler (e.g. Albuterol MDI, Proair, Qvar)
- Preparation
- Shake before use (mixes medication and propellant)
- Uncap Inhaler
- Prime once before first use
- Attach Inhaler Spacer
- Take a deep breath and then exhale all air out
- Place Inhaler with spacer to lips
- Start to breath in while pressing the Inhaler to release medication
- Inhale slowly and deeply and then hold breath for 10 seconds
IV. Technique: Hydrofluoroalkane Inhaler (HFA Inhaler)
- Prior to first use
- Shake new Inhaler for 45 seconds
- Prime Inhaler by spraying 3-4 puffs into air (do not inhale)
- Later uses
- Same technique as with CFC Inhalers
- Breath out, spray, and inhale deeply
- Hold breath for 10 seconds
- Wait one minute, while shaking Inhaler
- Repeat one more puff as above
- Other pointers
- Do not use "float test" (placing Inhaler in water) to see if has any medicine remaining
- Tally on the package the number of 2-puff doses used (expect about 100, 2-puff doses)
V. Technique: Dry Powder Inhaler (e.g. Advair, Flovent Diskus, Serevent, Asmanex, Spiriva)
- Precautions
- Never take the powders orally (and keep separate from oral medications)!
- Do not shake before use (contrast with MDI)
- Preparation
- Uncap the device
- Load the powder caps or other formulation as directed
- No Inhaler Spacer is needed
- Inhalation
- Exhale fully
- Place Inhaler with spacer to lips, holding it in level position
- Start to breath in while pressing the Inhaler to release medication
- Device punctures medication casing exposing the powder
- Inhale deeply, and in contrast to MDI, inhale rapidly
- Then hold breath for 10 seconds
- Then expire all air out and avoid exhaling on device (prevents wetting the powder)
- Device types
- Single-dose device (e.g. aerolizer, handihaler)
- One dose capsule inserted into device, punctured and inhaled once or twice
- Multi-dose device (e.g. Discus, Flexhaler, Twisthaler)
- Dose is advanced (specific to device) and then capsule punctured and inhaled
- Single-dose device (e.g. aerolizer, handihaler)
VI. Technique: Soft Mist Inhalers (e.g. Combivent Respimat)
- Spring-loaded device without propellant
- No shaking of suspension required
- Exhale, then press down on Inhaler while breathing in slowly and deeply and then hold breath for 10 seconds
VII. Preparations: Adjuncts
- Smart Inhaler Technology
- Add-on sensors (e.g. Hailie, Propeller) attach to Inhalers (or built in sensor for Proair Digihaler)
- Sensors relay Inhaler use and inspiratory flow to synchronized mobile applications
- May increase Inhaler compliance, but cost $160 and typically not covered by insurance
- (2019) Presc Lett 26(7): 41
VIII. References
- (2014) Presc Lett 21(2): 9
- (2017) Presc Lett 24(1): 3-4
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| Definition (HL7V3.0) | <p>A small device used for inhaling medicine in the form of a vapour or gas in order to ease a respiratory condition such as asthma or to relieve nasal congestion.</p> |
| Definition (HL7V3.0) | <p>A small device used for inhaling medicine in the form of a vapour or gas in order to ease a respiratory condition such as asthma or to relieve nasal congestion.</p> |
| Definition (NCI) | A device by means of which a medicinal product can be administered by inspiration through the nose or the mouth. |
| Definition (NCI_NCI-GLOSS) | A device for giving medicines in the form of a spray that is inhaled (breathed in) through the nose or mouth. Inhalers are used to treat medical problems such as bronchitis, angina, emphysema, and asthma. They are also used to help relieve symptoms that occur when a person is trying to quit smoking. |
| Concepts | Medical Device (T074) |
| MSH | D009330 |
| SnomedCT | 420317006, 334980009 |
| HL7 | 2.16.840.1.113883.1.11.16196, INH |
| English | Inhalator, Inhalators, Inhaler (product), Inhaler (qualifier value), INHALER, Inhaler [Dose Form], inhalators, inhaler, inhalers, InhalerMedicalDevice, Inhaler (physical object), INHALER (EA), INHALER (ML), Inhalers, Inhaler |
| Czech | inhalátory |
| Portuguese | Inaladores |
| Spanish | inhalador (calificador), inhalador (producto), Inhaladores, inhalador (objeto físico), inhalador |
| German | Inhaliergeräte, Inhalatoren |
| French | Inhalateurs |
| Italian | Inalatori |
| Norwegian | Inhalatorer, Sprayinhalatorer |
| Dutch | Inhalatoren |
Ontology: Metered Dose Inhaler (C0993596)
| Definition (MSH) | A small aerosol canister used to release a calibrated amount of medication for inhalation. |
| Definition (NCI) | A liquid medication delivered as a mist to be inhaled as a measured dose |
| Concepts | Medical Device (T074) |
| MSH | D036501 |
| SnomedCT | 422059006 |
| HL7 | MDINHL |
| English | Metered dose inhaler, Metered dose inhaler (product), Metered dose inhaler (qualifier value), Metered Dose Inhaler [Dose Form], Metered Dose Inhaler, mdi inhaler, mdi inhalers, meter dose inhaler, metered dose inhalers, dose inhalers meter, metered dose inhaler, MDI, Metered Dose Inhaler Dosage Form, Metered Dose Inhaler Dose Form, Inhaler, Metered Dose, Inhalers, Metered Dose, MDI (Inhalers), Metered Dose Inhalers, Metered-dose inhalers |
| Spanish | inhalador de dosis fija, inhalador de dosis fija (producto), inhalador de dosis fija (calificador), Aerosoles Dosimetrados, Inhaladores de Medida Dosificada, Inhaladores Dosimetrados, Inhaladores de Dosis Medida |
| Swedish | Dosreglerade inhalatorer |
| Czech | dávkovací inhalátory |
| Finnish | Annosinhalaattorit |
| Russian | INGALIATSIONNYE DOZATORY, ИНГАЛЯЦИОННЫЕ ДОЗАТОРЫ |
| Japanese | 定量噴霧型吸入器, 噴霧型吸入器-定量, スペーサー吸入器, 吸入器-定量, 計量式吸入器, 定量吸入器, 吸入器-計量式 |
| Italian | Inalatori MDI, Inalatori a dosi fisse, Turbohaler, Inalatori multidose |
| French | Sprays doseurs, Aérosols-doseurs, Inhalateurs-doseurs, Nébuliseurs-doseurs, Nébulisateurs-doseurs |
| Polish | Inhalatory dawkujące |
| Norwegian | Inhalatorer med dosering |
| Portuguese | Aerossóis Dosificadores, Aerossóis Dosimetrados, Inaladores Dosimetrados, Inaladores de Dose Medida |
| German | Dosieraerosole |
| Dutch | Inhalers, metered dose, Metered dose inhalers |
Ontology: Dry Powder Inhaler (C1967611)
| Definition (MSH) | A device that delivers medication to the lungs in the form of a dry powder. |
| Definition (NCI) | Powder intended for oral inhalation. |
| Concepts | Medical Device (T074) |
| MSH | D058995 |
| English | Dry Powder Inhaler [Dose Form], Dry Powder Inhalers, Inhaler, Dry Powder, Powder Inhaler, Dry, Inhalers, Dry Powder, Powder Inhalers, Dry, Powder Inhaler Dose Form, Powder Inhaler Dosage Form, Dry Powder Inhaler, Powder Inhaler |
| French | IPS (Inhalateur à Poudre Sèche), Inhalateurs de poudre sèche, Inhalateurs à poudre sèche |
| German | Inhalatoren, Trockenpulver, Trockenpulverinhalatoren |
| Czech | práškové inhalátory |
| Italian | Inalatori di polvere secca, Inalatori di polveri, Inalatori a polvere secca |
| Spanish | Inhaladores de Polvo Seco |
| Russian | INGALIATORY POROSHKOVYE, SUKHO-POROSHKOVYI INGALIATOR, СУХО-ПОРОШКОВЫЙ ИНГАЛЯТОР, ИНГАЛЯТОРЫ ПОРОШКОВЫЕ |
| Portuguese | Inaladores de Pó Seco |
| Polish | Inhalatory suchego proszku |
| Norwegian | Pulverinhalatorer |
